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Lule SA, Kushitor SB, Grijalva-Eternod CS, Adjaye-Gbewonyo K, Sanuade OA, Kushitor MK, Okoibhole L, Awuah R, Baatiema L, Kretchy IA, Arhinful D, de-Graft Aikins A, Koram K, Fottrell E. The contextual awareness, response and evaluation (CARE) diabetes project: study design for a quantitative survey of diabetes prevalence and non-communicable disease risk in Ga Mashie, Accra, Ghana. Glob Health Action 2024; 17:2297513. [PMID: 38323339 PMCID: PMC10851827 DOI: 10.1080/16549716.2023.2297513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/16/2023] [Indexed: 02/08/2024] Open
Abstract
Diabetes is estimated to affect between 3.3% and 8.3% of adults in Ghana, and prevalence is expected to rise. The lack of cost-effective diabetes prevention programmes designed specifically for the Ghanaian population warrants urgent attention. The Contextual Awareness, Response and Evaluation (CARE): Diabetes Project in Ghana is a mixed methods study that aims to understand diabetes in the Ga Mashie area of Accra, identify opportunities for community-based intervention and inform future diabetes prevention and control strategies. This paper presents the study design for the quantitative survey within the CARE project. This survey will take place in the densely populated Ga Mashie area of Accra, Ghana. A household survey will be conducted using simple random sampling to select households from 80 enumeration areas identified in the 2021 Ghana Population and Housing Census. Trained enumerators will interview and collect data from permanent residents aged ≥ 25 years. Pregnant women and those who have given birth in the last six months will be excluded. Data analysis will use a combination of descriptive and inferential statistics, and all analyses will account for the cluster sampling design. Analyses will describe the prevalence of diabetes, other morbidities, and associated risk factors and identify the relationship between diabetes and physical, social, and behavioural parameters. This survey will generate evidence on drivers and consequences of diabetes and facilitate efforts to prevent and control diabetes and other NCDs in urban Ghana, with relevance for other low-income communities.
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Affiliation(s)
| | - Sandra Boatemaa Kushitor
- Department of Community Health, Ensign Global College, Kpong, Ghana
- Department of Food Science and Centre for Sustainability Studies, Stellenbosch University, Stellenbosch, South Africa
| | - Carlos S. Grijalva-Eternod
- Institute for Global Health, University College London, London, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Olutobi Adekunle Sanuade
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Mawuli Komla Kushitor
- Department of Health Policy, Fred Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Lydia Okoibhole
- Institute for Global Health, University College London, London, UK
| | - Raphael Awuah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
- Center for Tropical Medicine and Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Irene Akwo Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Accra, Ghana
| | - Daniel Arhinful
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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Tagoe JNA, Yeboah C, Behene E, Kumordjie S, Nimo-Paintsil S, Attram N, Nyarko EO, Carroll JA, Fox AT, Watters C, Koram K, Anang AK, Sanders T, Letizia AG. Coinfection of Malaria and Bacterial Pathogens among Acute Febrile Patients in Selected Clinics in Ghana. Am J Trop Med Hyg 2023; 109:1036-1046. [PMID: 37748764 PMCID: PMC10622490 DOI: 10.4269/ajtmh.23-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/05/2023] [Indexed: 09/27/2023] Open
Abstract
Malaria remains the leading cause of acute febrile illness (AFI) in Africa despite successful control measures and programs. Acute febrile illnesses can be misdiagnosed as malaria as a result of the overlapping spectrum of nonspecific symptoms or may not be pursued because of limited diagnostic capabilities. This study investigated potential etiologies of AFIs in Ghana and determined the relationship between coinfection between malaria and Q fever, leptospirosis, and culturable bacteria in febrile patients. Participants were enrolled between July 2015 and December 2019 from four Ghanaian military treatment facilities. Of the 399 febrile participants, 222 (55.6%) males and 177 (44.6%) females were enrolled. Malaria was diagnosed in 275 (68.9%) participants. Malaria coinfection occurred with leptospirosis, Q fever, and blood-cultured bacteria in 11/206 (5.3%), 24/206 (11.7%), and 6/164 (3.7%) participants, respectively. Among the 124 malaria-negative samples, the positivity rates were 4.1% (3/74), 8.1% (6/74), and 3.6% (2/56) for leptospirosis, Q fever, and bacterial pathogens isolated from blood culture, respectively. The majority of documented clinical signs and symptoms were not significantly associated with specific diseases. Approximately 10% of malaria-positive participants also had evidence suggesting the presence of a bacterial coinfection. Therefore, even in the case of a positive malaria test, other pathogens contributing to febrile illness should be considered. Understanding the frequency of malaria coinfection and other etiological agents responsible for AFIs will improve diagnosis and treatment and better inform public health knowledge gaps in Ghana.
