University of Ghana http://ugspace.ug.edu.gh Substance use patterns and implications for drug policy: A study at Accra Psychiatric Hospital. By George Arthur (10587773) This dissertation is submitted to the University of Ghana, Legon in partial fulfillment of the requirement for the award of Master of Research and Public Policy degree. December, 2018 i University of Ghana http://ugspace.ug.edu.gh DECLARATION I declare that with the exception of references made to other people’s work for which I have duly acknowledged and given credence, this dissertation is my original work carried out at the Centre for Social Policy Studies, University of Ghana. No material in this write up has been submitted for any other degree, neither has it been submitted concurrently in candidature for any other degree or certificate. GEORGE ARTHUR (10587773) ………………….. ………………… (Student name & ID) Signature Date DR. E. N. N. NORTEY ..……………………. ………………… (Academic supervisor) Signature Date ii University of Ghana http://ugspace.ug.edu.gh DEDICATION I dedicate this work to my wife, Matilda and children, Alice and Nana. I dedicate same to my dear parents- Alice and George- who together have been a wonderful influence to everything I am or ever hope to be. iii University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT I am grateful to the Almighty God who has seen me through this programme successfully. My sincere thanks to Dr. E. N. N. Nortey who has been a wonderful academic supervisor during the period of my study. Sir, I appreciate your time spent in assisting with my data analysis and your support with the entire work. I am equally thankful to the entire faculty of CSPS, University of Ghana for the various constructive criticisms that have added value to this work. I appreciate the memorable learning experience at the Centre; a mention of “Tragedy of the commons” will always arouse nostalgia of Political Economy lecture which was brilliantly executed by Dr. George Domfe. I acknowledge the essential contributions of my treasured colleagues, the pioneering class of Master of Research and Public Policy (2017), which have positively influenced this work. I am also grateful to the Hospital Director, Dr. Pinaman Appau and the Laboratory Manager, Mrs. Irene Badu Bartels, all of Accra Psychiatric Hospital for granting me access to the facility and the relevant data needed for my research. iv University of Ghana http://ugspace.ug.edu.gh ABSTRACT Psychoactive and illicit drug use constitutes significant cause of morbidity and mortality but empirical laboratory data that complement epidemiological evidence are lacking. The study sought to examine the patterns of substance use among individuals who were investigated for evidence of psychoactive and illicit drug use at the Accra Psychiatric Hospital during the review period. All medical laboratory reports of investigations conducted on substance use at the facility over the five year period were reviewed. These reports were accessible from manual log books and laboratory information management system data available from the Medical Laboratory Department of the Hospital. The study revealed that tetrahydrocannabinol (contained in cannabis or marijuana), cocaine, benzodiazepines and opiates were the substances commonly used over the period. Contrary to claims from some earlier epidemiological surveys, there was no evidence of use of amphetamine or methamphetamine as discovered in this study. Psychoactive substance use was more pronounced among males than females with higher proportions of tetrahydrocannabinol and benzodiazepine use than those of cocaine and opiates. A national policy on narcotic and psychoactive drugs developed based on a body of research is recommended. Such policy document should have well thought-out considerations on the demand and supply of these substances as well as strategic interventions for harm reduction. v University of Ghana http://ugspace.ug.edu.gh Table of Content DECLARATION ............................................................................................................................................... ii DEDICATION ................................................................................................................................................. iii ACKNOWLEDGEMENT .................................................................................................................................. iv ABSTRACT ...................................................................................................................................................... v Table of Content .......................................................................................................................................... vi LIST OF TABLES ............................................................................................................................................. ix LIST OF FIGURES ............................................................................................................................................ x LIST OF ABBREVIATIONS .............................................................................................................................. xi CHAPTER ONE ............................................................................................................................................... 1 INTRODUCTION ............................................................................................................................................. 1 1.1 Introduction ........................................................................................................................................ 1 1.2 Background of the Study ..................................................................................................................... 1 1.3 Problem Statement ............................................................................................................................. 3 1.4 Justification ......................................................................................................................................... 5 1.5 Objectives............................................................................................................................................ 6 1.5.1 General objective ......................................................................................................................... 6 1.5.2 Specific objectives ........................................................................................................................ 6 1.6 Hypothesis of the Study ...................................................................................................................... 6 CHAPTER TWO .............................................................................................................................................. 7 LITERATURE REVIEW ..................................................................................................................................... 7 2.0 Introduction ........................................................................................................................................ 7 2.1 Theory underpinning substance use ................................................................................................... 7 2.2 Empirical literature ........................................................................................................................... 11 2.2.1 Background to substance use .................................................................................................... 11 2.2.2 Overview of drug test ................................................................................................................ 12 2.3 Categories of commonly abused substances and their effects ........................................................ 13 2.4 Substance use disorders (SUDs) ........................................................................................................ 16 2.5 Substance induced psychosis (SIP) .................................................................................................... 17 2.6 World drug menace .......................................................................................................................... 19 vi University of Ghana http://ugspace.ug.edu.gh 2.7 Drug use in Ghana ............................................................................................................................. 21 2.8 Impact of drug abuse ........................................................................................................................ 23 2.8.1 Effects of substance use on individual and public health .......................................................... 24 2.8.2 Consequence of drug use to public safety ................................................................................. 25 2.9 Drug control and prevention strategies ............................................................................................ 26 2.9.1. International control systems for narcotic and psychoactive drugs ......................................... 26 2.9.2. Drug policy vis-à-vis drug law.................................................................................................... 27 2.9.3. Narcotic drug control in Ghana ................................................................................................. 29 2.9.4. Drug policy of the Netherlands ................................................................................................. 30 2.9.5. Drug policy of Kenya ................................................................................................................. 31 2.9.6. Drug policy of Sweden .............................................................................................................. 34 2.9.7. Drug policy of Canada ............................................................................................................... 34 2.9.8. Drug policy of the United Kingdom (UK) ................................................................................... 35 CHAPTER THREE .......................................................................................................................................... 37 METHODOLOGY .......................................................................................................................................... 37 3.1 Introduction ...................................................................................................................................... 37 3.2 Study design ...................................................................................................................................... 37 3.3 Description of study site ................................................................................................................... 37 3.4 Ethical issues/considerations ............................................................................................................ 37 3.5 Data collection .................................................................................................................................. 38 3.6 Inclusion and exclusion criteria ......................................................................................................... 39 3.7 Data analysis ..................................................................................................................................... 39 3.8 Delimitations ..................................................................................................................................... 39 CHAPTER FOUR ........................................................................................................................................... 40 DATA ANAYSIS AND DISCUSSIONS .............................................................................................................. 40 4.1 Introduction ...................................................................................................................................... 40 4.2 Substances commonly used .............................................................................................................. 40 4.3 Age characteristics relative to suspected substance use .................................................................. 45 4.4 Hypotheses testing: .......................................................................................................................... 54 4.5 Multiple drug use .............................................................................................................................. 58 4.6 Prevalence of substance use ............................................................................................................. 59 4.7 Substances commonly used .............................................................................................................. 60 vii University of Ghana http://ugspace.ug.edu.gh 4.8 Age and gender characteristics with respect to drug use ................................................................ 64 4.9 Prevalence of substance use over the study period ......................................................................... 65 CHAPTER FIVE ............................................................................................................................................. 67 SUMMARY, CONCLUSION AND RECOMMENDATION ................................................................................. 67 5.1Introduction ....................................................................................................................................... 67 5.2 Summary of key findings ................................................................................................................... 67 5.3 Conclusions of the Study ................................................................................................................... 67 5.4 Policy Recommendations .................................................................................................................. 68 REFERENCES ................................................................................................................................................ 69 Appendix A: raw data (coded) ....................................................................................................................... I viii University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES Table 4.1: Analysis of substance use by year and gender………………………………41 Table 4.2: Age distribution of people screened for substance use from 2012-2016…….46 Table 4.3: Age distribution of individuals who tested positive for substance use from 2012-2016………………………………………………………………… 47 Table 4.4: Results of independent samples test…………………………………………49 Table 4.5: Analysis of confirmed substance use by year ….. …….……………………..59 ix University of Ghana http://ugspace.ug.edu.gh LIST OF FIGURES Figure 2.1.1: Theory of Planned Behaviour…………………………………………………...8 Figure 2.1.2: A simplified view of Theory of Planned Behaviour…………………………….10 Figure 4.1: Graphical presentation of substance use by year and gender…………………......45 Figure 4.2: Graphical presentation of confirmed substance use from 2102-2016…………….60 x University of Ghana http://ugspace.ug.edu.gh LIST OF ABBREVIATIONS AMP Amphetamine(s) BZD Benzodiazepine(s) CDC Centre for Disease Control CNS Central Nervous System COC Cocaine DSM Diagnostic and Statistical Manual of Mental Disorders EMCDDA European Monitoring Centre for Drugs and Drug Addiction GHS Ghana Health Service HIV Human immunodeficiency virus ICD International Statistical Classification of Diseases and Related Health Problems MET Methamphetamine(s) MOH Ministry of Health OPI Opiates SPSS Statistical Package for Social Scientists THC Tetrahydrocannabinol UNODCCP United Nations Office for Drug Control and Crime Prevention WHO World Health Organisation xi University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE INTRODUCTION 1.1 Introduction This chapter presents an introduction to the study. The chapter begins with a background of the study. This is followed by statement of the problem, justification for the study, study objectives and a hypothesis of the study. 1.2 Background of the Study The use of alcohol, tobacco and illicit drugs are among the key worldwide public health problems. The abuse of these and other prescription drugs is common among adolescents and young adults (Swadi, 2000). The use of licit and illicit drugs constitutes major risk factor for the development of somatic, psychological, interpersonal, and socio-cultural problems (Cullen, 2003). A substance is a chemical which in its natural or synthetic form can affect the way the body functions. It could cause change in temperament, discernment and behaviour when it is smoked, injected, drunk, inhaled, or swallowed (Hussein, 1998). A substance may also be referred to as drug abuse, psychoactive drug or toxin (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5, 2013). DSM-5 groups substances into 11 classes: alcohol, amphetamines, caffeine, cannabis, cocaine, hallucinogens, inhalants, tobacco, opioids, phencyclidine, and sedatives or hypnotics or anxiolytics. But for alcohol and tobacco, the other substances are generally regarded as illicit drugs. Anecdotal reports from psychiatric hospitals in Ghana indicate that substances that are commonly abused include alcohol, cannabis, cocaine, morphine, codeine, heroin, nicotine, pethidine as well as inhalants including glue, petrol and thinner. 1 University of Ghana http://ugspace.ug.edu.gh In the widest sense, a drug refers to any substance other than food or water which can cause changes in the way the body functions- mentally, physically or emotionally- following its use (Hussein, 1998). This definition encompasses alcohol, tobacco, caffeine, solvents (e.g. thinner or turpentine), over the counter drugs, prescribed drugs and illicit drugs. The World Drug Report 2015 (United Nations Office on Drugs and Crime, 2015) recorded that a total of 246 million people, or 1 in every 20 people aged 15 to 64 years, used at least one form of illicit drug in 2013. This meant an increase of 3 million over the previous year (2012). It was further recorded that 27 million people (out of the 246 million) were problem drug users, suffering from drug use disorders or drug dependence. About 12.19 million of those problem drug users injected drugs, while about 1.65 million of those who injected drugs lived with human immunodeficiency virus during the year 2013 (United Nations Office on Drugs and Crime, 2015). In their international classification of diseases, the WHO likens problem drug use to adverse use of drug and continuous reliance on drugs. Adverse drug use is described by distinct proof of the use of such substance being liable for physical injury (for example, as in organ damage) and psychosomatic harm (for instance, substance induced psychosis). According to the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10), evidence of drug dependence involves the affected person presenting with three or more of the following pointers (WHO 1993): victim demonstrates strong and consistent longing for the drug; reduced ability to resist the use of the substance; withdrawal and isolation of oneself; reduced response to usual effects of the substance; user has developed tolerance with transition into a state of yearning for greater doses in order to experience the desired personal effect; victim unreasonably expends time seeking, using and recovering from substance use; that victim continues to use other drugs 2 University of Ghana http://ugspace.ug.edu.gh without concern for consequent harms. Victim should be observed to have demonstrated or experienced the associated adverse effects for a minimum of a month at some point in time in the course of a year. The World Health Organisation’s report of the top ten causes of admission among psychiatric hospitals in Ghana in 2002 rated substance abuse second (17.43 %) to schizophrenia. Substance use related disorders placed fourth (16.3 %) among outpatient cases (WHO, 2006). In their report at a workshop organized by the Ministry of Interior, the Ghana Police Service estimated that about 70% of all crimes in the country were drug or alcohol related (Ministry of Interior Workshop Report on Public Safety -The Role of Security Agencies in Ghana, 2006). Public policy approach to sinking the harmful effects associated with illicit substance use in the general population, especially among the youth, are of particular importance due to the adversarial implications for the health of individuals, society and the economy of Ghana. This study seeks to analyze laboratory test results of substance use with focus on providing empirical evidence to inform public policy on drugs. 