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Background: Stratified care approach involving use of the STarT-Back tool to optimise care for patients with low back pain is gaining widespread attention in western countries. However, adoption and implementation of this approach in low-and-middle-income countries will be restricted by context-specific factors that need to be addressed. This study aimed to develop with physiotherapists, tailored intervention strategies for the implementation of stratified care for patients with low back pain.
Methods: A two-round web-based Delphi survey was conducted among purposively sampled physiotherapists with a minimum of three years of clinical experience, with post-graduation certification or specialists. Thirty statements on barriers and enablers for implementation were extracted from the qualitative phase. Statements were rated by a Delphi panel with additional open-ended feedback. After each Delphi round, participants received feedback which informed their subsequent responses. Additional qualitative feedback were analysed using qualitative content analysis. The criteria for consensus and stability were pre-determined using percentage agreement (≥ 75%), median value (≥ 4), Inter-quartile range (≤ 1), and Wilcoxon matched-pairs test respectively.
Results: Participants in the first round were 139 and 125 of them completed the study, yielding a response rate of 90%. Participants were aged 35.2 (SD6.6) years, and 55 (39.6%) were female. Consensus was achieved in 25/30 statements. Wilcoxon’s test showed stability in responses after the 5 statements failed to reach consensus: ‘translate the STarT-Back Tool to pidgin language’ 71% (p = 0.76), ‘begin implementation with government hospitals’ 63% (p = 0.11), ‘share knowledge with traditional bone setters’ 35% (p = 0.67), ‘get second opinion on clinician’s advice’ 63% (p = 0.24) and ‘carry out online consultations’ 65% (p = 0.41). Four statements strengthened by additional qualitative data achieved the highest consensus: ‘patient education’ (96%), ‘quality improvement appraisals’ (96%), ‘undergraduate training on psychosocial care’ (96%) and ‘patient-clinician communication’ (95%).
Conclusion: There was concordance of opinion that patients should be educated to correct misplaced expectations and proper time for communication is vital to implementation. This communication should be learned at undergraduate level, and for already qualified clinicians, quality improvement appraisals are key to sustained and effective care. These recommendations provide a framework for future research on monitored implementation of stratified care in middle-income countries.
Concerning human and environmental health, safe alternatives to synthetic pesticides are urgently needed. Many of the currently used synthetic pesticides are not authorized for application in organic agriculture. In addition, the developed resistances of various pests against classical pesticides necessitate the urgent demand for efficient and safe products with novel modes of action. Botanical pesticides are assumed to be effective against various crop pests, and they are easily biodegradable and available in high quantities and at a reasonable cost. Many of them may act by diverse yet unexplored mechanisms of action. It is therefore surprising that only few plant species have been developed for commercial usage as biopesticides. This article reviews the status of botanical pesticides, especially in Europe and Mediterranean countries, deepening their active principles and mechanisms of action. Moreover, some constraints and challenges in the development of novel biopesticides are highlighted.
Resource prospects of municipal solid wastes generated in the Ga East Municipal Assembly of Ghana
(2017)
Background: Municipal solid wastes management has recently become an important public health concern. Municipal solid wastes are a major source of raw materials that could be used for resource recovery for diverse applications.
Objectives: The present study aimed to determine the composition of municipal solid waste and recoverable resources from the waste of the Ga East Municipal Assembly (GEMA) in the Greater Accra region of Ghana.
Methods: An exploratory approach was used to collect pertinent data from the Abloradgei dumpsite in GEMA using semi-structured interviews and focus group discussion. A field characterization study was undertaken to segregate and estimate the value of various components of collected waste. Dumpsite workers were asked about current general composition of MSW, mode of collection and disposal, record of sanitation-related diseases, use of modern treatment plant, waste management legislation and enforcement challenges, number of trucks received by the dumpsite per day, record on pretreatment of MSW before disposal, and use of personnel protective equipment.
Results: The results showed that significant proportions (48.8%) of the municipal solid wastes were organic materials, while the remaining (51.2%) were inorganic materials. The results also showed that 63% of the municipal solid waste is collected with no sorting from the source and no modern treatment applied before dumping. It was estimated that the value of the recyclable materials in GEMA municipal solid waste amounts to Ghana Cedis (GH¢) 9,381,960 (plastic); 985,111 (mixed glass); 5,160,078 (paper) and 11,586,770 (metal) with a total of GH¢ 27,113,919 ($10,845,568) equivalent to 2,106,339.2 m3 (74,384,667.5 ft3) per annum of biogas from these components with a market value of GH¢ 1,997,972.17 ($768, 393.62); 11,579 Mwh (1.32 Mw) of electricity and 9,535 Mwh (1.09 Mw) of heat. This is estimated to be lost with the current waste management practices.
Conclusions: We recommend that GEMA institute sustainable recycling practices and utilization of biogas production technologies and prioritize sanitation and waste management education for the public, obligate home segregation of waste materials, involve workers by providing them with protective clothing, incorporate informal waste collectors and scavengers into the new system and collaborate with research institutions in waste-to-resource projects to ensure a more sustainable waste management system in the municipality.