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Affiliation(s)
- Janice N. A. Tagoe
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Clara Yeboah
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Eric Behene
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Selassie Kumordjie
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | | | - Naiki Attram
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | | | | | - Anne T. Fox
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Chaselynn Watters
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | - Terrel Sanders
- U.S. Naval Medical Research Unit-No.3, Ghana Detachment, Accra, Ghana
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Frimpong JA, Ampofo WK, Nyarko KM, Duque J, Aboagye J, Koram K, Widdowson M. Effect of antipyretics on performance of influenza surveillance in Ghana. Influenza Other Respir Viruses 2022; 17:e13068. [PMID: 36370028 PMCID: PMC9835404 DOI: 10.1111/irv.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The World Health Organization's case definition for influenza-like illness (ILI) includes a measured temperature of ≥38°C. We conducted this study to assess the effect of antipyretics on performance of ILI surveillance in Ghana. METHODS A cross-sectional study was conducted in two districts of Ghana from September 2013 to May 2014. We collected epidemiological data and respiratory specimens from an expanded ILI case definition, which included patients presenting to health facilities with measured temperature ≥38°C or reported fever (but afebrile at the time of evaluation), and cough, with onset in the last 10 days. Specimens were tested for influenza viruses by real time reverse-transcription polymerase chain reaction. RESULTS Of 321 participants who met our expanded ILI case definition, 236 presented with temperature of <38°C but reported subjective fever. Of these, 17% (39/236) were positive for influenza virus; Of those with fever ≤38°C who took antipyretics, 21%(16/77) were positive for influenza, compared with 14%(23/159) of those who did not take antipyretics. The addition of subjective fever to the standard ILI case definition captured approximately an additional 57% influenza cases but also required testing of approximately four times as many patients. However, including those without fever on presentation that had taken antipyretics found an additional 23% of Influenza cases and only two times as much testing. CONCLUSION Depending on the goals of surveillance (monitoring virus circulation or determining disease burden) and available resources, a more sensitive case definition including subjective fever and history of use of antipyretics may be warranted.
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Affiliation(s)
| | | | - Kofi Mensah Nyarko
- Department of Environmental and Public HealthUniversity of Environmental and Sustainable DevelopmentSomanyaGhana
| | | | - James Aboagye
- Noguchi Memorial Institute for Medical ResearchUniversity of GhanaAccraGhana
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical ResearchUniversity of GhanaAccraGhana
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Hewlett SA, Blankson PK, Aheto JMK, Anto F, Danso-Appiah T, Sackeyfio J, Koram K, Amoah AGB. Assessment of oral health status in a Ghanaian population: rationale, methods, and population characteristics. BMC Oral Health 2022; 22:67. [PMID: 35279167 PMCID: PMC8918279 DOI: 10.1186/s12903-022-02090-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Oral health surveys aid in estimating the oral health of a population and provide a projection for future oral health care needs. We report the procedures and rationale of a survey carried out to assess the oral health status and risk factors for oral disease among adults in the Greater Accra Region (GAR) of Ghana. The objective was to provide prevalence estimates on dental diseases, oral health behaviour and risk factors, and to establish baseline epidemiological data on the population’s oral health for further research.
Methods This was a population-based cross-sectional study of adults aged 25 years and above. A random, stratified two-stage sampling method was used to select participants from rural and urban communities in three types of districts (Metropolitan, Municipal, Ordinary). A semi- structured questionnaire was used to collect data on socio-demographic characteristics, oral health behaviours and risk factors for oral disease. Anthropometric data and a full-mouth clinical examination was carried out including: soft tissue assessment, tooth count, prosthodontic status, dental caries assessment and periodontal assessment. Results A total of 729 participants were included in the study with a mean age of 43.9 years (SD 14.6). Majority 425 (61.0%) were females. Though the metropolitan districts had more dental clinics and personnel, along with better health insurance coverage, they had a higher prevalence of missing teeth, retained roots, severe periodontitis and poorer oral health coverage. The findings also show some significant differences in disease prevalence, within the different localities and districts. Conclusions Availability and access to oral health services is not the most important determinant of good oral health outcomes in this region. We recommend exploring socio-behavioral and cultural factors as well. This study provides district level data to inform policy and guide further research.