1.3 Problem Statement Substance use and its associated problems impact comprehensively on society- socially (e.g. increasing crime rate), health related issues (e.g. risk of mental disorders, spread of HIV, hepatitis B & C, lung and liver problems, etc.) and economically (e.g. implication for government expenditure on treatment of substance use related disorders) (UNODC 2014). Only 1 out of every 6 problem drug users in the world has access to treatment, as many countries have large shortfalls in the provision of services (World Drug Report, 2014). Nonetheless, there 3 University of Ghana http://ugspace.ug.edu.gh exist huge regional inequalities, with 1 in 3 problem drug users having access to treatment in North America, 1 in 4 in Oceania, 1 in 5 in Western and Central Europe while about 1 in 18 problem drug users (primarily cannabis use) receive treatment in Africa. The UNODC (2014) laments that there were some 187,100 preventable deaths in 2012 attributed to drug overdose. Kandel et al (1976) argued that the formulation of policies regarding the availability of mood changing drugs and the strategies that could be developed in relation to prevention, education, and treatment programmes require methodical knowledge about rates of use of various identifiable substances, the changes in rates over time, the social and psychological factors associated with use, and the consequences of such use. However, Pollack et al (2002) cautioned that drug use is often surreptitious and therefore its true trends, patterns and prevalence within a population are imperfectly known. Nonetheless, most data used for substance use trends analyses and other related studies are based on self-reports of selected participants. Consequently, the National Institute of Drug Abuse (1997) raised important concerns about the possibility of deceptive or inaccurate responses with respect to these self-reported data for various reasons including participant’s fear of being socially stigmatized. Magura and Kang (1996) and the National Institute of Drug Abuse (1996) reported of available findings that were suggestive of widespread underreporting attributed to existing self-reported data from persons who participated in substance abuse studies and treatment programmes. Anecdotal report from the Ghana Narcotics Control Board calls for pressing need to investigate current trends and patterns of drug use in the countries of Sub-Saharan Africa, especially Ghana. However, review of literature reveals various analyses captured from self-reported data of 4 University of Ghana http://ugspace.ug.edu.gh selected participants. In Ghana, studies about substance use trends based on empirical data (laboratory confirmed results) are sparse. Studies such as this could form firm basis for policies and advocacy programmes concerning substance use in the country. 1.4 Justification The Narcotic Drugs Law, 1990 (PNDCL 236) provides for the control, enforcement, and sanctions relating to illicit dealings in narcotic drugs in Ghana. Furthermore, Ghana as a signatory to the United Nations Convention on Narcotic Drugs and Psychotropic Substances is obliged to enact national laws to implement the provisions of the Convention. In spite of these laws and conventions, worldwide trends since 2006 have suggested increases in illicit drug use in many dimensions, especially among the youth (World Drug Report, 2014). The United Nations’ Office on Drugs and Crime annual World Drug Report provides aggregated data source on drug use in West Africa but this is not without limitation. Individual countries are required to complete and submit the Annual Research Questionnaire (ARQ) provided by the United Nations Office on Drugs and Crime (UNODC). However, many African countries sometimes fail to provide the UNODC with the required data for these yearly estimates (UNODC, 2012). Estimates on substance use from this psychiatric facility will shed light on the potentially heightened risk group relative to age and gender. Such pattern analysis is of immense relevance to the assessment of the country’s drug use and for policies or programmes on drug control. 5 University of Ghana http://ugspace.ug.edu.gh 1.5 Objectives 1.5.1 General objective: To investigate the patterns in laboratory confirmed substance use among people who were screened at the Accra Psychiatric Hospital spanning from January 1, 2012 to December 31, 2016. 1.5.2 Specific objectives: i. To identify the kinds of substances commonly used. ii. To investigate the age and gender characteristics relative to substance use. iii. To examine the prevalence of confirmed substance use in the context of cumulative substance abuse tests which were performed during the period under study. 1.6 Hypothesis of the Study Existing data on substance use from self-reports and that of data from clinical laboratory tests are different but complementary and therefore a blend of both are relevant for designing drug policies and programmes in Ghana. 6 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO LITERATURE REVIEW 2.0 Introduction This chapter reviews relevant literature on drug use. The chapter begins with a theoretical perspective of drug use. This is followed by background of substance use, an overview of drug test, substances that are commonly abused and their effects, the world drug menace, an analysis of drug use situation in Ghana, the impact of drug use and ends with discussion of some drug control and prevention strategies. 2.1 Theory underpinning substance use Practitioners, researchers and policy makers are particularly interested in unravelling the psychosocial and biological risk factors underneath the cause of substance use as well as the protective factors that serve as risk mediators. Over the years, a number of identifiable institutions, groups and individuals have embarked on drug education campaign programmes aimed at increasing awareness about the dangers of substance use so as to dissuade people from drug use. Nonetheless, Litchfield and White (2006) reported from their evaluations that such programmes appeared not to have made significant change in reducing substance use. Crusaders of educational campaigns believe that behavioural theories could be adopted to stimulate positive attitudinal change to drug use. Thus, the theoretical framework underpinning this study has been adopted from the concepts in the theory of planned behaviour (Ajzen, 1991). 7 University of Ghana http://ugspace.ug.edu.gh Figure 2.1.1: The theory of planned behaviour, adapted from Ajzen (1991) The theory of planned behaviour (TPB) is one of the theories or models often employed in communicating health messages. This theory seeks to explain health behaviour options and also guide health promotion programmes and interventions such as the crusade against substance use. The theory of planned behaviour posits that the most probable determinant of behaviour is the intention to perform or not perform that behaviour. Theory of planned behaviour (TPB) was actually an expanded form of the theory of reasoned action (TRA) to embrace ‘perceived behaviour control’ into the scope. The TPB is based on the assumption that a person’s attitude, social beliefs and personal perception of control over a behaviour are the constituents that work together to drive the individual’s intention to perform that particular behaviour (Ajzen & Madden, 1986). The intention of whether or not to perform a ‘behaviour’ is further influenced by: 8 University of Ghana http://ugspace.ug.edu.gh i. The person’s attitude toward the behaviour: assessment of the advantages and disadvantages of performing that behaviour or the risks and rewards that the individual associates with those choices. ii. Subjective norms: evaluation of social pressure from other sources which the individual may consider as significant, for instance peers, family or media. iii. Perceived behavioural control: the perception that a person has about his or her ability to perform the behaviour. Lavin and Groarke (2005) observed that human beings are rational in their decision-making and therefore every rational being would use the information available to him or her in making decisions. The model could further be represented in a relatively simplified form as shown below: 9 University of Ghana http://ugspace.ug.edu.gh Figure 2.1.2: A simplified view of the Theory of Planned Behaviour Thus the simplified version predicts that a person is more likely to perform a particular behaviour provided that individual has strong personal motivation (or intention) and positive attitude towards that behaviour as well as a more supportive social environment surrounding the behaviour of interest and strong perception of personal control over the same (Lavin & Groarke, 2005). 10 University of Ghana http://ugspace.ug.edu.gh 2.1.3 Criticisms of theory of planned behaviour Naidoo and Wills (2000) argued that the theory of planned behaviour emphasizes attitude as the driving force predicting behaviour whereas behaviour cannot necessarily be determined by attitude. Critics suggested a careful study of the very attitudes that were more likely to lead to behavioural intentions among other broader determinants of health. Elder (2001) cautioned that for any given high risk population or group, TPB was more appropriate and worked conveniently for small homogeneous population or group than it did for that of a large heterogeneous population or a group. King et al (1995) observed that the cultural context of TPB appeared more westernized with more emphasis on the individual’s behavioural intentions. Therefore, Airhihenbuwa and Obregon (2000) warned that application of TPB in a more culturally sensitive environment would require critically examining the belief systems, values and the entire cultural setting of that particular people. 2.2 Empirical literature 2.2.1 Background to substance use Substance use has been defined by a number of terminologies, including drug abuse, drug use, substance abuse, substance misuse, substance dependence, drug dependent use, harmful use of drug, hazardous use of drug, substance or drug experimental use, problematic use of drug or substance, drug addiction, chemical abuse and chemical dependence among others. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, 2000) adequately defines and conceptualizes substance use by way of classifying substance users into two discrete groups: those with substance abuse problems and others who may have problems 11 University of Ghana http://ugspace.ug.edu.gh with substance dependence. Abuse refers to dysfunctional use that results in difficulty in fulfilling work, school and other social obligations. Dependence or addiction involves a condition where a person becomes biologically reliant on a drug (Simmons, 2008). 2.2.2 Overview of drug test The background of drug tests provides useful account for understanding various drug tests which are conducted currently while offering opportunities for technological advancement in the future. The United States of America were well-known for commonly using drug tests during the 1950s in hospitals for rapid diagnosis and as treatment guide for patients who had drug overdose (ASAM, 2013). The development of thin layer chromatographic technologies and automated immunoassay methodologies in the 1960s and 1970s respectively, enhanced the efficiency of laboratories and improved the feasibility to conduct large scale urine drug testing among large populations (ASAM, 2013). In recent years, there has been increased availability and accessibility to improved methods of drug testing both qualitatively and quantitatively to include other samples such as blood, saliva, nails and hairs. The Center for Substance Abuse Research (2013) predicts that with the rapid improvement in technology of drug testing, it may soon be possible to test for other drugs in breath and sweat, in addition to alcohol which is already known. However, the principles in the design of these tools will have to take into account the differences in the physical and chemical properties of these drugs and their metabolites which could impact significant variations in concentrations among these matrices. Drug test involves identification of a specific chemical compound (analyte) in body fluids or tissues. In rapid diagnostic testing technique, a ‘Positive’ result will mean a particular drug analyte is present in a given sample in quantities (concentration) that are equal to or above the 12 University of Ghana http://ugspace.ug.edu.gh level of detection for that compound. Conversely, a ‘Negative’ test will imply that the drug analyte may not be present in the sample at all or could be present but in very minute amounts that are below the detectable limits (Barry, 2015). The detection of a particular drug analyte in a person’s sample (i.e. blood, urine, saliva, nails, hair) in drug testing provides evidence of the person’s exposure to that specific drug. Many drug tests will include testing for alcohol. Drug test does not necessarily detect substance use disorder or physical dependence on drug. Rather, it provides indication about current use of drug. Thus, a ‘positive’ or ‘negative’ test result will necessarily require that the person being tested is carefully evaluated or examined (Office of National Drug Control Policy, 2002). The practice of detecting drug use with the application of drug test is particularly significant for the reason that majority of individuals who use drugs will usually conceal their usage. The Office of National Drug Control Policy (2012) observed that it was possible to obtain relevant information from people through talking with them about their individual use of drug. In a healthcare context, the Office further observed that close relatives and friends could also provide useful information with respect to an individual’s history about drug use. Nonetheless, it is not uncommon for a drug user to hide or deny drug use. Largely, drug test serves as a specific and superior marker for objectively assessing a person suspected of drug use. Thus, drug test has become an important scientific diagnostic tool providing support for drug control policies and advocacy programmes. 2.3 Categories of commonly abused substances and their effects A drug is considered psychoactive, psychotropic or psychopharmaceutic when it has the potential to alter brain function with consequences for changes in discernment, frame of mind, consciousness, reasoning or comportment (American Psychiatric Association, 2013). There are 13 University of Ghana http://ugspace.ug.edu.gh several reasons for which people may use psychoactive substances. Apart from recreational or experimental use, some psychotropic drugs are of therapeutic importance for the treatment of certain medical conditions. For instance, some psychoactive drugs are used in the manufacturing of analgesics (painkillers), anesthetics and anticonvulsant. Some psychoactive drugs are prescribed for use as antipsychotics, anxiolytics, antidepressants and stimulants to treat neuropsychiatric disorders. Some psychotropic drugs are also prescribed for use in the recovery and detoxification plans for people who are addicted to other substances. Others believe in the entheogenic attributes of these substances for shamanic or ritual uses; or for research purposes (WHO, 1992) Drug use poses harm in many ways. Drug use over time presents with both immediate and long- term effects. The following are some of the commonly abused substances and their associated effects. Marijuana Marijuana is commonly smoked in a similar way as cigarette. Occasionally, some consumers of marijuana mix it with alcohol, other beverages or food. Tetrahydrocannabinol (THC) is the principal psychoactive substance found in marijuana. It is basically processed and consumed from shreds of the leaves, seeds, flowers or stem of the hemp plant (cannabis sativa). Marijuana is a hallucinogen that influences reasoning, thought and judgement (American Psychiatric Association, 2013) The effects of the marijuana use vary from habits which involve irregular small amounts to frequent large amounts. Occasional marijuana use causes distress to cognitive development, 14 University of Ghana http://ugspace.ug.edu.gh learning and short-term memory. Long frequent use could result in blurred perception, distorted thoughts and difficulty in making decisions, lack of coordination and increased heartbeat (tachycardia), increased anxiety and unfounded panic attacks. Marijuana usage can interfere with brain and lung functions (WHO, 2014) Tobacco The main active constituent in tobacco is nicotine. Nicotine is among the common addictive substances used globally. Nicotine is a stimulant and smokers of tobacco expose themselves to increased risk of heart and lung cancers, chronic bronchitis, emphysema and other cardiovascular diseases. (American Psychiatric Association, 1994) Alcohol Alcohol is produced from fermentation or distillation of certain grains, vegetables and fruits. Alcohol is usually contained in various grades in spirits, wine, beer, and other alcoholic beverages. Alcohol affects almost all parts of the body. When ingested, alcohol is transported via the bloodstream to the brain, stomach, internal organs, liver, kidneys, muscles; reaching almost every part of the body. Alcohol use can cause a condition of psychological and physical dependence. Alcohol impacts on the central nervous system thereby lowering mental alertness, impairing judgement and perception and inhibiting muscular coordination. High doses of alcohol can cause unconsciousness and sometimes, death. Long-term alcoholism harms the liver, brain, heart and other organs (American Psychiatric Association, 2013). 15 University of Ghana http://ugspace.ug.edu.gh Cocaine Cocaine is potentially addictive; users readily become biologically dependent on this drug. It can be sniffed, injected or smoked. Cocaine use increases the heart rate and causes headache, tremors and hypertension. Long use of cocaine causes depression, insomnia, nausea and weight loss. Excessive doses may lead to convulsions, seizure, strokes, and heart failure or panic attacks (WHO, 2015) Heroin It is processed from morphine, a naturally occurring substance extracted from the seedpods of the Asian poppy plant. It can either be smoked or snorted. Heroin is strongly addictive and responsible for most of the drug related deaths globally (World Drug Report, 2015) During the initial stage, heroin use causes decreased respiration, slurred speech, nausea and slow reflexes. Over time, users develop physical and psychological dependence on the drug. Acute respiratory distress and possible death may result from high doses of heroin (WHO, 2016) 2.4 Substance use disorders (SUDs) According to Angrist and Gershon (1970), notable observations about substances inducing ephemeral psychotic symptoms were first recorded from studies in the 1960s. Subsequently, a number of investigational scholarships have demonstrated strong positive linkage between substance use and schizophrenic symptoms (D’Souza et al., 2004). Further, some modern pharmacological models trace their origin to the notable effects of drug abuse. 