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Mansoor R, Commons RJ, Douglas NM, Abuaku B, Achan J, Adam I, Adjei GO, Adjuik M, Alemayehu BH, Allan R, Allen EN, Anvikar AR, Arinaitwe E, Ashley EA, Ashurst H, Asih PBS, Bakyaita N, Barennes H, Barnes KI, Basco L, Bassat Q, Baudin E, Bell DJ, Bethell D, Bjorkman A, Boulton C, Bousema T, Brasseur P, Bukirwa H, Burrow R, Carrara VI, Cot M, D’Alessandro U, Das D, Das S, Davis TME, Desai M, Djimde AA, Dondorp AM, Dorsey G, Drakeley CJ, Duparc S, Espié E, Etard JF, Falade C, Faucher JF, Filler S, Fogg C, Fukuda M, Gaye O, Genton B, Ghulam Rahim A, Gilayeneh J, Gonzalez R, Grais RF, Grandesso F, Greenwood B, Grivoyannis A, Hatz C, Hodel EM, Humphreys GS, Hwang J, Ishengoma D, Juma E, Kachur SP, Kager PA, Kamugisha E, Kamya MR, Karema C, Kayentao K, Kazienga A, Kiechel JR, Kofoed PE, Koram K, Kremsner PG, Lalloo DG, Laman M, Lee SJ, Lell B, Maiga AW, Mårtensson A, Mayxay M, Mbacham W, McGready R, Menan H, Ménard D, Mockenhaupt F, Moore BR, Müller O, Nahum A, Ndiaye JL, Newton PN, Ngasala BE, Nikiema F, Nji AM, Noedl H, Nosten F, Ogutu BR, Ojurongbe O, Osorio L, Ouédraogo JB, Owusu-Agyei S, Pareek A, Penali LK, Piola P, Plucinski M, Premji Z, Ramharter M, Richmond CL, Rombo L, Roper C, Rosenthal PJ, Salman S, Same-Ekobo A, Sibley C, Sirima SB, Smithuis FM, Somé FA, Staedke SG, Starzengruber P, Strub-Wourgaft N, Sutanto I, Swarthout TD, Syafruddin D, Talisuna AO, Taylor WR, Temu EA, Thwing JI, Tinto H, Tjitra E, Touré OA, Tran TH, Ursing J, Valea I, Valentini G, van Vugt M, von Seidlein L, Ward SA, Were V, White NJ, Woodrow CJ, Yavo W, Yeka A, Zongo I, Simpson JA, Guerin PJ, Stepniewska K, Price RN. Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data. BMC Med 2022; 20:85. [PMID: 35249546 PMCID: PMC8900374 DOI: 10.1186/s12916-022-02265-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/18/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia. METHODS Individual patient data from eligible antimalarial efficacy studies of uncomplicated P. falciparum malaria, available through the WorldWide Antimalarial Resistance Network data repository prior to August 2015, were pooled using standardised methodology. The haematological response over time was quantified using a multivariable linear mixed effects model with nonlinear terms for time, and the model was then used to estimate the mean haemoglobin at day of nadir and day 7. Multivariable logistic regression quantified risk factors for moderately severe anaemia (haemoglobin < 7 g/dL) at day 0, day 3 and day 7 as well as a fractional fall ≥ 25% at day 3 and day 7. RESULTS A total of 70,226 patients, recruited into 200 studies between 1991 and 2013, were included in the analysis: 50,859 (72.4%) enrolled in Africa, 18,451 (26.3%) in Asia and 916 (1.3%) in South America. The median haemoglobin concentration at presentation was 9.9 g/dL (range 5.0-19.7 g/dL) in Africa, 11.6 g/dL (range 5.0-20.0 g/dL) in Asia and 12.3 g/dL (range 6.9-17.9 g/dL) in South America. Moderately severe anaemia (Hb < 7g/dl) was present in 8.4% (4284/50,859) of patients from Africa, 3.3% (606/18,451) from Asia and 0.1% (1/916) from South America. The nadir haemoglobin occurred on day 2 post treatment with a mean fall from baseline of 0.57 g/dL in Africa and 1.13 g/dL in Asia. Independent risk factors for moderately severe anaemia on day 7, in both Africa and Asia, included moderately severe anaemia at baseline (adjusted odds ratio (AOR) = 16.10 and AOR = 23.00, respectively), young age (age < 1 compared to ≥ 12 years AOR = 12.81 and AOR = 6.79, respectively), high parasitaemia (AOR = 1.78 and AOR = 1.58, respectively) and delayed parasite clearance (AOR = 2.44 and AOR = 2.59, respectively). In Asia, patients treated with an artemisinin-based regimen were at significantly greater risk of moderately severe anaemia on day 7 compared to those treated with a non-artemisinin-based regimen (AOR = 2.06 [95%CI 1.39-3.05], p < 0.001). CONCLUSIONS In patients with uncomplicated P. falciparum malaria, the nadir haemoglobin occurs 2 days after starting treatment. Although artemisinin-based treatments increase the rate of parasite clearance, in Asia they are associated with a greater risk of anaemia during recovery.