16 University of Ghana http://ugspace.ug.edu.gh Psychoactive substances have psychotogenic attributes that induce momentary conditions of deluded perception, usually imitating symptoms of psychosis, including false impression and phantasms. Several bodies of researches, past and present, draw linkages between a number of the substances and the development of psychosis and schizophrenia (Arseneault et al., 2002). Further, the diagnoses of substance induced psychosis have been copiously documented in both the International Classification of Diseases, version 10 (ICD-10) (WHO, 1992) and Diagnostic and Statistical Manual of Mental Disorders, versions 4 and 5 (DSM-IV&V) (American Psychiatric Association, 1994, 2013). For instance, Javitt and Zukin (1990) observed that stimulants and tetrahydrocannabinol (in cannabis) were more likely to induce paranoid ideas whereas Smith et al (2009) reported that lysergic acid diethylamide (LSD) was connected with visual hallucination and illusion. 2.5 Substance induced psychosis (SIP) It has been long-established that cannabis (marijuana) use is associated with the development of psychotic symptoms. Globally, marijuana tops the list of illicit drugs that are mostly used for recreational purposes. According to the 2009 annual report of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), the later part of the twentieth century had witnessed an upsurge in the cultivation of cannabis in several countries. Further, the report estimated that more than one hundred and sixty million people used cannabis daily. The earliest research conducted to establish substantial proof that marijuana use presented a risk factor for the development of psychosis involved a 15-year follow-up longitudinal study of 45,570 military inductees (Andreasson et al., 1987). Among the people who used cannabis, the 17 University of Ghana http://ugspace.ug.edu.gh study observed 2.4 folds higher risk for schizophrenia than those who did not use cannabis. In a dose–response correlation, it was observed that the risk for schizophrenia increased to 6 folds in heavy marijuana users (Andreasson et al., 1987). Other researchers including Arseneault et al (2002), Zammit et al (2002) and Fergusson et al (2003) have subsequently published further epidemiological studies that consistently support this sturdy association between cannabis use and schizophrenia. Studies by Verdoux et al (2003) and Sevy et al (2012) also strongly corroborate the relationship between heavy marijuana use and the risk of developing psychotic symptoms and disorder. Moore et al (2007) argued that of all marijuana related schizophrenia cases that were examined from different parts of the world, about 8 to 14 percent of them were traceable to users who possessed risk of 1.4 to 1.9 folds. In his argument against the legalization of cannabis in Ghana, the Chief Executive of Mental Health Authority and chief psychiatrist, Dr. Akwasi Osei is reported to have revealed that 30,000 of all outpatient cases seen at the three psychiatric hospitals in Ghana every year were related to cannabis use. He is further quoted to have said that more than ten percent of all inpatient cases in these three psychiatric hospitals were traceable to cannabis abuse (Graphic Online, 2017). Chen et al., 2003 also set out to address the important question of why some users of methamphetamine developed psychosis but others continued its use without presenting with major symptoms or illness. The authors reported that people who start to abuse methamphetamine early in life and those addicted to heavy doses had higher risk of developing psychotic disorders. Chen et al (2003) also observed that methamphetamine use was a strong 18 University of Ghana http://ugspace.ug.edu.gh environmental factor that could enhance familial and other genetic predisposition in an individual towards the development of frank psychosis. Subsequently, several researchers have been looking for genes responsible for conferring susceptibility to psychosis following methamphetamine use (McKetin et al, 2006). In a review that involved thirty-eight genetic epidemiological studies, four genes were reported to have linkage with psychosis (McKetin et al, 2006). 2.6 World drug menace Globally, substance use and abuse have become leading public health concern both at the domestic and international fronts. Donoghoe (1996) was the first to estimate the global burden of death and disability attributed to illicit drugs and this was first described in the global burden of disease report of 1990 (Murray & Lopez, 1996). According to Donoghoe’s estimates, illicit drug use accounted for 100,000 deaths worldwide in the year 1990; about 62% (i.e. majority) of these deaths were recorded in developing countries. However, Murray and Lopez (1996) argued that these estimates could have been underrated due to problems with accurately assessing the prevalence of illicit drug usage and the associated harmful effects on health. A number of studies that followed the 1990 estimations, including Frischer et al (1994), Australian Bureau of Criminal Intelligence (2000), EMCDDA (2000) and UNODCCP (2000) have reported seeming upsurge in illicit drug use in developed countries as well. The 2010 global burden of disease estimated that the burden of disease traceable to substance use increased significantly during 2010 in proportion to that of 1990. The study ranked drug use 19 University of Ghana http://ugspace.ug.edu.gh disorders (11%) third and alcohol use disorders (10%) fourth on the disability-adjusted life years (DALYs) scale of the top eleven mental and substance use disorders (Whiteford et al, 2013). According to the findings, depressive disorders (41%) and anxiety disorders (15%) were ranked first and second respectively. The 2010 global ranking for the top twenty-five conditions that accounted for the period (years) people lived with disabilities (YLDs) placed drug use disorders twelfth (Institute for Health Metrics and Evaluation, 2013). These among other studies revealed the negative impact and devastating consequences associated with drug use worldwide. In their 2016 World Drug Report, the United Nations Office on Drugs and Crime (2016) lamented the huge retrogressive health outcomes of drug use. In 2014, it was estimated that about 250 million people aged 15 to 64 years, used a minimum of one drug (World Drug Report, 2016). This number is comparable with the pooled populaces of United Kingdom, Germany, France and Italy. According to the Report, it was estimated that more than 29 million of those drug users could suffer drug-related disorders and other infectious diseases including HIV (resulting from unhealthy practices with respect to intravenous drug injection). In their study, Murray et al (2012) reported common drug disorders among people who used cannabis, cocaine, amphetamines, opioids and alcohol. Global trends reveal that cannabis (marijuana) continues to be the most frequently used drug followed by amphetamine (World Drug Report 2016; World Drug Report 2015; World Drug Report 2014). Cannabis remains the most extensively farmed drug plant and the most trafficked drug globally (World Drug Report 2016). In 2014, there were some 207,400 deaths attributed to drug use; about a third or more of this figure was blamed on deaths related to opioid overdose (World Drug Report 2016). However, the UNODC (2012; 2014; 2016) reported that “reliable and comprehensive information on the drug situation in Africa is not available.” The UNODC lamented the limited 20 University of Ghana http://ugspace.ug.edu.gh available data reported from African member states and therefore admonished that such scanty data be interpreted with caution. 2.7 Drug use in Ghana The problem of substance abuse in Ghana is not very different from what pertains in other countries although there may be variations in the magnitude of the problem across countries. It is not quite clear when it actually became a problem in Ghana but the phenomenon according to educated guesses could be traced to have existed post-independence in the 1960s. The use and abuse of substances have since extended to include the youth. The earliest study on substance use in Ghana which was conducted by Amarquaye (1967) focused on marijuana use; he observed that marijuana had been available in Ghana for many years and was locally grown. It revealed that 25% of the subjects in the study were active smokers at the time of the study and their ages ranged from 10 to 25 years. In their epidemiological study of drug abuse among Ghanaian youth aged 12 to 24 years, Nortey and Senah (1990) examined modes of consumption of drugs relative to the different categories of consumers, personality types involved with drug use, the mechanisms and places of distribution as well as the factors which facilitated changes in the consumption of drugs. The study concluded that the subjects were more knowledgeable about drugs than their actual rate of use. Further, the study recommended institutionalisation of drug education programmes as a means to discouraging drug use. Nonetheless, responses were solicited from participants through questionnaires and therefore the interpretation of the findings from such self-reports should be done with caution. From policy perspective, it sets the agenda for a comprehensive epidemiological study of the drug phenomenon in Ghana. Affinnih (1999) confirmed a change in 21 University of Ghana http://ugspace.ug.edu.gh the types of drugs that were abused in Ghana to include hard drugs such as heroin and cocaine and other psychotropic substances like valium and mandrax. The study argued that drug abuse in Tudu neighbourhood of the Greater Accra region was representative of what existed in several other neighbourhoods in the city. Nevertheless, there is yet to be conducted similar studies in other parts of the country in determining the magnitude of the problem as well as the national prevalence relative to substance use and abuse. In a research entitled “A national survey on prevalence and social consequences of substance (drug) use among second cycle and out of school youth in Ghana”, the Ministry of Health (MOH) / Ghana Health Service (GHS) and the World Health Organisation (WHO) reported that the commonest substances used by the youth were alcohol (25.3%), cigarette (8.7%) and cannabis (1.7%) (MOH / GHS & WHO, 2003). The report further revealed that cocaine, tranquilizers and heroin were less frequently used. In what appeared in literature as the most extensive study in Ghana on substance use among the youth so far, the Ministry of Health / Ghana Health Service and World Health Organisation (MOH / GHS & WHO, 2003) indicated that the average age at first use of substances ranged from 14 to 19 years. However, the study did not give detailed attention to examining the comparative differences that could have existed between in-school and out-of-school youth and which of them had the greater likelihood to abusing drugs. Further, it did not describe inter-regional similarities or differences that might have occasioned the findings. In his study on Substance Abuse among Senior High School Students in Ghana involving the use of Adolescent Alcohol and Drug Involvement Scale (AADIS), Nkyi (2014) found that the prevalence of substance use among senior high school students in Ghana was lower than those reported in other African and western countries. However, his study lacked cross-sectional 22 University of Ghana http://ugspace.ug.edu.gh representation of senior high school students in Ghana considering the fact that only two schools, one each from Cape Coast and Kumasi, with a relatively small sample size of 244 students was used as compared to the many senior high schools in the country with the huge population size and diverse settings. 2.8 Impact of drug abuse Drug abuse disadvantageously affects several facets of national development- including health, security, productivity and wealth creation. The overall peace and progress of societies and countries are evidently challenged by the global drug threat (UNODC, 2000). The economic, health and social costs that substance abuse inflicts on the individual, family, community and nation as a whole cannot be over emphasized. Individual substance use has been identified as major cause of crime, some depressive disorders, relational violence, many accidents and several avertable injuries. Often times, society does not benefit fully from the productive efforts and contributions of victims of drug abuse which are essentially required for national development. Efforts to estimate the financial burden associated with problems of drug abuse are thwarted with limited data in many countries. Nonetheless, the economic drain on national resource connected with substance abuse that has been estimated from few countries including Australia, Canada, United Kingdom and United States of America showed that a large fraction of gross national product was lost to drug related accidents, crime, violence and healthcare costs (Rehm et al, 2006). Thus, these estimates represent in microcosm the remarkable costs that nations could incur with respect to treatment and prevention efforts related to drug abuse. The accuracy of global estimates of problems associated with drug use undoubtedly relies on data gathered from many parts of the world. 23 University of Ghana http://ugspace.ug.edu.gh Unfortunately, very little data have been reported from several of these countries for such much needed global estimates. Public policy approaches and choices that seek to tackle drug abuse would require due cognizance of the possible externalities as well as whether or not there are any advances with this drug phenomenon. Thus, among other factors, the success of such policies is reliant on accurate analysis of relevant available data; which calls for countries to scale up their data collection efforts and strengthen reporting systems with respect to addressing the paucity of data. The drug abuse phenomenon affects many spheres of human lives including health, productivity, public security and safety, governance and crime (Rice et al, 1990). However, this review examines consequences of substance abuse on the individual, society and nations in two major areas: health and safety. Existing evidence suggests that the impact of drug abuse on these two prime domains are further determined by interplay of a number of factors such as cultural beliefs, social constructions as well as policy regimes and legislations. 2.8.1 Effects of substance use on individual and public health Drug abuse significantly affects the health of an individual. The habit of substance abuse increases one’s risk to ill health and premature death. Healthcare facility attendances with respect to drug related issues have considerable cost implications for individuals, families, communities and societies (Hursh, 1980). These visits are usually as consequence of adverse drug reaction such as drug induced psychotic episode, overdose and other infections such as HIV, viral hepatitis B and C and tuberculosis which could be transmitted through intravenous drug use (CDC, 2001). Moreover, such visits could be necessitated by people seeking treatment as victims 24 University of Ghana http://ugspace.ug.edu.gh of drug related crime or accident. Invariably, these have cost implications for treatment and prevention. Additionally, drug abuse contributes significantly towards increasing the death toll and disease burden of a country. Illicit drug users have increased risks of premature death from suicide, trauma and HIV/AIDS compared with their contemporaries who do not use illicit drugs (Reid & Costigan, 2002). Global assessments of mortalities found out that deaths attributable to substance use were between estimated ranges of 0.5% and 1.3% for all deaths occurring among people aged between 15 and 64 years. Worldwide projections reveal that about 211,000 people die every year from drug use and the youth are the most affected with people aged 15 to 49 years constituting the potentially high risk group (WHO, 2010). Drug related death in Europe averages the midrange of age 30 years (EMCDDA, 2000). However, there is scarce data on morbidity and mortality in Africa and Asia with respect to drug use. It is further estimated that 14 million people inject drugs (intravenous drug users) globally. Out of this number, 7.2 million were living with viral hepatitis C and those with HIV and viral hepatitis B were 1.6 million and 1.2 million respectively (Lim, 2012). 2.8.2 Consequence of drug use to public safety Drugs affect brain function thereby altering attention state, perception, judgement and coordination (National Institute on Drug Abuse, 2010). At any particular moment, people who find themselves under the influence of drugs constitute a major risk to the safety and peace of other individuals and the environment around them. For instance, drug-affected road traffic accidents have become global topical issue in contemporary times. Studies have revealed that drivers who frequently use cannabis are at 95% risk of road traffic accidents while 25 University of Ghana http://ugspace.ug.edu.gh benzodiazepines and cocaine raise the risk to 20-100% (Center for Behavioral Health Statistics and Quality, 2011). Besides, there has been increased awareness of the devastating effects of illicit drug farming and production on the environment. A number of studies have identified major linkages between drug use and crime. In fact some studies have established strong association of drug use per se with crime, hence the term “psychopharmacological crime.” Psychopharmacological crime refers to any act of criminal pursuit perpetrated by a person under the influence of a drug (Corman & Naci, 1996). 2.9 Drug control and prevention strategies 2.9.1. International control systems for narcotic and psychoactive drugs The current international drug control systems were carved out of the recognition that drug menace was a global phenomenon that transcended national and jurisdictional borders. Thus, a determination to effectively regulate drug use would require global concerted efforts. To achieve this, it would require that countries cooperate with each other as a global community. There are three major United Nations international drug control conventions, namely: i. Single Convention on Narcotic Drugs, 1961(amended by the 1972 Protocol); ii. Convention on Psychotropic Substances, 1971; and iii. Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988. The general objective of these conventions remains as it was identified many years ago: to limit the production, distribution and use of drugs to medical and scientific purposes. 26 University of Ghana http://ugspace.ug.edu.gh These three major international drug control treaties are mutually supportive and complementary. A significant purpose of the first two treaties is to codify internationally applicable control measures in order to ensure the availability of narcotic drugs and psychotropic substances for medical and scientific purposes, and to prevent their diversion into illicit channels. They also include general provisions in trafficking and drug abuse (UNODCCP, 2014). The United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988, provides comprehensive measures that aim to strengthen the legislative and judicial capacity of member states to ratify and implement international conventions and instruments on drug control, organised crime, corruption, terrorism and money-laundering; reducing drug trafficking; and enhancing the capacity of government institutions and civil society organisations to prevent drug use and the spread of related infections. Within the context of these drug control conventions, signatory countries are required to enact and enforce national legislations in order to comply with the obligations in these treaties. However, these international systems provide the overarching regulatory framework, and their agencies support national governments in meeting their requirements under these treaties. The agencies mandated by the United Nations to assist with the drug control efforts include the Commission on Narcotic Drugs, United Nations Office on Drugs and Crime and the International Narcotic Control Board (UNODCCP, 2014) 2.9.2. Drug policy vis-à-vis drug law A country’s drug policy is an example of public policy. Usually such instruments emanate from the national government in relation to the control systems and regulatory mechanisms relative to 27 University of Ghana http://ugspace.ug.edu.gh drugs that are considered dangerous, particularly those that are addictive. Dye (1987) defined public policy as whatever governments choose to do or not to. This definition suffices the conclusion that the actions or inactions of government in response to a national phenomenon, whether or not deliberate, are measured equally as policy tools of that government in dealing with that particular national issue. An essential constituent of public policy is law. The law is what gives impetus to public policy. Generally, the law includes specific legislation and more broadly defined provisions of constitutional or international law. There are many ways that the law can influence the course of policy and the overall policy objectives or outcomes. For instance, legislations could determine the funding mechanisms and the quantum of funds that may be allocated to national drug control programmes and activities. Therefore, it is not surprising that public policy discussions arise over proposed legislation vis-à-vis the funding options. From the perspective of psychoactive drugs, drug policy refers to the spectrum of strategies carefully developed to control the supply and demand for these drugs within a country. Some essential components of this policy design would include education campaigns and establishment of drug treatment structures among other activities and programmes. Thus, in strict sense, the definition of drug policy usually does not include pharmaceutical medicines (pharmaceutical policy) and social drugs like alcohol and tobacco (alcohol and tobacco policy). In brief an expansion of the definition of public policy by Kilpatrick (2000) aptly contextualizes the description for drug policy. Thus, drug policy encompasses system of laws, regulatory measures, courses of action, and funding priorities that are promulgated by a governmental entity or its representatives concerning psychoactive drugs. 28 University of Ghana http://ugspace.ug.edu.gh Many countries all over the world have enacted drug laws to check the supply of and demand for drugs. In addition to these laws, governments would require to design national drug policies that seek to address drug addiction problems, supply of and demand for drugs and strategies that seek to alleviate the harms associated with drug abuse. However, governments approach towards drug control varies from state to state. The following are examples of drug control strategies from some selected jurisdictions. 2.9.3. Narcotic drug control in Ghana Ghana like other African countries is a signatory to the three major United Nations international drug control conventions. The Narcotic Drugs Law of 1990 (PNDCL 236) of Ghana brings under one enactment offences relating to illicit dealing in narcotic drugs and also seeks to prevent illicit narcotic drug dealers from benefiting from their crimes. In terms of drug policy orientation, there have been some critiques that the focus of the Narcotic Drugs Law, 1990, has tended to be predominantly on law enforcement, in some cases with severe custodial sentences. It has been critiqued that the application of the laws has concentrated more on supply reduction than demand reduction. It is also worth mentioning that Ghana’s Public Health Act, 2012 gives further impetus to these conventions by way of providing for regulations of narcotic and psychotropic substances as contained in Section 126 of Act 851. It is worth mentioning that Ghana has National Drug Policy (currently under reformation) that guides the demand and supply of pharmaceutical products or medicines in the country. A similar thing cannot be said of narcotic and psychoactive drugs or substances. A national policy on 29 University of Ghana http://ugspace.ug.edu.gh narcotic and psychoactive substances could be developed and implemented through sustainable data collection, monitoring and surveillance systems that identify trends in drug use and drug- related problems. 2.9.4. Drug policy of the Netherlands Dutch drug policy aims to reduce both the demand for and supply of drugs, and to minimize any harm to drug users, their immediate environments and society at large (WHO, 2016). The policy assumes that it is near impossibility to prohibit drug use absolutely through fixed government policy. Government policy discourages drug use. Nonetheless, for those who go contrary to these regulations and abuse drugs, there are various programmes designed to manage potential social and health problems related to drug use. The court system and the police deal with the supply aspect of the problem (Ministry of Health, Welfare and Sports 2003). The existing policy bars the possession of, trade in and production of narcotic drugs. These constitute offences that are punishable by law. However, the Minister for Health, Welfare and Sports, who is responsible for enforcing this law, may grant waivers for medical, scientific and educational purposes. This provision is similar to PNDC Law 236 of Ghana which requires written application to be made to the Minister of Health seeking authorization to use any of these scheduled drugs for scientific or medical purpose (WHO, 2016). A major aspect of Dutch drug policy is that it permits the sale of cannabis in registered coffee shops to persons aged 18 years or above. Again, the law prescribes that the quantities of drug sold should not exceed 5 grams per person per visit. 30 University of Ghana http://ugspace.ug.edu.gh In the Netherlands, authorities consider addiction as a health problem rather than a criminal offence. Dutch policy towards drug users is designed to prevent addiction from resulting in increased health problems, degeneration, possible spread of diseases, including via used needles, nuisance for the social environment and criminality. The policy also aims to prevent and combat drug addiction and to prevent addicts from ending up in the criminal gangland. The Netherlands has broad, differentiated systems of medical and social facilities dedicated towards prevention and treatment of problematical abuse of alcohol, drugs and other psychoactive substances. This specialized addict care is part of mental health care and its functions include prevention, consultation, emergency medical and social assistance, counseling, treatment and aftercare. A major aim of drug addict care is to reach a drug-clean life and to improve physical and social functioning of the addicts, without necessarily ending addiction. This means that the inability to give up drug use is accepted as inevitable in the short run (WHO, 2016). Addiction care includes institutional clinical care and ambulatory services. Clinical care protocols involve access to detoxification procedures and extended admissions for comprehensive treatment programmes. 2.9.5. Drug policy of Kenya The most recent drug law to be enacted in Kenya is the Narcotic Drugs and Psychotropic Substances Control Act 1994. This law is considered by far the most important legislation against drugs and substance abuse in Kenya. Similar to much other legislation of United Nations member states, the Act integrates various provisions of international conventions on narcotics and psychotropic substances. Under this law, drug trafficking attract serious sanctions including life imprisonment, forfeiture of property and earnings and imposition of fines up to one million 31 University of Ghana http://ugspace.ug.edu.gh Kenyan shillings or three times the value of the seized drugs. There are also provisions for compulsory treatment and rehabilitation of drug addicts, recognition for international mutual assistance in drug investigations and proceedings and setting up of advisory councilor rehabilitation activities among others. The Kenyan government has been commended for enacting this law. However, its implementation has faced hindrances in respect to court interpretation and determination of bailing, sentences and nature of offences. Moreover, the law concentrates on hard drugs while overlooking other social drugs which are devastating society in likewise manner. According to UNODCCP (2000), although monies received from convicts in the form of fines under the Act were supposed to be channeled to the setting up of treatment and rehabilitation facilities, the money which has been accumulated by courts has never been reallocated for that purpose by the treasury. In complementing the provisions of this legislation, the government in 1995 constituted the inter- ministerial drug coordination committee to define, harmonize, coordinate, monitor and evaluate all drug control measures instituted against drug and substance abuse at the national level. The committee subsequently designed a drug control master plan in 1999. This was granted cabinet approval in April 2001. The master plan summarized the policies, defined priorities and assigned responsibilities to the various drug control agencies. It further provided an impetus and extension of the resources and scope of the inter-ministerial drug coordinating committee in order to harness drug control processes in the country effectively (NACADA 2002). Studies by international agencies including UNODCCP (1999) argued that the capacities of the government and non-governmental organisations in dealing with hard drugs were low. This was 32 University of Ghana http://ugspace.ug.edu.gh blamed on due insufficient funds, lack of well-trained personnels and poor understanding of the problem. The analyses further exposed a lack of collaboration among public institutions that were mandated with anti-drug control functions. The National Agency for the Campaign against Drug Abuse (NACADA) was established in March 2001 through the Kenya gazette notice number 2841. As part of its mandate, the NACADA was responsible for coordinating the activities of organisations, groups and individuals towards the campaign against drug abuse. It was mandated to initiate public educational campaign programmes against substance abuse in the country. It was also tasked to develop an action plan aimed at curbing drug abuse among the youth at all levels of their development; to sensitize parents about the abuse of drugs and its attendant problems as well as their functions as role models. It was a function of the NACADA to initiate rehabilitation programmes for drug-dependent persons. The NACADA directs attention to prevention as a method of tackling substance abuse. A significant aspect of this strategy was focused on changing people's perceptions, belief systems and their overall outlooks about substance use. This was further augmented with interventions that sought to enhance the capacity of young people to make informed decisions and choices about issues of drugs. The conceptual framework of this strategy was undoubtedly modeled on the theory of planned behaviour (Ajzen, 1991). The campaign sought to increase public awareness on the benefits of staying away from substance abuse. In exercising this mandate, NACADA was confronted with numerous obstacles which included lack of regular funding, human resource constraints and lack of harmonization among government departments and agencies in dealing with drug abuse. Again, the operations of NACADA were challenged by societal denial of existence of the drug problem and reports of cover-up by communities 33 University of Ghana http://ugspace.ug.edu.gh (NACADA, 2002). UNODCCP (1999) observed that there were problems with demand reduction programmes. For example, drug awareness education was incorporated into the educational syllabus of primary schools but majority of teachers did not have the requisite knowledge or training needed for the proper implementation of such programme. 2.9.6. Drug policy of Sweden The drug policy of Sweden is founded on zero tolerance for illegal drug dealings (WHO, 2016). It focuses on reducing supply of and demand for these drugs. Generally, the use of illegal substances constitutes a crime but personal usage does not attract jail term except when the person drives under the influence of such drugs. Unlike Ghana’s narcotic law that imposes a minimum jail term of 10 years, the Swedish drug law prescribes lesser magnitudes of sanctions. In Sweden, penalties for narcotic offences range from maximum of 6 months in jail for minor offences to maximum of 10 years in jail for exceptionally serious narcotic offences The legislations also make provision for compulsory health care that can be feasibly used in conjunction with a sentence for a drug-related offense depending on the case at hand (WHO, 2016). 2.9.7. Drug policy of Canada The Canadian drug policies that existed in the 1920’s were extremely different from that of the present day. Drug users were considered more as criminals than as those with an illness, and the enforcement of drug laws was given precedence over the treatment of offenders. Moreover, the drug laws then were more discriminatory against foreigners (UNODCCP, 2000). 34 University of Ghana http://ugspace.ug.edu.gh Between 1969 and 1973 a commission of inquiry was set up to look into the non-medical use of drugs. It was reported that the drug laws needed reforms to make them less harsh. It further recommended for a gradual decriminalization of illicit drugs in the country. The various arms of government differed on issue of whether or not to accept the recommendations of the Commission of Inquiry. Whereas the Senate approved of the recommendations including a proposal to decriminalize cannabis, the House of Commons disapproved of this. However, subsequent amendments and enactments have paved way for Canada to legalize the medical use of cannabis since 2001(WHO, 2016). 2.9.8. Drug policy of the United Kingdom (UK) Apart from alcohol and tobacco, all other drugs that are considered by the UK government as addictive or dangerous are termed as controlled substances and therefore regulated by law. Britain’s drug policy during the early 1960s kept drug use level relatively low. There was comparatively minimal recreational use of drugs and those addicted to drug use were very few with treatment options for problem users. Subsequent laws made drug use increasingly criminalized (UNODCCP, 2000). In 2016, Britain enacted the Psychoactive Substances Act with the focus on restricting production, sale and supply of a new class of psychoactive substances. The law is applicable over the entire United Kingdom jurisdiction (WHO, 2016). In summary, it is evident from the discussion that Ghana unlike many other countries does not have national policy on psychoactive and narcotic substances. This paper provides empirical 35 University of Ghana http://ugspace.ug.edu.gh baseline study which offers advocacy support base for a national psychoactive and narcotic substance policy in the Ghana. 36 University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE METHODOLOGY 3.1 Introduction This chapter discusses the methods used to address the stated objectives. The chapter begins with identification of the study design followed by description of the study site, ethical considerations for data collection, inclusion/exclusion criteria observed during collection, data analysis tool used and delimitations of the study. 3.2 Study design The research was descriptive in design and the Accra Psychiatric Hospital was used as a case study. This study design was employed to assist with building useful empirical data with respect to substance use in the country. 3.3 Description of study site Accra Psychiatric Hospital is one of the three major psychiatric referral centres in Ghana. The Hospital is situated at Adabraka in the Osu Klottey sub-metro of the Greater Accra Region. It is Ghana’s foremost psychiatric facility and is located adjacent the Ridge Hospital (i.e. the Greater Accra regional hospital). It is currently a 600 bed capacity hospital commissioned in 1906. The Hospital serves patients from all over Ghana and neighbouring countries. 3.4 Ethical issues/considerations Approval of topic and ethical clearance were sought from Graduate School through the Centre for Social Policy Studies. Approval for access to data was also sought from the Director of Accra 37 University of Ghana http://ugspace.ug.edu.gh Psychiatric Hospital. The results of the patients / clients and other matters inherent were treated with the strictest and utmost confidentiality. To ensure anonymity, codes or identification numbers were used in place of names. A combination of the year, month and the serial arrangement of test result in a matrix was used to generate a unique identification number or code for every individual test result. For example, the codes 201601001 and 201612001 represent the first test results in the year 2016 for the months of January and December respectively. Thus, the first four digits of the code represent the year while the last three digits indicate the serial position of the sample results relative to the month of the test, which is represented by the two digits appearing immediately after the year (as shown in appendix A). 3.5 Data collection The study focused on secondary data, in the form of results of clinical laboratory investigations conducted on urine samples of patients/clients who reported to the medical laboratory department of the Accra Psychiatric Hospital for the said test. The investigation serves as evidence-based practice to confirm or rule out substance use in people with suspected drug- related mental conditions. The results were obtained from laboratory information management system database and manual log books available from the laboratory department of the Hospital. For the period under review, the Accra Psychiatric Hospital Laboratory was carrying out investigations into suspected substance use through the use of a six-parameter rapid immunochromatographic test kit. This qualitative test method could detect tetrahydrocannabinol (THC) (i.e. marijuana), amphetamine (AMP), opiates (OPI), methamphetamine (MET), benzodiazepines (BZD) and cocaine (COC) metabolites in urine samples. 38 University of Ghana http://ugspace.ug.edu.gh 3.6 Inclusion and exclusion criteria Sample results with both age and gender indicated were included in the data whereas those without age and / or gender were excluded. Before 2012, these investigations were outsourced. 3.7 Data analysis Quantitative methods were employed in analyzing the data. Data were entered into database and analysed using SPSS (version 20). Descriptive statistical method was used in analyzing the data. Frequency tables and distribution charts were drawn to describe and compare variables and patterns over the periods studied. To determine associations among age, gender and substance use across the years, cross tabulations and Pearson’s chi-square were used. Thus, at a significance level of 5%, all p-values less than 0.05 were considered significant. 