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Toh KB, Millar J, Psychas P, Abuaku B, Ahorlu C, Oppong S, Koram K, Valle D. Guiding placement of health facilities using multiple malaria criteria and an interactive tool. Malar J 2021; 20:455. [PMID: 34861874 PMCID: PMC8641186 DOI: 10.1186/s12936-021-03991-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to healthcare is important in controlling malaria burden and, as a result, distance or travel time to health facilities is often a significant predictor in modelling malaria prevalence. Adding new health facilities may reduce overall travel time to health facilities and may decrease malaria transmission. To help guide local decision-makers as they scale up community-based accessibility, the influence of the spatial allocation of new health facilities on malaria prevalence is evaluated in Bunkpurugu-Yunyoo district in northern Ghana. A location-allocation analysis is performed to find optimal locations of new health facilities by separately minimizing three district-wide objectives: malaria prevalence, malaria incidence, and average travel time to health facilities. METHODS Generalized additive models was used to estimate the relationship between malaria prevalence and travel time to the nearest health facility and other geospatial covariates. The model predictions are then used to calculate the optimisation criteria for the location-allocation analysis. This analysis was performed for two scenarios: adding new health facilities to the existing ones, and a hypothetical scenario in which the community-based healthcare facilities would be allocated anew. An interactive web application was created to facilitate efficient presentation of this analysis and allow users to experiment with their choice of health facility location and optimisation criteria. RESULTS Using malaria prevalence and travel time as optimisation criteria, two locations that would benefit from new health facilities were identified, regardless of scenarios. Due to the non-linear relationship between malaria incidence and prevalence, the optimal locations chosen based on the incidence criterion tended to be inequitable and was different from those based on the other optimisation criteria. CONCLUSIONS This study findings underscore the importance of using multiple optimisation criteria in the decision-making process. This analysis and the interactive application can be repurposed for other regions and criteria, bridging the gap between science, models and decisions.
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Affiliation(s)
- Kok Ben Toh
- School of Natural Resources and Environment, University of Florida, Gainesville, USA.
| | - Justin Millar
- School of Forest, Fisheries, and Geomatics Sciences, University of Florida, Gainesville, USA
| | - Paul Psychas
- Centers for Disease Control, US President's Malaria Initiative, Atlanta, USA
| | - Benjamin Abuaku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Denis Valle
- School of Forest, Fisheries, and Geomatics Sciences, University of Florida, Gainesville, USA
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de-Graft Aikins A, Sanuade O, Baatiema L, Asante PY, Agyei F, Asah-Ayeh V, Okai JAO, Osei-Tutu A, Koram K. COVID-19, chronic conditions and structural poverty: A social psychological assessment of the needs of a marginalized community in Accra, Ghana. J Soc Polit Psych 2021. [DOI: 10.5964/jspp.7543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In the African region COVID-19 infection and death rates are increasing (writing in May 2020), most deaths have occurred among individuals with chronic conditions, and poor communities face higher risks of infection and socio-economic insecurities. We assessed the psychosocial needs of a chronic illness support group in Accra, Ghana, within the context of their broader community. The community lives in structural poverty and has a complex burden of infectious and chronic non-communicable diseases (NCDs). Between March and May 2020, we conducted interviews, group discussions, and surveys, with members of the support group and their caregivers, frontline healthcare workers, and religious and community leaders. Data was analysed through the social psychology of participation framework. Community members understood COVID-19 as a new public health threat and drew on eclectic sources of information to make sense of this. Members of the support group had psychosocial and material needs: they were anxious about infection risk as well as money, food and access to NCD treatment. Some community members received government food packages during the lockdown period. This support ended after lockdown in April and while anti-poverty COVID policies have been unveiled they have yet to be implemented. We discuss the impact of these representational, relational and power dynamics on the community’s access to COVID-19 and NCD support. We argue that strategies to address immediate and post-COVID needs of vulnerable communities have to focus on the politics and practicalities of implementing existing rights-based policies that intersect health, poverty reduction and social protection.
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Balachandran N, Ntiri M, Duque J, Addo C, Edu-Quansah E, Badji E, Brightson K, Houphouet EE, Ndahwouh TN, Koram K, McMorrow M, Ampofo W. Incidence of Laboratory-Confirmed Influenza among HIV-Infected versus HIV-Uninfected Individuals in Two Districts of Ghana, 2014 to 2016. Am J Trop Med Hyg 2021; 105:783-787. [PMID: 34228633 DOI: 10.4269/ajtmh.20-1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/25/2021] [Indexed: 11/07/2022] Open
Abstract
Influenza is known to cause severe respiratory illness in HIV-infected adults, but there are few data describing the relationship between HIV infection and influenza in West African countries such as Ghana. We conducted a prospective cohort study in the Shai-Osudoku and Ningo Prampram districts of Ghana from 2014 to 2016. Beginning May 2014, 266 HIV-infected and 510 HIV-uninfected participants age 18 to 73 years were enrolled and monitored for 12 months. We observed 4 and 11 laboratory-confirmed influenza cases among HIV-infected and HIV-uninfected persons, respectively. The overall rate of laboratory-confirmed influenza among HIV-infected participants was 15.0 per 1,000 person years (PY) (95% CI, 0.3-29.80 per 1,000 PY), whereas that among HIV-uninfected participants was 21.6 per 1,000 PY (95% CI, 8.8-34.3 per 1,000 PY) (incidence density ratio, 0.70; P = 0.56). Our study found no significant difference in the incidence of laboratory-confirmed influenza-associated illness among HIV-infected and HIV-uninfected individuals in Ghana.
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Affiliation(s)
- Neha Balachandran
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.,Emory Rollins School of Public Health, Atlanta, Georgia
| | - Michael Ntiri
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Jazmin Duque
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.,Battelle Atlanta, Atlanta, Georgia
| | - Christabel Addo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Elijah Edu-Quansah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Edem Badji
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | | | - Talla Nzussouo Ndahwouh
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.,Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.,MassGenics, Atlanta, Georgia
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Meredith McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Sanuade OA, Dodoo FNA, Koram K, de-Graft Aikins A. Explanatory models of stroke in Ghana: perspectives of stroke survivors and their caregivers. Ethn Health 2021; 26:697-719. [PMID: 30922062 DOI: 10.1080/13557858.2018.1557116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Abstract
Objective: This study examines explanatory models (EMs) of stroke and its complications among people living with stroke, and their caregivers, in two urban poor communities in Accra (Ga Mashie) and Korle Bu Teaching Hospital (KBTH), Accra.Methods: Twenty-two stroke survivors and 29 caregivers were recruited from 2 urban poor communities in Accra and KBTH. Qualitative data were obtained using semi-structured interviews that lasted between 45 minutes and 2 hours. The interviews were audiotaped, transcribed and analysed thematically, informed by the concept of EMs of illness.Results: Participants referred to stroke as a sudden event and they expressed different emotional responses after the stroke onset. Stroke survivors and their caregivers attributed stroke with poor lifestyle practices, high blood pressure, unhealthy diet and dietary practices, supernatural causes, stress, family history, other chronic diseases, and delay in treatment of symptoms. While the stroke survivors associated stroke complications with physical disability and stigmatisation, the caregivers associated these with physical disability, behavioural and psychological changes, cognitive disability and death. These associations were mostly influenced by the biomedical model of stroke.Conclusion: The biomedical model of stroke is important for developing interventions that will be accepted by the stroke survivors and the caregivers. Nevertheless, sociocultural explanations of stroke need to be taken into consideration during delivery of medical information to the participants. This study proposes an integrated biopsychosociocultural approach for stroke intervention among the study participants.