3.8 Delimitations There were no readily accessible data on socio-demographic variables such as occupational history, educational background, marital status and ethnicity among others for data inclusion. Record of clinical history could have been used to tell apart prescribed use and probable abuse of benzodiazepines. It could have also provided some relevant information about possible use of other psychoactive substances including alcohol and tobacco. There was no documentation of medical record numbers (folder numbers) at the primary study site (Laboratory) to facilitate tracking of relevant folders which could be reliable sources of such data. Tracking folders with names was laborious, time consuming and many times unfruitful given the manual filing systems and the different storage locations of the folders (i.e. archives section, consulting rooms and records area). 39 University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR DATA ANAYSIS AND DISCUSSIONS 4.1 Introduction This chapter presents findings of the study obtained from the data that were collected and analysed. This has been done relative to the objectives of the study. Statistical analyses were conducted as 2-tailed and declared significant for p-value less than 0.05 (p<0.05). 4.2 Substances commonly used The review revealed that substance screening protocol at the study site involved a matrix that distinguished and detected six drug parameters (analytes)- cocaine, tetrahydrocannabinol (marijuana), amphetamine, opiates, methamphetamine and benzodiazepine (Table 4.1 and appendix A). From Table 4.1, it was observed that screening tests for THC and BZD returned more commonly positive while those of COC and OPI returned less frequently positive. However, there was no single positive result for AMP or MET to suggest amphetamine or methamphetamine use during the period under review. 40 University of Ghana http://ugspace.ug.edu.gh Table 4.1: Analysis of substance use by year and gender Year N Mean Std. Deviation Std. Error Mean 2012 THC M 229 .43 (98/229) .496 .033 F 14 .07 (1/14) .267 .071 AMP M 229 0.00 .000 0.000 F 14 0.00 .000 0.000 OPI M 229 .04 (10/229) .195 .013 F 14 0.00 0.000 0.000 MET M 229 0.00 .000 0.000 F 14 0.00 .000 0.000 BZD M 229 .41 (94/229) .493 .033 F 14 .50 (7/14) .519 .139 COC M 229 .05 (12/229) .223 .015 F 14 0.00 0.000 0.000 2013 THC M 269 .38(103/269) .487 .030 F 20 .25 (5/20) .444 .099 AMP M 269 0.00 .000 0.000 F 20 0.00 .000 0.000 OPI M 269 .03 (7/269) .159 .010 F 20 0.00 0.000 0.000 MET M 269 0.00 .000 0.000 F 20 0.00 .000 0.000 BZD M .49 269 .501 .031 (132/269) F 20 .50 (10/20) .513 .115 COC M 269 .03 (9/269) .180 .011 F 20 0.00 0.000 0.000 (Source: Field data, 2017) 41 University of Ghana http://ugspace.ug.edu.gh Table 4.1: Analysis of substance use by year and gender (continuation) Year N Mean Std. Deviation Std. Error Mean 2014 THC M 160 .23 (36/160) .419 .033 25 .12 (3/25) .332 .066 F AMP M 160 0.00 .000 0.000 F 25 0.00 .000 0.000 OPI M 160 .03 (4/160) .157 .012 F 25 0.00 0.000 0.000 MET M 160 0.00 .000 0.000 F 25 0.00 .000 0.000 BZD M 160 .27 (43/160) .445 .035 F 25 .44 (11/25) .507 .101 COC M 160 .01 (2/160) .111 .009 F 25 0.00 0.000 0.000 2015 THC M 139 .19 (26/139) .391 .033 F 15 .13 (2/15) .352 .091 AMP M 139 0.00 .000 0.000 F 15 0.00 .000 0.000 OPI M 139 .01 (2/139) .120 .010 F 15 .07 (1/15) .258 .067 MET M 139 0.00 .000 0.000 F 15 0.00 .000 0.000 BZD M 139 .45 (62/139) .499 .042 F 15 .40 (6/15) .507 .131 COC M 139 .01 (2/139) .120 .010 F 15 0.00 0.000 0.000 (Source: Field data, 2017) 42 University of Ghana http://ugspace.ug.edu.gh Table 4.1: Analysis of substance use by year and gender (continuation) Year N Mean Std. Deviation Std. Error Mean 2016 THC M 185 .30 (56/185) .461 .034 F 18 .11 (2/18) .323 .076 AMP M 185 0.00 .000 0.000 F 18 0.00 .000 0.000 OPI M 185 .01 (2/185) .104 .008 F 18 0.00 0.000 0.000 MET M 185 0.00 .000 0.000 F 18 0.00 .000 0.000 BZD M 185 .46 (85/185) .500 .037 F 18 .44 (8/18) .511 .121 COC M 185 .01 (2/185) .104 .008 F 18 0.00 0.000 0.000 (Source: Field data, 2017) Throughout the period under review, there were more males than females screened for suspected substance use. The proportions of males who used THC outnumbered those of females for each of the years studied (Figure 4.1). The proportion of THC use among the males had consistently declined from 43% in 2012 to 19% in 2015 but it increased to 30% in 2016. Over the years, COC use was common among the males declining from 5% in 2012 and stagnating at 1% during the past three most recent years (2014, 2015 and 2016). But for one female with the code 2015055008 (Appendix A) who was diagnosed positive for OPI as well as THC and BZD use, OPI use was commonly observed among the males over the years. OPI use among males declined from 4% in 2012 to 1% in 2016. BZD use among males increased consistently over the past three recent from 27% in 2014 to 46% in 2016. Nevertheless, BZD use among the females dropped from 44% in 2014 to 40% in 2015 but returned to 44% in 2016. 43 University of Ghana http://ugspace.ug.edu.gh From Table 4.1, standard error of proportions of males who indulged in substance usage stood at <5% (i.e. SEM range: 0.8% to 4.2%). Conversely, the standard error of proportions attributable to females who engaged in substance usage recorded relatively high SEM (range: 6.6%-13.9%; SEM >5%). Thus, sample statistics for males had smaller variabilities as compared to those of the females. It was observed that substance use affected males more significantly than their female counterparts. 44 University of Ghana http://ugspace.ug.edu.gh Figure 4.1: Graphical presentation of substance use by year and gender .60 .50 .40 .30 THC OPI BZD .20 COC .10 .00 Mean Mean Mean Mean Mean Mean Mean Mean Mean Mean Male Female Male Female Male Female Male Female Male Female 2012 2013 2014 2015 2016 (Source: Field data, 2017) 4.3 Age characteristics relative to suspected substance use Table 4.2 presents the group analysis of age ranges and means of individuals screened for suspected substance use. The large standard errors suggest that there were no significant differences detected between variances of the individual ages. Similarly, equal variances existed between the means across the table (standard error >5%). The minimum and maximum mean ages of suspected substance use were 26.85±7.80 years and 30.49±8.92 years respectively. 45 University of Ghana http://ugspace.ug.edu.gh Table 4.2: Age distribution of people screened for substance use from 2012 to 2016 Std. N Minimum Maximum Mean Deviation Skewness Kurtosis Std. Std. Std. Year Statistic Statistic Statistic Statistic Error Statistic Statistic Error Statistic Error 2012 AGE 243 13 64 30.49 .572 8.915 .755 .156 .874 .311 243 Valid N 2013 AGE 289 14 62 29.23 .550 9.349 .963 .143 .768 .286 Valid N 289 2014 AGE 185 14 53 26.85 .574 7.804 .871 .179 .482 .355 Valid N 185 2015 AGE 154 13 72 26.97 .836 10.378 1.917 .195 5.014 .389 Valid N 154 2016 AGE 203 11 78 28.58 .711 10.136 1.497 .171 3.157 .340 Valid N 203 (Source: Field data, 2017) 46 University of Ghana http://ugspace.ug.edu.gh Table 4.3: Age distribution of individuals who tested positive for substance use from 2012 to 2016 Year N Minimum Maximum Mean Std. deviation p- statistic statistic statistic statistic std. statistic value error 2012 AGE THC 99 16 59 30.22 0.86 8.57 0.798 COC 12 25 47 31.00 1.64 5.67 0.845 OPI 10 19 55 31.70 3.02 9.55 0.675 BZD 101 13 64 31.62 0.94 9.40 0.293 2013 AGE THC 108 16 57 28.64 0.78 8.13 0.563 COC 9 30 50 35.00 2.12 6.32 0.067 OPI 7 20 50 33.86 3.50 9.26 0.196 BZD 142 15 62 29.98 0.82 9.73 0.440 2014 AGE THC 39 16 53 28.23 1.35 8.42 0.323 COC 2 25 30 27.50 1.77 2.50 0.907 OPI 4 19 30 24.75 1.95 3.90 0.593 BZD 54 17 51 27.46 1.03 7.57 0.611 2015 AGE THC 28 14 70 27.00 2.31 12.24 0.989 COC 2 18 29 23.50 3.89 5.50 0.638 OPI 3 18 27 23.00 2.16 3.74 0.510 BZD 68 13 72 28.65 1.07 8.83 0.247 2016 AGE THC 58 16 64 28.88 1.30 9.92 0.842 COC 2 41 42 41.50 0.35 0.50 0.074 OPI 2 41 42 41.50 0.35 0.50 0.074 BZD 93 11 64 29.10 1.07 10.34 0.684 (Source: Field data, 2017) 47 University of Ghana http://ugspace.ug.edu.gh Table 4.3 presents the number of individuals who tested positive for the various substances and their respective age characteristics over the years studied. There were relatively more BZD positive cases recorded each year, followed by THC positive cases. Between COC and OPI, there were relatively less positives (ranging from 2 to 12 people). The minimum ages of use of THC and BZD were 14 years and 11 years whereas that of COC and OPI was 18 years. The maximum ages of use of THC, BZD, COC and OPI were 70 years, 72 years, 50 years and 55 years respectively. Thus, the age of start of use of THC and BZD were quite lower (early start) compared to COC and OPI use. Similarly, there were much older people (those aged 70 years and above) engaged in THC and BZD use as compared to COC and OPI use. The respective minimum and maximum average ages of individuals who used the various substances were 27.50±2.50 years and 35.00±6.32 years. It was further observed that during the period under review, the group mean ages of the respective years (as presented in Table 4.2) did not vary significantly from the corresponding mean ages of individuals with confirmed substance use (as shown in Table 4.3). Thus, comparison between the mean age of individuals suspected of substance use with the mean ages of those who actually tested positive for the various substances within a particular period revealed that there were no statistically significant differences between the means (p>0.05). In this regard, it could be concluded that the mean ages of those suspected of substance use were not different from those who actually tested positive for substance use or abuse. 48 University of Ghana http://ugspace.ug.edu.gh Table 4.4: Independent samples test Levene's Test for Equality of Variances t-test for Equality of Means 95% Confidence Interval of the Difference Sig. (2- Mean Std. Error Year F Sig. t df tailed) Difference Difference Lower Upper 2012 THC Equal variances 219.431 .000 2.663 241 .008 .357 .134 .093 .620 assumed Equal variances not 4.537 18.999 .000 .357 .079 .192 .521 assumed OPI Equal variances 2.482 .116 .755 241 .451 .039 .052 -.063 .142 assumed Equal variances not 3.054 227.000 .003 .039 .013 .014 .065 assumed BZD Equal variances .460 .498 -.658 241 .511 -.090 .136 -.358 .179 assumed Equal variances not -.628 14.472 .540 -.090 .142 -.394 .215 assumed COC Equal variances 3.441 .065 .876 241 .382 .052 .060 -.065 .170 assumed Equal variances 3.551 228.000 .000 .052 .015 .023 .081 not assumed (Source: Field data, 2017) 49 University of Ghana http://ugspace.ug.edu.gh Table 4.4: Independent samples test (continuation) Levene’s Test for Equality of t-test for Equality of Means Variances 95% Confidence Year Interval of the Difference Sig. (2- Mean Std. Error F Sig. t df tailed) Difference Difference Lower Upper 2013 THC Equal variances 11.499 .001 1.184 287 .237 .133 .112 -.088 .354 assumed Equal variances not 1.282 22.534 .213 .133 .104 -.082 .348 assumed OPI Equal variances 2.241 .136 .728 287 .467 .026 .036 -.044 .096 assumed Equal variances not 2.676 268.000 .008 .026 .010 .007 .045 assumed BZD Equal variances .007 .934 -.080 287 .936 -.009 .116 -.238 .220 assumed Equal variances not -.078 21.781 .938 -.009 .119 -.256 .237 assumed COC Equal variances 2.951 .087 .829 287 .408 .033 .040 -.046 .113 assumed Equal variances 3.046 268.000 .003 .033 .011 .012 .055 not assumed (Source: Field data, 2017) 50 University of Ghana http://ugspace.ug.edu.gh Table 4.4: Independent samples test (continuation) Levene’s Test for Equality of t-test for Equality of Means Variances 95 % Confidence Internal of the Year Difference Sig. (2- Mean Std. Error F Sig. t df tailed) Difference Difference Lower Upper 2014 THC Equal variances assumed 7.513 .007 1.195 183 .234 .105 .088 -.068 .278 Equal variances not 1.416 37.107 .165 .105 .074 -.045 .255 assumed OPI Equal variances 2.672 .104 .796 183 .427 .025 .031 -.037 .087 assumed Equal variances not 2.019 159.000 .045 .025 .012 .001 .049 assumed BZD Equal variances 5.778 .017 -1.757 183 .081 -.171 .097 -.364 .021 assumed Equal variances not -1.597 30.061 .121 -.171 .107 -.390 .048 assumed COC Equal variances 1.284 .259 .559 183 .577 .013 .022 -.032 .057 assumed Equal variances 1.419 159.000 .158 .013 .009 -.005 .030 not assumed (Source: Field data, 2017) 51 University of Ghana http://ugspace.ug.edu.gh Table 4.4: Independent samples test (continuation) Levene’s Test for Equality of Variances t-test for Equality of Means 95% Confidence Year Interval of the Sig. (2- Mean Std. Error Difference F Sig. t df tailed) Difference Difference Lower Upper 2015 THC Equal variances assumed 1.191 .277 .510 152 .611 .054 .105 -.155 .262 Equal variances not .555 17.955 .586 .054 .097 -.150 .257 assumed OPI Equal variances 7.420 .007 -1.392 152 .166 -.052 .038 -.127 .022 assumed Equal variances not -.775 14.654 .451 -.052 .067 -.196 .092 assumed BZD Equal variances .760 .385 .339 152 .735 .046 .136 -.222 .314 assumed Equal variances not .335 17.058 .742 .046 .138 -.244 .336 assumed COC Equal variances .890 .347 .465 152 .643 .014 .031 -.047 .076 assumed Equal variances 1.419 138.000 .158 .014 .010 -.006 .034 not assumed (Source: Field data, 2017) 52 University of Ghana http://ugspace.ug.edu.gh Table 4.4: Independent samples test (continuation) Levene’s Test t-test for Equality of Means for Equality of Variances 95% Confidence Interval of the Year Difference Sig. (2- Mean Std. Error F Sig. t df tailed) Difference Difference Lower Upper 2016 THC Equal variances assumed 23.248 .000 1.722 201 .087 .192 .111 -.028 .411 Equal variances not 2.297 24.289 .031 .192 .083 .020 .364 assumed OPI Equal variances .796 .373 .441 201 .659 .011 .024 -.037 .059 assumed Equal variances not 1.418 184.000 .158 .011 .008 -.004 .026 assumed BZD Equal variances .077 .782 .121 201 .903 .015 .124 -.229 .259 assumed Equal variances not .119 20.290 .906 .015 .126 -.248 .278 assumed COC Equal variances .796 .373 .441 201 .659 .011 .024 -.037 .059 assumed Equal variances not 1.418 184.000 .158 .011 .008 -.004 .026 assumed (Source: Field data, 2017) Table 4.4 is SPSS output of independent samples t-test. The independent samples t-test compares the means of two independent groups to determine whether or not there is statistical evidence that the associated population averages are significantly different. Thus, the independent t-test in 53 University of Ghana http://ugspace.ug.edu.gh Table 4.4 examines whether substance usage differed based on gender. The dependent variable is ‘type of substance’ and the independent variable is ‘gender’ which has two discrete outcomes- ‘male’ or ‘female’. Table 4.4 presents results of test of statistical difference between males and females with respect to substance usage over the period under review. 4.4 Hypotheses testing: The null hypothesis (H0) and alternative hypothesis (H1) of the independent samples t-test can be expressed as: H0:µ1=µ2 (‘the two population means are equal’) H1:µ1≠µ2 (‘the two population means are not equal’), where µ1 and µ2 are the population means for males and females respectively. Table 4.4 also includes a test for the homogeneity of variance, called Levene’s test. The null and alternative hypotheses for Levene’s test are: 2 2 H0:σ1 = σ2 (‘the two population variances of males and females are equal’) 2 2 2 H1: σ1 ≠ σ2 (‘the two population variances of males and females are not equal’), where σ1 and 2 σ2 are the variances for males and females respectively. Thus, if the null hypothesis of Levene’s test is rejected, it implies that the variances between the two genders are not equal; and as such the homogeneity of variances assumption is violated. 54 University of Ghana http://ugspace.ug.edu.gh Year 2012: The significance value of Levene’s test (Sig.) for THC in 2012 was less than 0.05 (p<0.001). This implies that the variability between the means of males and females with respect to THC use is significantly different. Further, since p<0.001 (2-tailed) is less than the declared significance level of α=0.05 it can be concluded that the variability in the means of males and females with respect to THC usage was statistically significant (i.e. t(18.999)=4.537, p<0.001). Thus, the average THC usage among males was 35.7% more than that of the females in 2012. Regarding OPI usage, Sig. value is greater than 0.05 (p=0.116). Thus, the variability between genders with respect to OPI usage was not significantly different. Further, p>0.05 (2-tailed) and therefore it can be concluded that there is no statistically significant difference between males and females with regards to OPI use (i.e. t(241)=0.755, p=0.451). Similarly, BZD and COC Sig. values are greater than 0.05 (i.e. p(BZD) =0.498 and p(COC) = 0.065), which implies that there were no significant variances between the means of males and females. Further, the associated p-values (2-tailed) are greater than 0.05 (i.e. p(BZD) =0.511 and p(COC) = 0.382). Therefore, it can be concluded that there are no statistically significant differences between the means of males and females with reference to usage of BZD and COC (tBZD(241)=-0.658, p=0.511; tCOC(241)=0.876, p=0.382). Year 2013: Sig. value of THC usage is less than 0.05 (p=0.001) which implies that the variance between means of the genders is significant. But p=0.213 (2-tailed) and therefore there is no statistically significant difference between gender and THC usage (t(22.534)=1.282, p=0.213). It can be 55 University of Ghana http://ugspace.ug.edu.gh concluded that the differences in means between males and females with reference to THC usage are likely due to chance and not likely due to difference in gender. Sig. values with respect to usage of OPI, BZD and COC are all greater than 0.05 (i.e. p(OPI) = 0.136, p(BZD) =0.934 and p(COC) = 0.087) which implies that the variabilities in the means of gender with reference to these three substances are not significantly different. Further, p>0.05 for OPI (p=0.467), BZD (p=0.936) and COC (p=0.408) and therefore it can be concluded that that there are no statistically significant differences between the gender and usage of OPI, BZD and COC in 2013. Year 2014: The Sig. value for THC usage is less than 0.05 (p=0.007). Thus, there is significant difference between the means of males of females with reference to THC use. However, p=0.165 (2-tailed, p>0.05) which implies that there is no statistically significant difference with THC usage between the genders (i.e. t(37.107)=1.416, p=0.165). Hence, the differences between the means are likely due to chance. Similarly, for BZD Sig. <0.05 (i.e. p=0.017) which implies that there is significant difference between the means of males and females with regards to BZD usage. Since p=0.121 (2-tailed, p>0.05), it implies that there is no statistically significant difference between males and females with respect to BZD use (i.e. t(30.061)=-1.597, p=0.121). Thus, the differences between the means of the genders are likely due to chance. Sig. values with reference to OPI and COC usage were greater than 0.05 (i.e. p(OPI) = 0.104 and p(COC)=0.259) which implies that there are no significant variances in the means of the genders with respect to OPI and COC usage. Further, the associated p-values (2-tailed) are greater than 56 University of Ghana http://ugspace.ug.edu.gh 0.05 (i.e. p(OPI)= 0.427 and p(COC) = 0.577). This implies that there are no statistically significant differences between males and females with regards to OPI and COC usage. Year 2015: Sig. value for OPI is less than 0.05 (i.e. p=0.007) which implies that there is significant difference between the means of males and females regarding OPI usage. But the associated p=0.451 (2-tailed, p>0.05) which implies that there is no statistically significant difference between the means of males and females with respect to OPI usage (i.e. t(14.654) = -0.775, p = 0.451). Thus, the differences in the means are likely due to chance. However, Sig. values for THC, BZD and COC are greater than 0.05 (i.e. p(THC) = 0.277, p(BZD)=0.385 and p(COC) = 0.347) which implies that there are no significant differences in the means of males and females with reference to these substances. Also, the associated p-values (2- tailed) for THC, BZD and COC are all greater than 0.05 (i.e. p(THC) = 0.611, p(BZD) = 0.735 and p(COC) = 0.643). Thus, there were no statistically significant differences in the means of the genders with respect to usage of these substances. Year 2016: Sig value for THC is less than 0.05 (i.e. p<0.001) which implies that there is significant difference between the means of males and females with reference to THC usage. Further, the associated p-value is less than 0.05 (i.e. p=0.031) which implies that there is statistically 57 University of Ghana http://ugspace.ug.edu.gh significant difference between the means of males and females with reference to THC use (i.e. t(24.289) = 2.297, p = 0.031). On the other hand, Sig. values for OPI, BZD and COC are all greater than 0.05 (i.e. p(OPI) = 0.373, p(BZD)= 0.782 and p(COC) = 0.373). Further, the corresponding p-values (2- tailed) for OPI, BZD and COC are all greater than 0.05 (i.e. p(OPI) = 0.659, p(BZD) = 0.903 and p(COC) = 0.659) which implies that there are no statistically significant differences between gender and usage of these substances. 