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Affiliation(s)
| | | | - Kwadwo Koram
- The Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
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Joannides J, Dzodzomenyo M, Azerigyik F, Agbosu EE, Pratt D, Nyarko Osei JH, Pwalia R, Amlalo GK, Appawu M, Takashi H, Iwanaga S, Buchwald A, Rochford R, Boakye D, Koram K, Bonney K, Dadzie S. Species composition and risk of transmission of some Aedes-borne arboviruses in some sites in Northern Ghana. PLoS One 2021; 16:e0234675. [PMID: 34061882 PMCID: PMC8168856 DOI: 10.1371/journal.pone.0234675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 05/19/2021] [Indexed: 11/19/2022] Open
Abstract
Aedes-borne viral diseases mainly Yellow Fever (YF), Dengue (DEN), Zika (ZIK) and Chikungunya (CHK) have contributed to many deaths’ in the world especially in Africa. There have been major outbreaks of these diseases in West Africa. Although, YF outbreaks have occurred in Ghana over the years, no outbreak of DEN, ZIK and CHK has been recorded. However, the risk of outbreak is high due to its proximity to West African countries where outbreaks have been recently been recorded. This study surveyed the mosquito fauna to assess the risk of transmission of Yellow fever (YFV), Dengue (DENV), Chikungunya (CHKV) and Zika (ZIKV) viruses in Larabanga and Mole Game Reserve areas in Northern Ghana. The immature and adult stages of Aedes mosquitoes were collected from Larabanga and Mole Game Reserve area. There was a significant (P>0.001) number of mosquitoes collected during the rainy season than the dry season. A total of 1,930 Aedes mosquitoes were collected during the rainy season and morphologically identified. Of these, 1,915 (99.22%) were Aedes aegypti and 15 (0.22%) were Aedes vittatus. During the dry season, 27 Ae. aegypti mosquitoes were collected. A total of 415 Ae. aegypti mosquitoes were molecularly identified to subspecies level of which Ae. (Ae) aegypti aegypti was the predominant subspecies. Both Ae. aegypti aegypti and Ae aegypti formosus exist in sympatry in the area. All Aedes pools (75) were negative for DENV, ZIKV and CHKV when examined by RT- PCR. Three Larval indices namely House Index, HI (percentage of houses positive for Aedes larvae or pupae), Container Index, CI (the percentage of containers positive for Aedes larvae or pupae) and Breteau Index, BI (number of positive containers per 100 houses inspected) were assessed as a measure for risk of transmission in the study area. The HI, CI and BI for both sites were as follows; Mole Game Reserve (HI, 42.1%, CI, 23.5% and BI, 100 for rainy season and 0 for all indices for dry season) and Larabanga (39%, 15.5% and 61 for rainy season and 2.3%, 1.3% and 2.3 for dry season). The spatial distribution of Aedes breeding sites in both areas indicated that Aedes larvae were breeding in areas with close proximity to humans. Lorry tires were the main source of Aedes larvae in all the study areas. Information about the species composition and the potential role of Aedes mosquitoes in future outbreaks of the diseases that they transmit is needed to design efficient surveillance and vector control tools.
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Affiliation(s)
- Joannitta Joannides
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Department of Environmental and Occupational Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Mawuli Dzodzomenyo
- Department of Environmental and Occupational Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Faustus Azerigyik
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Eudocia Esinam Agbosu
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Deborah Pratt
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joseph Harold Nyarko Osei
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Rebecca Pwalia
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Godwin Kwame Amlalo
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Maxwell Appawu
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Hayashi Takashi
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Department of Molecular Virology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shiroh Iwanaga
- Department of Environmental Parasitology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Andrea Buchwald
- Department of Environmental and Occupational Health, School of Public Health, University of Colorado, Aurora, CO, United States of America
| | - Rosemary Rochford
- Department of Immunology and Microbiology, University of Colorado, Aurora, Colorado, United States of America
| | - Daniel Boakye
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kwadwo Koram
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Kofi Bonney
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Samuel Dadzie
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- * E-mail:
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11