4.5 Multiple drug use It was observed that some of the clients used more than one type of substance, a phenomenon often referred to as multiple or poly drug use. Thus, multiple or poly drug use is the combined usage of more than one psychoactive drug with the view of achieving a certain effect. However, for the purpose of this review, the matrix of multi-drug use has been redefined to include all substances other than benzodiazepine (BZD). In this context, multi-drug use implied combined usage of any two or all of THC, OPI and COC. The number of multiple drug users consistently reduced from 13 individuals in 2012 to 8 in 2013 through to 3 in 2014. It is significant to note that these individuals were all males. In 2015, there were 2 males and a female who were multiple drug users. In 2016, the number of multi-drug users dropped from 3 in 2015 to 2 individuals who were all males (Appendix A). In summary, there were statistically significant differences between males and females with reference to THC usage in 2012 and 2016 at the declared significance level of α=0.05. Thus, all 58 University of Ghana http://ugspace.ug.edu.gh other observed differences between gender and substance usage were likely due to chance. It was also observed that multi-drug use was a consistent problem of males as compared to females. 4.6 Prevalence of substance use Table 4.5 Analysis of confirmed substance use by year Year THC OPI BZD COC Cases/Total 99/243 10/243 101/243 12/243 2012 Percentage 40.7 4.1 41.6 4.9 Cases/Total 108/289 7/289 142/289 9/289 2013 Percentage 37.4 2.4 49.1 3.1 Cases/Total 39/185 4/185 54/185 2/185 2014 Percentage 21.1 2.2 29.2 1.1 Cases/Total 28/154 3/154 68/154 2/154 2015 Percentage 18.2 1.9 44.2 1.3 Cases/Total 58/203 2/203 93/203 2/203 2016 Percentage 28.6 1.0 45.8 1.0 (Source: Field data, 2017) The annual prevalence of substance use was arrived at by comparing the number of people who were diagnosed positive for substance use (defined cases) with the total number of people screened for suspected substance use in a specified year, expressed as a percentage. The periodic prevalence for OPI declined from 4.1% (maximum) in 2012 to 1.0% (minimum) in 2016. Similarly, prevalence of COC declined from 4.9% (maximum) in 2012 to approximately 1.0% (minimum) in 2016. However, prevalence of THC had dropped steadily from 40.7% (maximum) in 2012 to 18.2% (minimum) in 2015 but increased to 28.6% in 2016. Nonetheless, prevalence for BZD declined from 49.1% (maximum) in 2013 to 29.2% (lowest rate) in 2014, it subsequently rose through to 45.8% in 2016. Thus, the rate of use or abuse of 59 University of Ghana http://ugspace.ug.edu.gh OPI and COC had declined during the period under review whereas that of THC and BZD had increased during the last most recent year (2016) under studied. Figure 4.2: Graphical presentation of confirmed substance use from 2012 to 2016 60 50 40 THC 30 OPI BZD 20 COC 10 0 Percentage Percentage Percentage Percentage Percentage 2012 2013 2014 2015 2016 (Source: Field data, 2017) 4.7 Substances commonly used The diagnostic test method employed by the study site for investigating suspected substance use during the period under review involved a six-parameter rapid immunochromatographic testing device which could detect tetrahydrocannabinol (THC) (in marijuana or cannabis), cocaine (COC), opiates (OPI), benzodiazepine (BZD), amphetamine (AMP) and methamphetamine (MET) metabolites in urine samples at certain minimum concentrations. 60 University of Ghana http://ugspace.ug.edu.gh THC (i.e. delta- 9-tetrahydrocannabinol) is the main psychoactive element in cannabis (marijuana). THC is sedative and has hallucinogenic effect that could persist for several hours. Abusers present with loss of coordination, confusion, impaired short-term memory, altered mood and sensory perceptions hallucinations, euphoria and palpitations. Cannabis preparations are often smoked and less frequently swallowed. COC (cocaine or ‘coke’) is more frequently snorted and sometimes injected. It is a central nervous stimulant that confers certain therapeutic use as local anaesthetic. Synthetic variants could be used medically as appetite-suppressing agents (anorectics or slimming medications). OPI (opiates) refer to a group of naturally occurring drugs derived from the opium poppy including morphine, opium and codeine, semi-synthetic heroin and synthetic opioids- pethidine, methadone, fentanyl and tramadol. OPI are central nervous system (CNS) depressants and are medically used as painkillers (analgesics), anti-diarrhoeal agents and cough suppressants. There are reports of non-prescribed usage of OPI for reasons of inducing euphoria, overcoming boredom or anxiety and curing emotional or physical pain. OPI in one form or the other could be smoked, snorted or inhaled. Abuse or misuse of OPI could result in reduced coordination, poor judgement, decreased respiration, low body temperature (hypothermia) and coma. BZD (benzodiazepines) are a category of CNS depressants that function as hypnotics (inducing sleep) at high doses; as anxiolytics (relieving anxiety) in moderate doses; and as sedatives or tranquilizers (inducing a state of calmness or restfulness) in low doses. BZD are commonly prescribed for the short-term treatment of anxiety and insomnia. They could also be used therapeutically as anti-convulsants and anaesthetics. They are either swallowed or injected. 61 University of Ghana http://ugspace.ug.edu.gh AMP/MET (Amphetamine/methamphetamine) and there are potent CNS stimulants. The resultant effects of acute doses include restlessness, euphoria, and a feeling of increased energy and power within user’s own self. Effects of chronic use include paranoia, anxiety and increased heartbeat (WHO, 2006). Among these, THC, COC, OPI and BZD were identified as the commonly used substances. Further, the findings revealed that more people used THC and BZD than COC and OPI. All test results for amphetamine and methamphetamine returned negative during the period under review. Affinnih (1999) reported that there was a shift in substance use in the Greater Accra region from orthodox marijuana abuse to include heroin, cocaine and other psychotropic substances such as valium. The findings of this present study largely corroborate this claim. According to the principle of the test method, heroin could be detected equally the same way as other opiates including morphine and codeine. THC is the principal active component in marijuana and valium (diazepam) is an example of benzodiazepine (tranquilizer). In their national epidemiological study of drug abuse among Ghanaian youth aged between 12 and 24 years, Nortey and Senah (1990) held that the rates of use of marijuana, valium and librium were substantially significant to require policy intervention. The authors believed that although the rate of cocaine use was low, it further strengthened their recommendation for key decisions and actions to be taken. The survey did not quantify the rates of marijuana, valium and librium (chlordiazepoxide) use. However, the qualitative descriptions given were indicative of higher proportions of marijuana and benzodiazepine (i.e. valium and librium) use as compared to 62 University of Ghana http://ugspace.ug.edu.gh cocaine. The findings of this present study support the authors claim that more people used marijuana and benzodiazepines than cocaine and opiates. In a survey conducted in December, 1970 among 52 pharmacology students with ages ranging between 23 years and 27 years at the University of Ghana Medical School, Akyea-Ofori and Lewis (1972) concluded that amphetamine use was more prevalent among the participants. In what appeared to be the most extensive study in Ghana on substance use among second cycle and out-of-school youth, the Ministry of Health/World Health Organisation (MOH/WHO, 2003) had it that only 4 (0.2%) of the respondents admitted to previous use of amphetamines. Contrary to these claims, the present study did not find a single record of a positive amphetamine result over the five year review. Also in the study by Akyea-Ofori and Lewis (1972), and in variance to the findings of this study, none of the respondents had ever tasted cocaine or any opiate before. In their research, the Ministry of Health/World Health Organisation (MOH/WHO, 2003) reported that alcohol and tobacco were among other substances such as cannabis (marijuana), tranquilizers (example valium), cocaine and heroin which were most commonly abused by the youth. According to the survey reports, 8.7 % of the respondents admitted to have used tobacco in the past whereas 25.3% of the respondents self-confessed previous use of alcohol. It was further observed that the home or school could provide convenient environments that facilitated access to these drugs. However, the diagnostic method that was employed in the present study did not include provisions for the detection of alcohol and tobacco. It is also worth mentioning that in the case of BZD, it was possible that the sheer high positive numbers could have confounding elements of prescribed medical usage (e.g. diazepam) which 63 University of Ghana http://ugspace.ug.edu.gh required segregation from non-prescribed use or abuse. However, there were no readily available data to tell the two apart. 4.8 Age and gender characteristics with respect to drug use This objective was set out to investigate age and gender distributions as probable predictors of substance use. It was to examine whether or not there were significant differences in rates of substance use across gender and age among the people who were screened. There were no statistically significant differences across gender with respect to COC, OPI and BZD use over the years. Thus, the patterns of COC, OPI and BZD use among males and females were similar. However, there were statistically significant differences (p<0.05) observed across gender with respect to THC use during 2012 and 2016. Thus, there were significantly higher proportions of males than females who used THC in 2012 and 2016. The male-female sex characteristics observed over the study period were consistent with the findings of previous studies (Swendsen et al, 2012; Degenhardt et al, 2008; and Degenhardt et al, 2007). From this study and in concordance with other studies, males have greater likelihood than females towards drug use. However, it was observed as it was also reported by Degenhardt et al (2008) that though variations existed with regards to drug use and gender distribution, the seemingly traditional gap between males and females was closing up in recent times. With reference to age distributions, the study did not reveal statistically significant differences among age groupings. However, there were clear and important age-specific modifications observed over the period. Whereas THC and BZD use was confirmed among adolescents aged 14 and below and adults (aged 70 and above) who were above the compulsory retirement age in 64 University of Ghana http://ugspace.ug.edu.gh Ghana (60 years), there were a few significant others who deferred the initiation of COC and OPI use to age 18 through to 55 years. What was significant about the age of COC and OPI users or abusers was that such time of life bracket (18-55 years) constituted a critical stage of an individual’s development during which people could be actively engaged in productive work. 4.9 Prevalence of substance use over the study period The annual prevalence rates for OPI use suggested consistent decline from 2012 through to 2016. These were similar to declining global trends that reached stable rates in recent years (World Drug Report, 2015; World Drug Report, 2016; World Drug Report, 2017). In recent times there is emerging trend of rising number of people going into treatment as a result of opiate use disorders (World Drug Report, 2017) in some African countries including Nigeria, Mozambique, South Africa and Tanzania. In Ireland for example, annual prevalence rate of opiate use dropped from 7.2/10000 population to 6.18/10000 population (National Advisory Committee on Drugs and Alcohol (NACDA), 2018). Although results of the present study revealed decreasing rates, it is important that access to and non–medical use of opiates is checked in view of their dreaded effects. The pattern was similar with COC use except for a marginal rise from1.1% in 2014 to 1.3% in 2015. Similar to the study by Wallace et al (2002), the prevalence rates for COC were relatively low in this study. Contrary to the minimal variations observed in this study, the patterns recorded by Wallace et al (2002) varied greatly over the period. In the case of THC there were significant decline in annual prevalence rates from 2012 through to 2015. However, the annual prevalence of THC jumped to 28.6% in 2016 from a low of 18.2% 65 University of Ghana http://ugspace.ug.edu.gh in 2015. This was consistent with the findings by Wallace et al (2002) among United States school seniors studied between 1976 and 2000. Wallace et al (2002) concluded that there were high prevalence rates of marijuana (THC) use which had been rising since 1992 after observing consistent decline in the late 1970s and early 1990s. In Africa, THC remains the main cause of drug abuse related treatment (World Drug Report, 2017). The case of BZD use was largely characterized by checkered prevalence pattern; period prevalence was highest at 49.1% (i.e. the highest of all the period prevalence rates) in 2013 and this was followed with the lowest dip at 29.2% in 2014. However, in 2015 the prevalence rate had risen substantially to 44.2% with a further jump to 45.8% in 2016. It is significant to point out that the prevalence rates for use of THC and BZD, at any point in time, were all higher (i.e. more than 15%) than those of OPI and COC (i.e. less than 5%). It is as well worth mentioning that the high proportions of BZD use were most probably inclusive of medical (prescribed) usage which could not be teased out of non-medical usage for lack of readily available data. 66 University of Ghana http://ugspace.ug.edu.gh CHAPTER FIVE SUMMARY, CONCLUSION AND RECOMMENDATION 5.1Introduction This chapter summarizes the key findings of the study. Conclusions are then drawn based on the findings after which policy recommendations are suggested. 5.2 Summary of key findings The research findings did not confirm amphetamine or methamphetamine use over the period of review contrary to previously reported findings of their use. However, the findings confirmed the use of substances including tetrahydrocannabinol, cocaine, opiates and benzodiazepine. The pattern of substance use was more pronounced among males than their female counterparts. Again, drug use was significantly common among the youth over the years. 5.3 Conclusions of the Study This study employed the use of laboratory data to construct empirical evidence of substance use which represents a departure from earlier studies that relied on self-reported data. Although the study makes valuable contribution in describing the pattern of drug use in Ghana, it adopted a methodological approach of secondary data analysis of persons who submitted to drug test at a single health facility. Additional extensive epidemiological researches, including genetic epidemiological investigations and broad longitudinal studies that examine biological and sociological bases of drug addiction and trends of drug use are recommended to build broad knowledge that informs policy. 67 University of Ghana http://ugspace.ug.edu.gh 5.4 Policy Recommendations Currently, Ghana has a National Drug Policy that seeks to guide the pharmaceutical industry of the country. The overarching aim of the policy is to improve and sustain the health of the national population by ensuring the rational use and access to safe, effective, good quality and affordable pharmaceutical products (MOH, 2004). Ghana also has the Narcotic Drug Law of 1990, which appears to be predominantly on law enforcement and in some cases with severe custodial sentences. However, Ghana does not have a national policy on narcotic and psychoactive drugs. 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British Medical Journal, 325, 1199. 77 University of Ghana http://ugspace.ug.edu.gh Appendix A: raw data (coded) ID AGE SEX COC THC AMP OPI MET BZD 201201001 34 M NEG POS NEG NEG NEG POS 201201002 18 M NEG NEG NEG NEG NEG POS 201201003 31 M NEG POS NEG NEG NEG NEG 201201004 44 M NEG POS NEG NEG NEG POS 201201005 36 M NEG NEG NEG NEG NEG POS 201201006 36 M NEG POS NEG NEG NEG NEG 201201007 31 M NEG NEG NEG NEG NEG NEG 201201008 17 M NEG NEG NEG NEG NEG NEG 201201009 23 M NEG POS NEG NEG NEG POS 201201010 30 M NEG POS NEG NEG NEG POS 201201011 28 M NEG POS NEG NEG NEG NEG 201201012 16 M NEG POS NEG NEG NEG POS 201201013 27 M POS NEG NEG POS NEG POS 201201014 30 M NEG POS NEG NEG NEG POS 201201015 52 M NEG NEG NEG NEG NEG POS 201201016 30 M NEG POS NEG NEG NEG NEG 201201017 33 M NEG POS NEG NEG NEG NEG 201201018 49 M NEG NEG NEG NEG NEG NEG 201201019 26 M NEG NEG NEG NEG NEG NEG 201201020 43 M NEG POS NEG NEG NEG POS 201201021 43 M NEG POS NEG NEG NEG POS I University of Ghana http://ugspace.ug.edu.gh 201201022 26 M POS POS NEG POS NEG NEG 201201023 20 M NEG NEG NEG NEG NEG NEG 201201024 43 M NEG POS NEG NEG NEG POS 201201025 40 M NEG NEG NEG NEG NEG POS 201201026 25 M NEG POS NEG NEG NEG NEG 201201027 35 M NEG NEG NEG NEG NEG NEG 201202001 25 M POS NEG NEG POS NEG NEG 201202002 39 M NEG POS NEG NEG NEG NEG 201202003 29 M NEG NEG NEG NEG NEG NEG 201202004 32 M NEG POS NEG NEG NEG POS 201202005 42 M NEG POS NEG NEG NEG POS 201202006 28 M NEG NEG NEG NEG NEG POS 201202007 21 M NEG NEG NEG NEG NEG NEG 201202008 64 M NEG NEG NEG NEG NEG POS 201202009 32 M NEG NEG NEG NEG NEG NEG 201202010 22 M NEG NEG NEG NEG NEG NEG 201202011 28 M NEG NEG NEG NEG NEG NEG 201202012 31 M NEG NEG NEG NEG NEG POS 201202013 31 M NEG NEG NEG NEG NEG POS 201202014 30 M NEG NEG NEG NEG NEG POS 201202015 13 F NEG NEG NEG NEG NEG NEG 201202016 26 M NEG NEG NEG NEG NEG NEG 201202017 17 M NEG POS NEG NEG NEG POS II University of Ghana http://ugspace.ug.edu.gh 201202018 32 M NEG POS NEG POS NEG NEG 201202019 35 M NEG POS NEG NEG NEG NEG 201202020 31 M NEG NEG NEG NEG NEG NEG 201202021 22 M NEG POS NEG NEG NEG POS 201202022 25 M NEG POS NEG NEG NEG POS 201202023 30 M NEG POS NEG NEG NEG POS 201202024 40 M NEG NEG NEG NEG NEG NEG 201202025 23 M NEG POS NEG NEG NEG POS 201202026 30 M NEG NEG NEG NEG NEG POS 201202027 46 M NEG NEG NEG NEG NEG POS 201203001 26 M NEG NEG NEG NEG NEG NEG 201203002 45 M NEG NEG NEG NEG NEG NEG 201203003 28 M NEG POS NEG NEG NEG POS 201203004 28 M NEG NEG NEG NEG NEG POS 201203005 41 M NEG NEG NEG NEG NEG NEG 201203006 23 M NEG POS NEG NEG NEG POS 201203007 33 M NEG POS NEG NEG NEG POS 201203008 31 M NEG NEG NEG NEG NEG POS 201203009 26 M NEG POS NEG NEG NEG NEG 201203010 55 M NEG POS NEG P0S NEG POS 201203011 19 M NEG NEG NEG NEG NEG POS 201203012 42 M NEG POS NEG NEG NEG POS 201203013 32 M NEG POS NEG NEG NEG NEG III University of Ghana http://ugspace.ug.edu.gh 201203014 17 M NEG NEG NEG NEG NEG NEG 201203015 20 M NEG NEG NEG NEG NEG POS 201203016 35 M NEG NEG NEG NEG NEG NEG 201203017 40 F NEG NEG NEG NEG NEG NEG 201203018 32 M NEG NEG NEG NEG NEG POS 201203019 20 M NEG POS NEG NEG NEG NEG 201203020 31 M NEG NEG NEG NEG NEG NEG 201203021 27 M NEG POS NEG NEG NEG NEG 201203022 37 M NEG POS NEG NEG NEG NEG 201203023 38 M NEG POS NEG NEG NEG POS 201203024 30 M POS POS NEG POS NEG NEG 201203025 54 F NEG NEG NEG NEG NEG POS 201203026 42 M NEG POS NEG NEG NEG NEG 201203027 34 M NEG NEG NEG NEG NEG NEG 201203028 29 M NEG POS NEG NEG NEG POS 201203029 20 M NEG POS NEG NEG NEG POS 201204001 36 M NEG NEG NEG NEG NEG NEG 201204002 41 M NEG POS NEG NEG NEG POS 201204003 24 M NEG POS NEG NEG NEG POS 201204004 32 M NEG NEG NEG NEG NEG POS 201204005 59 M NEG NEG NEG NEG NEG NEG 201204006 30 M NEG NEG NEG NEG NEG NEG 201204007 26 M NEG NEG NEG NEG NEG NEG IV University of Ghana http://ugspace.ug.edu.gh 201204008 34 M NEG NEG NEG NEG NEG NEG 201204009 33 M NEG NEG NEG NEG NEG NEG 201204010 33 M NEG NEG NEG NEG NEG NEG 201205001 24 M NEG POS NEG NEG NEG NEG 201205002 59 M NEG POS NEG NEG NEG NEG 201205003 35 M NEG NEG NEG NEG NEG POS 201205004 28 M NEG POS NEG NEG NEG NEG 201205005 26 M NEG NEG NEG NEG NEG POS 201205006 39 M NEG NEG NEG NEG NEG NEG 201205007 25 M NEG POS NEG NEG NEG POS 201205008 24 M NEG NEG NEG NEG NEG NEG 201205009 34 M NEG NEG NEG NEG NEG NEG 201205010 27 M NEG POS NEG NEG NEG NEG 201205011 32 M NEG POS NEG NEG NEG NEG 201205012 31 M NEG NEG NEG NEG NEG NEG 201205013 30 M NEG POS NEG NEG NEG POS 201205014 38 F NEG NEG NEG NEG NEG POS 201205015 16 M NEG POS NEG NEG NEG POS 201205016 27 M NEG NEG NEG NEG NEG NEG 201205017 25 M NEG POS NEG NEG NEG NEG 201205018 27 M NEG NEG NEG NEG NEG NEG 201205019 26 M NEG NEG NEG NEG NEG NEG 201205020 31 M NEG NEG NEG NEG NEG POS V University of Ghana http://ugspace.ug.edu.gh 201205021 35 M NEG NEG NEG NEG NEG NEG 201205022 33 M NEG POS NEG NEG NEG NEG 201205023 40 M NEG POS NEG NEG NEG NEG 201205024 27 M NEG NEG NEG NEG NEG POS 201205025 27 M POS POS NEG NEG NEG NEG 201205026 45 M NEG NEG NEG NEG NEG NEG 201205027 33 F NEG NEG NEG NEG NEG POS 201206001 41 F NEG NEG NEG NEG NEG POS 201206002 21 F NEG POS NEG NEG NEG POS 201206003 32 M NEG NEG NEG NEG NEG POS 201206004 28 M NEG POS NEG NEG NEG POS 201206005 32 M POS POS NEG NEG NEG POS 201206006 33 M NEG POS NEG NEG NEG NEG 201206007 22 M NEG NEG NEG NEG NEG NEG 201206008 28 M NEG NEG NEG NEG NEG NEG 201206009 25 M NEG POS NEG NEG NEG POS 201206010 40 M NEG NEG NEG NEG NEG NEG 201206011 43 M NEG NEG NEG NEG NEG NEG 201206012 32 M NEG POS NEG NEG NEG NEG 201206013 30 M NEG POS NEG NEG NEG POS 201206014 24 M NEG POS NEG NEG NEG POS 201206015 35 M NEG POS NEG NEG NEG POS 201206016 44 M NEG NEG NEG NEG NEG POS VI University of Ghana http://ugspace.ug.edu.gh 201206017 26 M NEG NEG NEG NEG NEG POS 201206018 35 M NEG NEG NEG NEG NEG POS 201206019 33 M NEG NEG NEG NEG NEG POS 201206020 26 M NEG NEG NEG NEG NEG NEG 201206021 18 M NEG NEG NEG NEG NEG POS 201206022 29 M NEG NEG NEG NEG NEG POS 201206023 36 M NEG NEG NEG NEG NEG POS 201206024 43 M NEG POS NEG NEG NEG POS 201206025 35 M NEG NEG NEG NEG NEG NEG 201206026 18 M NEG NEG NEG NEG NEG NEG 201206027 25 M NEG POS NEG NEG NEG POS 201206028 20 M NEG NEG NEG NEG NEG NEG 201206029 36 M NEG NEG NEG NEG NEG POS 201206030 28 M NEG NEG NEG NEG NEG NEG 201207001 13 F NEG NEG NEG NEG NEG POS 201207002 23 M NEG NEG NEG NEG NEG NEG 201207003 35 M NEG NEG NEG NEG NEG NEG 201207004 29 M POS POS NEG NEG NEG NEG 201207005 41 M NEG NEG NEG NEG NEG POS 201207006 24 M NEG NEG NEG NEG NEG NEG 201207007 22 M NEG NEG NEG NEG NEG NEG 201207008 47 F NEG NEG NEG NEG NEG POS 201207009 30 M NEG POS NEG NEG NEG POS VII University of Ghana http://ugspace.ug.edu.gh 201207010 20 M NEG NEG NEG NEG NEG NEG 201207011 19 M NEG POS NEG NEG NEG POS 201207012 32 M NEG POS NEG NEG NEG POS 201207013 27 M NEG NEG NEG NEG NEG NEG 201207014 28 M NEG NEG NEG NEG NEG NEG 201207015 25 M NEG POS NEG NEG NEG POS 201207016 19 M NEG POS NEG POS NEG POS 201207017 35 M NEG NEG NEG NEG NEG POS 201207018 26 M NEG NEG NEG NEG NEG NEG 201207019 34 M NEG NEG NEG NEG NEG NEG 201207020 41 M NEG NEG NEG NEG NEG POS 201207021 23 M NEG POS NEG NEG NEG POS 201208001 29 M NEG NEG NEG NEG NEG POS 201208002 29 M NEG NEG NEG NEG NEG POS 201208003 40 M NEG POS NEG NEG NEG POS 201208004 33 M POS NEG NEG NEG NEG POS 201208005 31 M NEG NEG NEG NEG NEG POS 201208006 28 M NEG NEG NEG NEG NEG POS 201208007 47 M POS NEG NEG NEG NEG POS 201208008 37 M NEG NEG NEG NEG NEG NEG 201208009 25 M NEG NEG NEG NEG NEG NEG 201208010 30 M NEG POS NEG NEG NEG NEG 201208011 47 M NEG POS NEG NEG NEG POS VIII University of Ghana http://ugspace.ug.edu.gh 201208012 22 M NEG NEG NEG NEG NEG NEG 201208013 50 M NEG NEG NEG NEG NEG NEG 201208014 28 M POS POS NEG POS NEG POS 201208015 40 M NEG NEG NEG NEG NEG NEG 201208016 22 M NEG NEG NEG NEG NEG POS 201208017 34 M POS NEG NEG NEG NEG NEG 201209001 34 M POS POS NEG POS NEG NEG 201209002 35 M NEG POS NEG NEG NEG NEG 201209003 21 M NEG POS NEG NEG NEG NEG 201209004 25 M NEG NEG NEG NEG NEG NEG 201209005 34 M NEG NEG NEG NEG NEG POS 201209006 25 M NEG POS NEG NEG NEG POS 201209007 36 M NEG POS NEG NEG NEG NEG 201209008 36 M NEG NEG NEG NEG NEG NEG 201209009 22 M NEG POS NEG NEG NEG NEG 201209010 19 M NEG NEG NEG NEG NEG NEG 201209011 41 M NEG POS NEG POS NEG NEG 201209012 25 M NEG POS NEG NEG NEG POS 201209013 22 M NEG POS NEG NEG NEG NEG 201209014 14 F NEG NEG NEG NEG NEG NEG 201209015 23 M NEG NEG NEG NEG NEG NEG 201209016 30 F NEG NEG NEG NEG NEG NEG 201209017 26 M NEG NEG NEG NEG NEG NEG IX University of Ghana http://ugspace.ug.edu.gh 201209018 24 M NEG NEG NEG NEG NEG NEG 201209019 19 M NEG POS NEG NEG NEG NEG 201209020 20 M NEG POS NEG NEG NEG NEG 201209021 36 M NEG NEG NEG NEG NEG NEG 201210001 26 F NEG NEG NEG NEG NEG NEG 201210002 41 M NEG NEG NEG NEG NEG NEG 201210003 28 M NEG NEG NEG NEG NEG NEG 201210004 33 M NEG NEG NEG NEG NEG NEG 201210005 30 M NEG POS NEG NEG NEG NEG 201210006 27 M NEG POS NEG NEG NEG NEG 201210007 18 M NEG POS NEG NEG NEG POS 201210008 23 M NEG NEG NEG NEG NEG NEG 201210009 25 M NEG NEG NEG NEG NEG NEG 201210010 18 M NEG NEG NEG NEG NEG NEG 201210011 20 M NEG NEG NEG NEG NEG NEG 201210012 21 M NEG POS NEG NEG NEG NEG 201210013 27 M NEG NEG NEG NEG NEG POS 201210014 30 M NEG POS NEG NEG NEG POS 201210015 29 F NEG NEG NEG NEG NEG NEG 201211001 16 M NEG NEG NEG NEG NEG NEG 201211002 27 M NEG NEG NEG NEG NEG NEG 201211003 25 F NEG NEG NEG NEG NEG NEG 201211004 25 M NEG NEG NEG NEG NEG NEG X University of Ghana http://ugspace.ug.edu.gh 201211005 16 M NEG NEG NEG NEG NEG NEG 201211006 33 M NEG NEG NEG NEG NEG NEG 201211007 24 M NEG NEG NEG NEG NEG NEG 201211008 45 M NEG NEG NEG NEG NEG NEG 201211009 43 M NEG POS NEG NEG NEG NEG 201211010 20 M NEG POS NEG NEG NEG NEG 201211011 29 M NEG NEG NEG NEG NEG NEG 201212001 20 M NEG NEG NEG NEG NEG NEG 201212002 18 M NEG POS NEG NEG NEG NEG 201212003 33 M NEG NEG NEG NEG NEG NEG 201212004 18 M NEG NEG NEG NEG NEG NEG 201212005 24 M NEG POS NEG NEG NEG NEG 201212006 51 M NEG POS NEG NEG NEG NEG 201212007 43 M NEG NEG NEG NEG NEG POS 201212008 35 M NEG POS NEG NEG NEG NEG 201301001 18 M NEG NEG NEG NEG NEG NEG 201301002 19 M NEG POS NEG NEG NEG NEG 201301003 24 F NEG NEG NEG NEG NEG NEG 201301004 35 M NEG NEG NEG NEG NEG POS 201301005 31 M NEG POS NEG NEG NEG POS 201301006 36 M NEG NEG NEG NEG NEG NEG 201301007 25 M NEG POS NEG NEG NEG NEG 201301008 22 M NEG NEG NEG NEG NEG POS XI University of Ghana http://ugspace.ug.edu.gh 201301009 35 M NEG POS NEG NEG NEG NEG 201301010 23 M NEG NEG NEG NEG NEG POS 201301011 26 M NEG NEG NEG NEG NEG NEG 201301012 42 M NEG NEG NEG NEG NEG POS 201301013 41 M NEG NEG NEG NEG NEG POS 201301014 21 M NEG NEG NEG NEG NEG POS 201301015 37 M NEG NEG NEG NEG NEG NEG 201301016 20 M NEG POS NEG NEG NEG POS 201301017 26 F NEG POS NEG NEG NEG POS 201301018 35 M NEG NEG NEG NEG NEG NEG 201301019 26 F NEG NEG NEG NEG NEG POS 201301020 30 M NEG POS NEG NEG NEG NEG 201301021 26 M NEG NEG NEG NEG NEG NEG 201301022 33 M NEG NEG NEG NEG NEG POS 201301023 28 M NEG POS NEG NEG NEG POS 201301024 36 M NEG NEG NEG NEG NEG POS 201301025 30 M NEG POS NEG NEG NEG NEG 201301026 16 M NEG NEG NEG NEG NEG NEG 201301027 21 M NEG POS NEG NEG NEG POS 201301028 26 M NEG POS NEG NEG NEG NEG 201301029 19 M NEG POS NEG NEG NEG NEG 201301030 19 M NEG NEG NEG NEG NEG NEG 201301031 34 M NEG POS NEG NEG NEG POS XII University of Ghana http://ugspace.ug.edu.gh 201301032 23 F NEG NEG NEG NEG NEG NEG 201301033 30 M NEG NEG NEG NEG NEG NEG 201302001 18 M NEG NEG NEG NEG NEG NEG 201302002 19 M NEG POS NEG NEG NEG NEG 201302003 55 M NEG NEG NEG NEG NEG POS 201302004 53 M NEG NEG NEG NEG NEG POS 201302005 28 M NEG POS NEG NEG NEG POS 201302006 19 M NEG NEG NEG NEG NEG POS 201302007 54 M NEG NEG NEG NEG NEG NEG 201302008 28 M NEG POS NEG NEG NEG NEG 201302009 32 M NEG POS NEG NEG NEG POS 201302010 31 M NEG NEG NEG NEG NEG NEG 201302011 19 F NEG NEG NEG NEG NEG POS 201302012 25 F NEG NEG NEG NEG NEG POS 201302013 50 M POS POS NEG POS NEG POS 201302014 26 M NEG POS NEG NEG NEG NEG 201302015 18 M NEG POS NEG NEG NEG NEG 201302016 35 M NEG NEG NEG NEG NEG POS 201302017 22 M NEG POS NEG NEG NEG POS 201302018 15 M NEG NEG NEG NEG NEG NEG 201302019 34 M NEG POS NEG NEG NEG POS 201302020 33 M NEG NEG NEG NEG NEG NEG 201302021 27 M NEG NEG NEG NEG NEG NEG XIII University of Ghana http://ugspace.ug.edu.gh 201302022 16 M NEG NEG NEG NEG NEG NEG 201302023 24 M NEG POS NEG NEG NEG POS 201302024 16 F NEG NEG NEG NEG NEG NEG 201302025 41 M NEG POS NEG NEG NEG POS 201302026 27 M NEG POS NEG NEG NEG NEG 201302027 21 M NEG POS NEG NEG NEG POS 201302028 14 M NEG NEG NEG NEG NEG NEG 201302029 32 M POS POS NEG POS NEG NEG 201302030 29 M NEG NEG NEG NEG NEG POS 201302031 39 M NEG POS NEG NEG NEG POS 201302032 32 M NEG NEG NEG NEG NEG POS 201302033 23 M NEG NEG NEG NEG NEG POS 201302034 16 F NEG NEG NEG NEG NEG NEG 201302035 32 M NEG NEG NEG NEG NEG NEG 201303001 18 M NEG NEG NEG NEG NEG NEG 201303002 35 M NEG POS NEG NEG NEG POS 201303003 39 M NEG NEG NEG NEG NEG POS 201303004 42 M NEG NEG NEG NEG NEG NEG 201303005 24 M NEG POS NEG NEG NEG NEG 201303006 25 M NEG NEG NEG NEG NEG POS 201303007 35 M NEG NEG NEG NEG NEG NEG 201303008 30 M NEG POS NEG NEG NEG POS 201303009 32 M NEG NEG NEG NEG NEG POS XIV University of Ghana http://ugspace.ug.edu.gh 201303010 22 M NEG POS NEG NEG NEG POS 201303011 31 M NEG POS NEG NEG NEG NEG 201303012 31 M POS NEG NEG NEG NEG NEG 201303013 36 F NEG POS NEG NEG NEG POS 201303014 24 M NEG NEG NEG NEG NEG NEG 201303015 36 M NEG NEG NEG NEG NEG NEG 201303016 35 M NEG NEG NEG NEG NEG POS 201303017 20 M NEG POS NEG NEG NEG NEG 201304001 27 M NEG NEG NEG NEG NEG POS 201304002 42 M NEG NEG NEG NEG NEG POS 201304003 26 M NEG NEG NEG NEG NEG NEG 201304004 19 M NEG NEG NEG NEG NEG POS 201304005 51 M NEG NEG NEG NEG NEG POS 201304006 27 M NEG NEG NEG NEG NEG POS 201304007 19 M NEG NEG NEG NEG NEG NEG 201304008 25 M NEG POS NEG NEG NEG NEG 201304009 45 M NEG NEG NEG NEG NEG POS 201304010 32 M NEG NEG NEG NEG NEG POS 201304011 26 M NEG POS NEG NEG NEG NEG 201304012 25 M NEG NEG NEG NEG NEG POS 201304013 45 M NEG POS NEG NEG NEG NEG 201304014 27 M NEG NEG NEG NEG NEG POS 201304015 18 M NEG POS NEG NEG NEG POS XV University of Ghana http://ugspace.ug.edu.gh 201304016 51 M NEG NEG NEG NEG NEG NEG 201304017 34 M NEG NEG NEG NEG NEG NEG 201304018 26 M NEG POS NEG NEG NEG NEG 201304019 27 M NEG NEG NEG NEG NEG NEG 201304020 33 M NEG NEG NEG NEG NEG NEG 201304021 48 M NEG NEG NEG NEG NEG POS 201304022 23 M NEG POS NEG NEG NEG POS 201304023 50 M NEG NEG NEG NEG NEG POS 201304024 24 M NEG POS NEG NEG NEG POS 201304025 26 M NEG POS NEG NEG NEG POS 201304026 22 M NEG POS NEG NEG NEG NEG 201304027 24 M NEG POS NEG NEG NEG POS 201304028 30 M NEG NEG NEG NEG NEG POS 201304029 20 M NEG POS NEG NEG NEG NEG 201304030 30 M POS NEG NEG NEG NEG POS 201304031 25 M NEG POS NEG NEG NEG POS 201305001 25 M NEG NEG NEG NEG NEG POS 201305002 57 M NEG POS NEG NEG NEG POS 201305003 29 M NEG NEG NEG NEG NEG POS 201305004 32 M NEG NEG NEG NEG NEG NEG 201305005 21 M NEG NEG NEG NEG NEG POS 201305006 17 M NEG NEG NEG NEG NEG NEG 201305007 26 M NEG NEG NEG NEG NEG POS XVI University of Ghana http://ugspace.ug.edu.gh 201305008 20 M NEG NEG NEG NEG NEG NEG 201305009 49 M NEG NEG NEG NEG NEG POS 201305010 26 M NEG NEG NEG NEG NEG POS 201305011 26 M NEG NEG NEG NEG NEG POS 201305012 30 M NEG NEG NEG NEG NEG POS 201305013 24 M NEG NEG NEG NEG NEG POS 201305014 32 M NEG NEG NEG NEG NEG NEG 201305015 30 F NEG NEG NEG NEG NEG NEG 201305016 33 M NEG POS NEG NEG NEG NEG 201305017 26 M NEG POS NEG NEG NEG POS 201305018 35 M NEG NEG NEG NEG NEG POS 201305019 26 M NEG NEG NEG NEG NEG NEG 201305020 19 M NEG NEG NEG NEG NEG POS 201305021 26 M NEG NEG NEG NEG NEG POS 201305022 55 M NEG NEG NEG NEG NEG POS 201305023 30 M NEG POS NEG NEG NEG POS 201306001 33 M NEG NEG NEG NEG NEG NEG 201306002 27 M NEG NEG NEG NEG NEG POS 201306003 32 M NEG NEG NEG NEG NEG NEG 201306004 34 M POS POS NEG POS NEG POS 201306005 25 M NEG POS NEG NEG NEG NEG 201306006 52 M NEG NEG NEG NEG NEG POS 201306007 26 M NEG NEG NEG NEG NEG NEG XVII University of Ghana http://ugspace.ug.edu.gh 201306008 27 M NEG NEG NEG NEG NEG POS 201306009 25 M NEG POS NEG NEG NEG POS 201306010 31 M NEG NEG NEG NEG NEG POS 201306011 39 M NEG NEG NEG NEG NEG POS 201306012 23 F NEG POS NEG NEG NEG NEG 201306013 26 M NEG POS NEG NEG NEG POS 201306014 33 F NEG NEG NEG NEG NEG NEG 201306015 42 M NEG POS NEG NEG NEG NEG 201306016 51 M NEG POS NEG NEG NEG POS 201306017 36 M NEG POS NEG NEG NEG NEG 201306018 35 F NEG POS NEG NEG NEG NEG 201306019 42 F NEG NEG NEG NEG NEG POS 201306020 15 M NEG NEG NEG NEG NEG POS 201306021 54 M NEG POS NEG NEG NEG NEG 201306022 26 M NEG POS NEG NEG NEG NEG 201306023 25 M NEG POS NEG NEG NEG POS 201306024 36 M NEG NEG NEG NEG NEG NEG 201306025 42 M NEG POS NEG NEG NEG NEG 201307001 17 M NEG NEG NEG NEG NEG POS 201307002 31 M NEG NEG NEG NEG NEG NEG 201307003 27 M NEG NEG NEG NEG NEG NEG 201307004 31 M NEG NEG NEG NEG NEG NEG 201307005 21 M NEG POS NEG NEG NEG POS XVIII University of Ghana http://ugspace.ug.edu.gh 201307006 37 F NEG NEG NEG NEG NEG NEG 201307007 44 M NEG NEG NEG NEG NEG NEG 201307008 26 M NEG NEG NEG NEG NEG POS 201307009 35 M NEG NEG NEG NEG NEG POS 201307010 47 M NEG NEG NEG NEG NEG NEG 201307011 15 M NEG NEG NEG NEG NEG NEG 201307012 20 M NEG NEG NEG NEG NEG NEG 201307013 32 M NEG POS NEG NEG NEG NEG 201307014 25 M NEG POS NEG NEG NEG POS 201307015 32 M NEG POS NEG NEG NEG POS 201307016 20 M NEG POS NEG POS NEG POS 201307017 35 F NEG NEG NEG NEG NEG NEG 201307018 24 M NEG NEG NEG NEG NEG POS 201307019 29 M NEG NEG NEG NEG NEG NEG 201307020 20 M NEG POS NEG NEG NEG POS 201307021 34 M NEG POS NEG NEG NEG NEG 201307022 17 F NEG NEG NEG NEG NEG POS 201308001 36 M NEG NEG NEG NEG NEG POS 201308002 33 M NEG POS NEG NEG NEG POS 201308003 21 M NEG NEG NEG NEG NEG POS 201308004 16 M NEG POS NEG NEG NEG NEG 201308005 17 F NEG NEG NEG NEG NEG POS 201308006 40 M NEG NEG NEG NEG NEG POS XIX University of Ghana http://ugspace.ug.edu.gh 201308007 30 M POS NEG NEG NEG NEG POS 201308008 35 M NEG NEG NEG NEG NEG POS 201308009 24 M NEG NEG NEG NEG NEG POS 201308010 30 M NEG POS NEG NEG NEG POS 201308011 29 M NEG NEG NEG NEG NEG NEG 201308012 37 M NEG POS NEG NEG NEG NEG 201308013 23 M NEG NEG NEG NEG NEG POS 201308014 28 M NEG NEG NEG NEG NEG NEG 201308015 26 M NEG NEG NEG NEG NEG NEG 201308016 48 M NEG NEG NEG NEG NEG NEG 201308017 29 M NEG POS NEG NEG NEG POS 201308018 31 M NEG POS NEG NEG NEG POS 201309001 46 M NEG NEG NEG NEG NEG NEG 201309002 24 M NEG POS NEG NEG NEG POS 201309003 27 M NEG NEG NEG NEG NEG NEG 201309004 47 M NEG NEG NEG NEG NEG POS 201309005 24 M NEG NEG NEG NEG NEG POS 201309006 30 M NEG NEG NEG NEG NEG NEG 201309007 25 M NEG NEG NEG NEG NEG NEG 201309008 33 M NEG NEG NEG NEG NEG NEG 201309009 31 M NEG NEG NEG NEG NEG NEG 201309010 27 M NEG NEG NEG NEG NEG NEG 201309011 17 M NEG NEG NEG NEG NEG NEG XX University of Ghana http://ugspace.ug.edu.gh 201309012 19 M NEG NEG NEG NEG NEG NEG 201309013 31 M NEG POS NEG NEG NEG NEG 201309014 62 M NEG NEG NEG NEG NEG POS 201310001 19 M NEG NEG NEG NEG NEG NEG 201310002 19 M NEG NEG NEG NEG NEG POS 201310003 34 M NEG NEG NEG NEG NEG NEG 201310004 27 M NEG NEG NEG NEG NEG NEG 201310005 19 M NEG NEG NEG NEG NEG NEG 201310006 25 M NEG POS NEG POS NEG NEG 201310007 42 M POS NEG NEG POS NEG NEG 201310008 22 M NEG NEG NEG NEG NEG NEG 201310009 15 M NEG NEG NEG NEG NEG POS 201310010 26 M NEG POS NEG NEG NEG POS 201310011 23 M NEG POS NEG NEG NEG POS 201310012 35 M NEG POS NEG NEG NEG NEG 201310013 22 M NEG NEG NEG NEG NEG NEG 201310014 27 M NEG NEG NEG NEG NEG POS 201310015 22 M NEG POS NEG NEG NEG POS 201310016 26 M NEG NEG NEG NEG NEG POS 201310017 22 M NEG POS NEG NEG NEG POS 201310018 30 M NEG NEG NEG NEG NEG POS 201310019 28 M NEG NEG NEG NEG NEG POS 201310020 20 M NEG NEG NEG NEG NEG NEG XXI University of Ghana http://ugspace.ug.edu.gh 201311001 35 M NEG NEG NEG NEG NEG NEG 201311002 25 M NEG POS NEG NEG NEG NEG 201311003 41 M NEG NEG NEG NEG NEG POS 201311004 43 M NEG POS NEG NEG NEG NEG 201311005 34 M POS POS NEG POS NEG NEG 201311006 32 M NEG POS NEG NEG NEG POS 201311007 18 M NEG NEG NEG NEG NEG NEG 201311008 32 M NEG NEG NEG NEG NEG NEG 201311009 19 F NEG POS NEG NEG NEG POS 201311010 24 M NEG NEG NEG NEG NEG NEG 201311011 17 M NEG POS NEG NEG NEG NEG 201311012 26 M NEG POS NEG NEG NEG NEG 201311013 32 M NEG POS NEG NEG NEG POS 201311014 33 M NEG POS NEG NEG NEG NEG 201311015 36 M NEG NEG NEG NEG NEG NEG 201311016 16 M NEG NEG NEG NEG NEG NEG 201311017 21 M NEG NEG NEG NEG NEG NEG 201311018 30 M NEG NEG NEG NEG NEG NEG 201311019 25 M NEG POS NEG NEG NEG POS 201311020 22 M NEG NEG NEG NEG NEG POS 201311021 27 M NEG NEG NEG NEG NEG NEG 201311022 32 M NEG NEG NEG NEG NEG NEG 201311023 17 M NEG NEG NEG NEG NEG NEG XXII University of Ghana http://ugspace.ug.edu.gh 201311024 38 M NEG NEG NEG NEG NEG POS 201311025 27 M NEG NEG NEG NEG NEG NEG 201312001 21 M NEG POS NEG NEG NEG NEG 201312002 17 M NEG NEG NEG NEG NEG NEG 201312003 20 M NEG NEG NEG NEG NEG NEG 201312004 33 M NEG NEG NEG NEG NEG NEG 201312005 24 M NEG NEG NEG NEG NEG NEG 201312006 24 M NEG POS NEG NEG NEG POS 201312007 51 M NEG POS NEG NEG NEG POS 201312008 27 M NEG POS NEG NEG NEG POS 201312009 29 M NEG POS NEG NEG NEG NEG 201312010 48 M NEG NEG NEG NEG NEG NEG 201312011 22 M NEG POS NEG NEG NEG POS 201312012 25 M NEG NEG NEG NEG NEG POS 201312013 22 M NEG POS NEG NEG NEG NEG 201312014 32 M POS POS NEG NEG NEG NEG 201312015 26 M NEG NEG NEG NEG NEG NEG 201312016 43 M NEG NEG NEG NEG NEG NEG 201312017 22 M NEG POS NEG NEG NEG NEG 201312018 56 M NEG NEG NEG NEG NEG NEG 201312019 26 M NEG POS NEG NEG NEG NEG 201312020 39 M NEG POS NEG NEG NEG POS 201312022 20 F NEG NEG NEG NEG NEG POS XXIII University of Ghana http://ugspace.ug.edu.gh 201312023 21 M NEG NEG NEG NEG NEG POS 201312024 20 M NEG POS NEG NEG NEG POS 201312025 17 M NEG NEG NEG NEG NEG NEG 201312026 27 M NEG POS NEG NEG NEG POS 201312027 26 M NEG NEG NEG NEG NEG POS 201401001 21 M NEG NEG NEG NEG NEG POS 201401002 21 M NEG NEG NEG NEG NEG POS 201401003 30 M NEG POS NEG NEG NEG POS 201401004 30 M NEG NEG NEG NEG NEG NEG 201401005 27 M NEG NEG NEG NEG NEG NEG 201401006 20 F NEG NEG NEG NEG NEG POS 201401007 19 M NEG NEG NEG NEG NEG NEG 201401008 22 M NEG NEG NEG NEG NEG POS 201401009 24 M NEG NEG NEG NEG NEG NEG 201401010 17 M NEG POS NEG NEG NEG POS 201401011 20 M NEG NEG NEG NEG NEG POS 201401012 17 F NEG NEG NEG NEG NEG NEG 201402001 38 M NEG NEG NEG NEG NEG NEG 201402002 16 M NEG NEG NEG NEG NEG NEG 201402003 25 M NEG NEG NEG NEG NEG NEG 201402004 25 F NEG NEG NEG NEG NEG POS 201402005 28 F NEG NEG NEG NEG NEG POS 201402006 26 M NEG NEG NEG NEG NEG POS XXIV University of Ghana http://ugspace.ug.edu.gh 201402007 21 M NEG NEG NEG NEG NEG NEG 201402008 21 M NEG NEG NEG NEG NEG NEG 201402009 28 M NEG NEG NEG NEG NEG POS 201402010 21 M NEG POS NEG NEG NEG NEG 201402011 42 M NEG NEG NEG NEG NEG NEG 201402012 36 M NEG POS NEG NEG NEG NEG 201402013 22 M NEG NEG NEG NEG NEG NEG 201402014 24 M NEG NEG NEG NEG NEG POS 201402015 18 M NEG NEG NEG NEG NEG POS 201402016 53 M NEG POS NEG NEG NEG NEG 201403001 27 M NEG NEG NEG NEG NEG POS 201403002 27 M NEG NEG NEG NEG NEG NEG 201403003 23 M NEG POS NEG NEG NEG NEG 201403004 28 M NEG NEG NEG NEG NEG POS 201403005 18 F NEG NEG NEG NEG NEG NEG 201403006 26 M NEG NEG NEG NEG NEG POS 201403007 17 M NEG NEG NEG NEG NEG NEG 201403008 22 M NEG NEG NEG NEG NEG POS 201403009 31 M NEG NEG NEG NEG NEG NEG 201403010 31 M NEG NEG NEG NEG NEG POS 201403011 24 M NEG NEG NEG NEG NEG NEG 201403012 24 M NEG POS NEG NEG NEG NEG 201403013 28 M NEG NEG NEG NEG NEG NEG XXV University of Ghana http://ugspace.ug.edu.gh 201403014 24 M NEG NEG NEG NEG NEG NEG 201403015 16 M NEG NEG NEG NEG NEG NEG 201403016 30 M NEG NEG NEG NEG NEG NEG 201403017 20 M NEG NEG NEG NEG NEG NEG 201403018 20 M NEG POS NEG NEG NEG POS 201403019 29 M NEG NEG NEG NEG NEG NEG 2014040001 22 M NEG POS NEG NEG NEG NEG 201404002 34 M NEG POS NEG NEG NEG POS 201404003 42 M NEG NEG NEG NEG NEG NEG 201404004 16 M NEG POS NEG NEG NEG NEG 201404005 17 M NEG NEG NEG NEG NEG POS 201404006 25 M NEG NEG NEG NEG NEG NEG 201404007 31 M NEG POS NEG NEG NEG POS 201404008 23 M NEG POS NEG NEG NEG POS 201404009 42 M NEG NEG NEG NEG NEG NEG 201404010 26 M NEG NEG NEG NEG NEG NEG 201404011 39 M NEG POS NEG NEG NEG NEG 201404012 34 M NEG NEG NEG NEG NEG POS 201404013 30 M NEG NEG NEG NEG NEG NEG 201404014 45 M NEG POS NEG NEG NEG NEG 201405001 31 M NEG NEG NEG NEG NEG POS 201405002 24 M NEG NEG NEG NEG NEG POS 201405003 21 M NEG NEG NEG NEG NEG NEG XXVI University of Ghana http://ugspace.ug.edu.gh 201405004 31 M NEG NEG NEG NEG NEG POS 201405005 36 F NEG NEG NEG NEG NEG POS 201405006 22 M NEG NEG NEG NEG NEG NEG 201405007 17 M NEG NEG NEG NEG NEG POS 201405008 26 M NEG NEG NEG NEG NEG NEG 201405009 28 M NEG NEG NEG NEG NEG POS 201405010 38 M NEG NEG NEG NEG NEG NEG 201405011 19 M NEG POS NEG NEG NEG NEG 201405012 25 M NEG NEG NEG NEG NEG NEG 201405013 14 M NEG NEG NEG NEG NEG NEG 201405014 25 M NEG NEG NEG POS NEG NEG 201406001 23 M NEG NEG NEG NEG NEG NEG 201406002 18 M NEG NEG NEG NEG NEG NEG 201406003 20 F NEG NEG NEG NEG NEG NEG 201406004 20 M NEG NEG NEG NEG NEG NEG 201406005 14 M NEG NEG NEG NEG NEG NEG 201406006 41 M NEG NEG NEG NEG NEG NEG 201406007 25 M NEG POS NEG NEG NEG NEG 201406008 25 M NEG NEG NEG NEG NEG NEG 201406009 23 M NEG NEG NEG NEG NEG NEG 201406010 23 M NEG NEG NEG NEG NEG NEG 201406011 33 M NEG NEG NEG NEG NEG NEG 201406012 26 M NEG NEG NEG NEG NEG NEG XXVII University of Ghana http://ugspace.ug.edu.gh 201406013 33 F NEG NEG NEG NEG NEG NEG 201406014 18 M NEG NEG NEG NEG NEG NEG 201406015 22 M NEG NEG NEG NEG NEG NEG 201406016 15 M NEG NEG NEG NEG NEG NEG 201406017 18 M NEG NEG NEG NEG NEG NEG 201406018 22 M NEG NEG NEG NEG NEG NEG 201406019 39 M NEG NEG NEG NEG NEG NEG 201406020 16 F NEG NEG NEG NEG NEG NEG 201406021 40 M NEG POS NEG NEG NEG NEG 201406022 22 M NEG NEG NEG NEG NEG NEG 201406023 26 M NEG NEG NEG NEG NEG NEG 201406024 25 M NEG NEG NEG NEG NEG NEG 201407001 33 M NEG NEG NEG NEG NEG NEG 201407002 45 M NEG NEG NEG NEG NEG NEG 201407003 38 M NEG POS NEG NEG NEG NEG 201407004 26 M NEG NEG NEG NEG NEG NEG 201407005 15 F NEG NEG NEG NEG NEG NEG 201407006 40 M NEG POS NEG NEG NEG NEG 201407007 23 M NEG POS NEG NEG NEG NEG 201407008 32 M NEG POS NEG NEG NEG NEG 201407009 22 F NEG NEG NEG NEG NEG NEG 201407010 35 M NEG NEG NEG NEG NEG NEG 201407011 21 M NEG NEG NEG NEG NEG NEG XXVIII University of Ghana http://ugspace.ug.edu.gh 201408001 22 M NEG NEG NEG NEG NEG NEG 201408002 16 M NEG NEG NEG NEG NEG NEG 201408003 30 M POS POS NEG POS NEG NEG 201408004 44 F NEG NEG NEG NEG NEG POS 201408005 23 M NEG NEG NEG NEG NEG NEG 201408006 32 M NEG NEG NEG NEG NEG NEG 201408007 30 M NEG NEG NEG NEG NEG NEG 201408008 30 M NEG NEG NEG NEG NEG NEG 201408009 20 F NEG NEG NEG NEG NEG NEG 201408010 24 M NEG NEG NEG NEG NEG NEG 201408011 22 M NEG POS NEG NEG NEG POS 201408012 30 M NEG NEG NEG NEG NEG NEG 201408013 29 F NEG NEG NEG NEG NEG POS 201408014 36 F NEG NEG NEG NEG NEG NEG 201408015 22 M NEG NEG NEG NEG NEG NEG 201408016 21 F NEG POS NEG NEG NEG POS 201408017 26 M NEG NEG NEG NEG NEG NEG 201408018 22 M NEG NEG NEG NEG NEG NEG 201408019 37 M NEG NEG NEG NEG NEG POS 201408020 24 M NEG NEG NEG NEG NEG NEG 201408021 34 M NEG NEG NEG NEG NEG POS 201408022 24 M NEG NEG NEG NEG NEG POS 201408023 19 M NEG POS NEG POS NEG POS XXIX University of Ghana http://ugspace.ug.edu.gh 201408024 26 M NEG NEG NEG NEG NEG NEG 201408025 24 M NEG NEG NEG NEG NEG NEG 201408026 30 M NEG POS NEG NEG NEG POS 201408027 34 M NEG NEG NEG NEG NEG NEG 201408028 43 M NEG POS NEG NEG NEG POS 201408029 20 M NEG NEG NEG NEG NEG NEG 201408030 28 M NEG NEG NEG NEG NEG POS 201409001 29 M NEG NEG NEG NEG NEG NEG 201409002 25 M POS POS NEG POS NEG NEG 201409003 15 M NEG NEG NEG NEG NEG NEG 201409004 37 M NEG NEG NEG NEG NEG POS 2014090005 35 F NEG POS NEG NEG NEG NEG 201409006 23 M NEG POS NEG NEG NEG NEG 201409007 22 M NEG NEG NEG NEG NEG NEG 201409008 22 M NEG POS NEG NEG NEG POS 201409009 51 M NEG NEG NEG NEG NEG POS 201409010 22 M NEG POS NEG NEG NEG POS 201409011 22 M NEG NEG NEG NEG NEG POS 201409012 27 M NEG POS NEG NEG NEG NEG 201410001 26 M NEG NEG NEG NEG NEG NEG 201410002 30 M NEG POS NEG NEG NEG NEG 201410003 48 M NEG NEG NEG NEG NEG NEG 201410004 21 M NEG POS NEG NEG NEG NEG XXX University of Ghana http://ugspace.ug.edu.gh 201410005 23 M NEG NEG NEG NEG NEG NEG 201410006 26 M NEG NEG NEG NEG NEG NEG 201410007 22 M NEG NEG NEG NEG NEG NEG 201410008 30 M NEG NEG NEG NEG NEG NEG 201410009 20 M NEG NEG NEG NEG NEG NEG 201410010 25 F NEG NEG NEG NEG NEG NEG 201410011 29 M NEG NEG NEG NEG NEG NEG 201410012 27 M NEG NEG NEG NEG NEG NEG 201410013 36 M NEG NEG NEG NEG NEG NEG 201410014 16 F NEG NEG NEG NEG NEG NEG 201411001 22 M NEG NEG NEG NEG NEG NEG 201411002 28 M NEG NEG NEG NEG NEG NEG 201411003 22 F NEG NEG NEG NEG NEG NEG 201411004 38 M NEG NEG NEG NEG NEG NEG 201411005 30 F NEG NEG NEG NEG NEG NEG 201411006 42 M NEG NEG NEG NEG NEG POS 201411007 28 F NEG NEG NEG NEG NEG POS 201411008 36 M NEG NEG NEG NEG NEG NEG 201412001 41 M NEG NEG NEG NEG NEG NEG 201412002 26 F NEG NEG NEG NEG NEG POS 201412003 26 M NEG POS NEG NEG NEG POS 201412004 25 M NEG NEG NEG NEG NEG NEG 201412005 43 M NEG NEG NEG NEG NEG POS XXXI University of Ghana http://ugspace.ug.edu.gh 201412006 29 F NEG POS NEG NEG NEG POS 201412007 25 M NEG POS NEG NEG NEG NEG 201412008 26 F NEG NEG NEG NEG NEG POS 201412009 19 M NEG NEG NEG NEG NEG NEG 201412010 18 M NEG NEG NEG NEG NEG POS 201412011 35 M NEG NEG NEG NEG NEG NEG 201501001 19 M NEG NEG NEG NEG NEG NEG 201501002 35 M NEG NEG NEG NEG NEG NEG 201501003 37 M NEG NEG NEG NEG NEG NEG 201501004 33 M NEG NEG NEG NEG NEG POS 201501005 25 M NEG NEG NEG NEG NEG POS 201501006 31 M NEG NEG NEG NEG NEG NEG 201501007 29 M NEG NEG NEG NEG NEG POS 201501008 30 M NEG POS NEG NEG NEG POS 201501009 28 M NEG NEG NEG NEG NEG POS 201501010 24 M NEG NEG NEG NEG NEG NEG 201501011 18 M NEG NEG NEG NEG NEG NEG 201501012 16 M NEG NEG NEG NEG NEG NEG 201501013 30 M NEG NEG NEG NEG NEG POS 201501014 30 M NEG NEG NEG NEG NEG POS 201501015 19 M NEG NEG NEG NEG NEG NEG 201501016 70 M NEG POS NEG NEG NEG NEG 201501017 20 M NEG POS NEG NEG NEG POS XXXII University of Ghana http://ugspace.ug.edu.gh 201501018 40 M NEG NEG NEG NEG NEG NEG 201501019 18 M NEG NEG NEG NEG NEG POS 201501020 43 M NEG NEG NEG NEG NEG POS 201501021 18 F NEG NEG NEG NEG NEG NEG 201501022 57 F NEG NEG NEG NEG NEG POS 201501023 24 F NEG NEG NEG NEG NEG POS 201502001 28 M NEG NEG NEG NEG NEG NEG 201501002 28 F NEG NEG NEG NEG NEG POS 201501003 27 M NEG NEG NEG NEG NEG POS 201502004 29 M NEG NEG NEG NEG NEG POS 201502005 20 M NEG NEG NEG NEG NEG POS 201502006 35 M NEG NEG NEG NEG NEG NEG 201502007 65 M NEG POS NEG NEG NEG NEG 201502008 30 M NEG NEG NEG NEG NEG POS 201502009 43 F NEG NEG NEG NEG NEG POS 201502010 22 M NEG POS NEG NEG NEG POS 201502011 18 M NEG POS NEG NEG NEG POS 201502012 26 M NEG NEG NEG NEG NEG POS 201502013 25 M NEG POS NEG NEG NEG POS 201502014 25 M NEG POS NEG NEG NEG NEG 201503001 24 M NEG NEG NEG NEG NEG POS 201503002 23 M NEG NEG NEG NEG NEG NEG 201503003 21 M NEG NEG NEG NEG NEG NEG XXXIII University of Ghana http://ugspace.ug.edu.gh 201503004 23 M NEG POS NEG NEG NEG POS 201503005 25 M NEG NEG NEG NEG NEG POS 201503006 25 M NEG NEG NEG NEG NEG NEG 201503007 53 M NEG NEG NEG NEG NEG NEG 201503008 29 M NEG NEG NEG NEG NEG NEG 201503009 14 M NEG POS NEG NEG NEG NEG 201504001 27 M NEG POS NEG POS NEG POS 201504002 21 N NEG NEG NEG NEG NEG NEG 201504003 25 M NEG POS NEG NEG NEG POS 201504004 13 M NEG NEG NEG NEG NEG NEG 201504005 24 M NEG NEG NEG NEG NEG POS 201504006 31 M NEG NEG NEG NEG NEG NEG 201504007 20 M NEG NEG NEG NEG NEG NEG 201504008 32 M NEG POS NEG NEG NEG POS 201504009 22 M NEG POS NEG NEG NEG POS 201505001 22 M NEG NEG NEG NEG NEG POS 201505002 35 M NEG NEG NEG NEG NEG POS 201505003 28 M NEG NEG NEG NEG NEG POS 201505004 23 M NEG NEG NEG NEG NEG NEG 201505005 30 M NEG NEG NEG NEG NEG POS 201505006 21 M NEG NEG NEG NEG NEG NEG 201505007 32 M NEG NEG NEG NEG NEG NEG 201505008 24 F NEG POS NEG POS NEG POS XXXIV University of Ghana http://ugspace.ug.edu.gh 201506001 27 M NEG NEG NEG NEG NEG POS 201506002 23 M NEG NEG NEG NEG NEG NEG 201506003 14 M NEG NEG NEG NEG NEG NEG 201506004 18 M NEG NEG NEG NEG NEG NEG 201506005 19 M NEG NEG NEG NEG NEG POS 201506006 16 M NEG POS NEG NEG NEG NEG 201506007 25 M NEG NEG NEG NEG NEG NEG 201506008 30 M NEG NEG NEG NEG NEG POS 201506009 46 F NEG NEG NEG NEG NEG POS 201506010 26 M NEG NEG NEG NEG NEG NEG 201506011 28 M NEG NEG NEG NEG NEG NEG 201506012 23 F NEG POS NEG NEG NEG NEG 201506013 23 M NEG POS NEG NEG NEG POS 201506014 25 M NEG NEG NEG NEG NEG POS 201506015 31 M NEG NEG NEG NEG NEG POS 201506016 24 F NEG NEG NEG NEG NEG NEG 201507001 53 M NEG NEG NEG NEG NEG NEG 201507002 36 M NEG NEG NEG NEG NEG NEG 201507003 20 M NEG NEG NEG NEG NEG NEG 201507004 28 M NEG NEG NEG NEG NEG POS 201507005 39 M NEG NEG NEG NEG NEG POS 201507006 18 M POS NEG NEG POS NEG NEG 201507007 27 M NEG NEG NEG NEG NEG NEG XXXV University of Ghana http://ugspace.ug.edu.gh 201507008 19 M NEG NEG NEG NEG NEG NEG 201507009 22 M NEG NEG NEG NEG NEG NEG 201507010 21 M NEG NEG NEG NEG NEG NEG 201507011 24 F NEG NEG NEG NEG NEG NEG 201507012 18 M NEG NEG NEG NEG NEG NEG 201507013 17 M NEG POS NEG NEG NEG NEG 201507014 36 M NEG NEG NEG NEG NEG POS 201507015 36 M NEG POS NEG NEG NEG POS 201508001 18 M NEG NEG NEG NEG NEG NEG 201508002 42 M NEG NEG NEG NEG NEG NEG 201508003 13 M NEG NEG NEG NEG NEG POS 201508004 21 M NEG NEG NEG NEG NEG NEG 201508005 16 M NEG NEG NEG NEG NEG NEG 201508006 29 M NEG NEG NEG NEG NEG NEG 201509001 37 M NEG NEG NEG NEG NEG NEG 201509002 27 M NEG POS NEG NEG NEG POS 201509003 46 M NEG NEG NEG NEG NEG NEG 201509004 24 M NEG NEG NEG NEG NEG NEG 201509005 27 M NEG NEG NEG NEG NEG POS 201509006 18 M NEG POS NEG NEG NEG NEG 201509007 32 M NEG POS NEG NEG NEG POS 201509008 72 M NEG NEG NEG NEG NEG POS 201509009 27 F NEG NEG NEG NEG NEG NEG XXXVI University of Ghana http://ugspace.ug.edu.gh 201509010 18 M NEG NEG NEG NEG NEG NEG 201509011 25 M NEG POS NEG NEG NEG NEG 201509012 23 M NEG NEG NEG NEG NEG POS 201509013 19 M NEG NEG NEG NEG NEG NEG 201509014 23 M NEG NEG NEG NEG NEG POS 201509015 31 M NEG NEG NEG NEG NEG POS 201509016 31 M NEG NEG NEG NEG NEG POS 201509017 61 M NEG NEG NEG NEG NEG NEG 201510001 34 M NEG NEG NEG NEG NEG POS 201510002 16 F NEG NEG NEG NEG NEG NEG 201510003 25 M NEG NEG NEG NEG NEG NEG 201510004 22 M NEG NEG NEG NEG NEG NEG 201510005 35 M NEG NEG NEG NEG NEG POS 201510006 29 M POS NEG NEG NEG NEG POS 201510007 19 M NEG NEG NEG NEG NEG NEG 201510008 31 F NEG NEG NEG NEG NEG NEG 201510009 25 M NEG POS NEG NEG NEG POS 201510010 20 M NEG NEG NEG NEG NEG NEG 201511001 32 F NEG NEG NEG NEG NEG NEG 201511002 15 M NEG NEG NEG NEG NEG NEG 201511003 16 M NEG NEG NEG NEG NEG NEG 201511004 24 M NEG POS NEG NEG NEG POS 201511005 15 M NEG NEG NEG NEG NEG NEG XXXVII University of Ghana http://ugspace.ug.edu.gh 201511006 18 M NEG NEG NEG NEG NEG NEG 201511007 24 M NEG NEG NEG NEG NEG POS 201511008 26 M NEG NEG NEG NEG NEG POS 201511009 22 M NEG NEG NEG NEG NEG NEG 201511010 31 M NEG NEG NEG NEG NEG NEG 201511011 21 M NEG NEG NEG NEG NEG POS 201512001 25 F NEG NEG NEG NEG NEG NEG 201512002 22 M NEG POS NEG NEG NEG NEG 201512003 30 M NEG NEG NEG NEG NEG POS 201512004 24 M NEG NEG NEG NEG NEG NEG 201512005 15 M NEG NEG NEG NEG NEG NEG 201512006 23 M NEG NEG NEG NEG NEG NEG 201512007 21 M NEG NEG NEG NEG NEG NEG 201512008 29 M NEG NEG NEG NEG NEG POS 201512009 26 M NEG POS NEG NEG NEG POS 201512010 15 M NEG NEG NEG NEG NEG POS 201512011 26 M NEG NEG NEG NEG NEG NEG 201512012 19 M NEG NEG NEG NEG NEG NEG 201512013 14 M NEG NEG NEG NEG NEG NEG 201512014 15 M NEG NEG NEG NEG NEG NEG 201512015 41 M NEG NEG NEG NEG NEG NEG 201512016 35 M NEG NEG NEG NEG NEG POS 201601001 41 M NEG NEG NEG NEG NEG NEG XXXVIII University of Ghana http://ugspace.ug.edu.gh 201601002 35 M NEG NEG NEG NEG NEG POS 201601003 20 M NEG NEG NEG NEG NEG NEG 201601004 25 M NEG NEG NEG NEG NEG POS 201601005 41 M NEG NEG NEG NEG NEG POS 201601006 17 M NEG POS NEG NEG NEG NEG 201601007 21 M NEG POS NEG NEG NEG NEG 201601008 28 M NEG NEG NEG NEG NEG NEG 201601009 32 M NEG POS NEG NEG NEG POS 201601010 40 M NEG POS NEG NEG NEG POS 201601011 20 F NEG NEG NEG NEG NEG POS 201601012 23 M NEG NEG NEG NEG NEG NEG 201601013 35 M NEG NEG NEG NEG NEG NEG 201601014 46 M NEG NEG NEG NEG NEG POS 201601015 19 M NEG NEG NEG NEG NEG NEG 201602001 27 M NEG POS NEG NEG NEG POS 201602002 29 M NEG NEG NEG NEG NEG NEG 201602003 14 F NEG NEG NEG NEG NEG NEG 201602004 22 M NEG POS NEG NEG NEG NEG 201602005 41 M NEG NEG NEG NEG NEG NEG 201602006 31 M NEG POS NEG NEG NEG NEG 201602007 22 M NEG NEG NEG NEG NEG NEG 201602008 30 F NEG NEG NEG NEG NEG NEG 201602009 30 M NEG NEG NEG NEG NEG NEG XXXIX University of Ghana http://ugspace.ug.edu.gh 201602010 25 M NEG POS NEG NEG NEG NEG 201602011 22 M NEG NEG NEG NEG NEG POS 201602012 24 M NEG POS NEG NEG NEG POS 201602013 23 F NEG NEG NEG NEG NEG POS 201602014 26 M NEG NEG NEG NEG NEG POS 201602015 31 M NEG NEG NEG NEG NEG NEG 201602016 24 M NEG NEG NEG NEG NEG NEG 201602017 20 M NEG NEG NEG NEG NEG NEG 201602018 18 M NEG NEG NEG NEG NEG POS 201603001 24 M NEG POS NEG NEG NEG NEG 201603002 30 M NEG POS NEG NEG NEG POS 201603003 22 M NEG POS NEG NEG NEG POS 201603004 21 M NEG POS NEG NEG NEG NEG 201603005 23 M NEG NEG NEG NEG NEG NEG 201603006 25 M NEG POS NEG NEG NEG NEG 201603007 27 M NEG NEG NEG NEG NEG NEG 201603008 29 M NEG NEG NEG NEG NEG NEG 201603009 30 M NEG NEG NEG NEG NEG NEG 201603010 39 M NEG NEG NEG NEG NEG NEG 201603011 24 M NEG NEG NEG NEG NEG POS 201603012 21 F NEG NEG NEG NEG NEG NEG 201603013 36 M NEG NEG NEG NEG NEG NEG 201603014 36 F NEG NEG NEG NEG NEG POS XL University of Ghana http://ugspace.ug.edu.gh 201603015 55 M NEG POS NEG NEG NEG POS 201604001 26 M NEG POS NEG NEG NEG NEG 201604002 25 M NEG NEG NEG NEG NEG NEG 201604003 27 M NEG NEG NEG NEG NEG NEG 201604004 34 M NEG POS NEG NEG NEG POS 201604005 23 F NEG POS NEG NEG NEG NEG 201604006 25 M NEG NEG NEG NEG NEG NEG 201604007 21 M NEG NEG NEG NEG NEG POS 206104008 30 F NEG NEG NEG NEG NEG NEG 201604009 33 M NEG NEG NEG NEG NEG POS 201604010 25 M NEG POS NEG NEG NEG NEG 201604011 27 M NEG NEG NEG NEG NEG POS 201604012 30 M NEG NEG NEG NEG NEG POS 201604013 30 M NEG POS NEG NEG NEG NEG 201604014 17 M NEG POS NEG NEG NEG NEG 201605001 35 M NEG POS NEG NEG NEG POS 201605002 41 M POS POS NEG POS NEG POS 201605003 78 M NEG NEG NEG NEG NEG NEG 201605004 33 M NEG NEG NEG NEG NEG NEG 201605005 58 M NEG NEG NEG NEG NEG POS 201605006 46 M NEG NEG NEG NEG NEG NEG 201605007 21 M NEG POS NEG NEG NEG NEG 201605008 43 F NEG NEG NEG NEG NEG NEG XLI University of Ghana http://ugspace.ug.edu.gh 201605009 39 M NEG NEG NEG NEG NEG NEG 201605010 15 M NEG NEG NEG NEG NEG POS 201605011 50 M NEG NEG NEG NEG NEG NEG 201605012 20 M NEG NEG NEG NEG NEG POS 201605013 58 M NEG POS NEG NEG NEG NEG 201605014 21 M NEG POS NEG NEG NEG POS 201605015 36 M NEG NEG NEG NEG NEG NEG 201605016 42 F NEG NEG NEG NEG NEG POS 201605017 29 F NEG NEG NEG NEG NEG NEG 201605018 11 M NEG NEG NEG NEG NEG POS 201605019 21 M NEG NEG NEG NEG NEG NEG 201605020 23 M NEG NEG NEG NEG NEG NEG 201605021 18 M NEG NEG NEG NEG NEG NEG 201605022 24 M NEG NEG NEG NEG NEG NEG 201605023 19 F NEG NEG NEG NEG NEG NEG 201605024 27 M NEG POS NEG NEG NEG NEG 201605025 29 M NEG NEG NEG NEG NEG POS 201606001 27 M NEG NEG NEG NEG NEG NEG 201606002 33 M NEG POS NEG NEG NEG NEG 201606003 30 M NEG POS NEG NEG NEG NEG 201606004 32 M NEG NEG NEG NEG NEG POS 201606005 27 M NEG POS NEG NEG NEG POS 201606006 22 M NEG POS NEG NEG NEG NEG XLII University of Ghana http://ugspace.ug.edu.gh 201606007 24 M NEG NEG NEG NEG NEG NEG 201606008 21 M NEG NEG NEG NEG NEG NEG 201606009 32 M NEG NEG NEG NEG NEG NEG 201606010 22 M NEG NEG NEG NEG NEG NEG 201606011 24 M NEG NEG NEG NEG NEG NEG 201606012 21 M NEG POS NEG NEG NEG POS 201606013 53 M NEG NEG NEG NEG NEG NEG 201606014 22 M NEG POS NEG NEG NEG POS 201606015 31 F NEG NEG NEG NEG NEG POS 201606016 46 M NEG NEG NEG NEG NEG NEG 201606017 17 M NEG NEG NEG NEG NEG NEG 201606018 25 M NEG NEG NEG NEG NEG NEG 201606019 49 M NEG NEG NEG NEG NEG NEG 201606020 29 M NEG NEG NEG NEG NEG POS 201606021 64 M NEG POS NEG NEG NEG POS 201606022 30 M NEG NEG NEG NEG NEG POS 201606023 26 M NEG NEG NEG NEG NEG POS 201606024 25 M NEG NEG NEG NEG NEG POS 201606025 19 M NEG NEG NEG NEG NEG POS 201606026 48 M NEG POS NEG NEG NEG NEG 201606027 25 M NEG NEG NEG NEG NEG POS 201606028 20 M NEG NEG NEG NEG NEG POS 201606029 24 M NEG NEG NEG NEG NEG POS XLIII University of Ghana http://ugspace.ug.edu.gh 201607001 24 M NEG POS NEG NEG NEG POS 201607002 25 M NEG NEG NEG NEG NEG NEG 201607003 31 M NEG NEG NEG NEG NEG POS 201607004 22 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201609009 25 M NEG NEG NEG NEG NEG POS 201609010 25 F NEG NEG NEG NEG NEG POS 201609011 19 M NEG NEG NEG NEG NEG POS 201610001 34 M NEG POS NEG NEG NEG NEG 201610002 25 M NEG POS NEG NEG NEG POS 201610003 22 M NEG POS NEG NEG NEG NEG 201610004 25 M NEG NEG NEG NEG NEG NEG 201610005 22 M NEG NEG NEG NEG NEG NEG 201610006 27 M NEG POS NEG NEG NEG NEG 201610007 26 M NEG NEG NEG NEG NEG NEG 201610008 28 M NEG POS NEG NEG NEG POS 201610009 43 M NEG NEG NEG NEG NEG POS 201611001 23 M NEG NEG NEG NEG NEG POS 201611002 32 M NEG POS NEG NEG NEG NEG 201611003 42 M POS POS NEG POS NEG POS 201611004 24 M NEG NEG NEG NEG NEG POS 201611005 30 M NEG NEG NEG NEG NEG POS XLVI University of Ghana http://ugspace.ug.edu.gh 201611006 28 M NEG NEG NEG NEG NEG NEG 201611007 16 F NEG NEG NEG NEG NEG NEG 201611008 35 M NEG NEG NEG NEG NEG POS 201611009 27 M NEG NEG NEG NEG NEG POS 201611010 40 F NEG NEG NEG NEG NEG POS 201611011 27 M NEG NEG NEG NEG NEG POS 201612001 29 M NEG POS NEG NEG NEG NEG 201612002 30 M 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