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Hodoameda P, Duah-Quashie NO, Hagan CO, Matrevi S, Abuaku B, Koram K, Quashie NB. Plasmodium falciparum genetic factors rather than host factors are likely to drive resistance to ACT in Ghana. Malar J 2020; 19:255. [PMID: 32669113 PMCID: PMC7362516 DOI: 10.1186/s12936-020-03320-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/04/2020] [Indexed: 12/13/2022] Open
Abstract
Background Artemisinin-based combination therapy (ACT) partner drugs, currently used in Ghana are lumefantrine, amodiaquine and piperaquine. Plasmodium falciparum isolates with reduced susceptibility to these partner drugs may affect treatment outcome. Mutations in pfmdr1 gene is linked to reduced parasite susceptibility to amodiaquine and lumefantrine. In addition, the potency of the partner drugs in vivo depends on the metabolism by the cytochrome P450 (CYP) enzyme in the host. Mutations in the CYP2C8 and CYP3A4 genes are linked to reduced metabolism of amodiaquine and lumefantrine in vitro, respectively. This study investigated the host and parasite genetic factors affecting the susceptibility of the malaria parasite to ACT partner drugs. Methods Archived samples from 240 patients age ≤ 9 years participating in anti-malarial drug resistance survey in Ghana, and given artemether with lumefantrine (AL) or artesunate with amodiaquine (AA), were selected and analysed. Polymerase chain reaction (PCR) followed by Sanger sequencing was used to determine the polymorphisms in CYP2C8, CYP3A4 and pfmdr1 genes. Results For CYP3A4, all had wild type alleles, suggesting that the hosts are good metabolizers of lumefantrine. For CYP2C8 60% had wild type alleles, 35% heterozygous and 5% homozygous recessive alleles suggesting efficient metabolism of amodiaquine by the hosts. For pfmdr1 gene, at codon 86, 95% were wild type (N86) and 5% mutant (Y86). For codon 184, 36% were wild type (Y184) and 64% mutant (F184) while for codons 1034, 1042 and 1246, 100% (all) were wild type. The high prevalence of N86-F184-D1246 haplotype (NFD) suggest presence of parasites with reduced susceptibility to lumefantrine and not amodiaquine. Delayed clearance was observed in individuals with mutations in the pfmdr1 gene and not cytochrome 450 gene. Both synonymous and non-synonymous mutations were observed in the pfmdr1 at low prevalence. Conclusion The outcome of this study indicates that the parasite's genetic factors rather than the host’s are likely to drive resistance to ACT in Ghana.
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Affiliation(s)
- Peter Hodoameda
- West African Center for Cell Biology of Infectious Pathogens, University of Ghana, P. O. Box LG54, Legon, Ghana
| | - Nancy Odurowah Duah-Quashie
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana
| | | | - Sena Matrevi
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana
| | - Benjamin Abuaku
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana
| | - Kwadwo Koram
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana
| | - Neils Ben Quashie
- West African Center for Cell Biology of Infectious Pathogens, University of Ghana, P. O. Box LG54, Legon, Ghana. .,Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana. .,Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, P. O. Box GP4236, Accra, Ghana.
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12
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de‐Graft Aikins A, Kushitor M, Kushitor SB, Sanuade O, Asante PY, Sakyi L, Agyei F, Koram K, Ogedegbe G. Building cardiovascular disease competence in an urban poor Ghanaian community: A social psychology of participation approach. J Community Appl Soc Psychol 2020. [DOI: 10.1002/casp.2447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ama de‐Graft Aikins
- Institute of Advanced StudiesUniversity College London London UK
- Regional Institute for Population StudiesUniversity of Ghana Accra Ghana
| | - Mawuli Kushitor
- Regional Institute for Population StudiesUniversity of Ghana Accra Ghana
| | | | - Olutobi Sanuade
- Institute of Advanced StudiesUniversity College London London UK
- Regional Institute for Population StudiesUniversity of Ghana Accra Ghana
| | | | - Lionel Sakyi
- Centre for Migration StudiesUniversity of Ghana Accra Ghana
| | - Francis Agyei
- Department of PsychologyUniversity of Ghana Accra Ghana
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical ResearchUniversity of Ghana Accra Ghana
| | - Gbenga Ogedegbe
- New York University School of MedicineNew York University New York NY USA
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13
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Abuaku B, Duah-Quashie NO, Quaye L, Matrevi SA, Quashie N, Gyasi A, Owusu-Antwi F, Malm K, Koram K. Therapeutic efficacy of artesunate-amodiaquine and artemether-lumefantrine combinations for uncomplicated malaria in 10 sentinel sites across Ghana: 2015-2017. Malar J 2019; 18:206. [PMID: 31234874 PMCID: PMC6591907 DOI: 10.1186/s12936-019-2848-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Routine surveillance on the therapeutic efficacy of artemisinin-based combination therapy (ACT) has been ongoing in Ghana since 2005. The sixth round of surveillance was conducted between 2015 and 2017 to determine the therapeutic efficacy of artesunate–amodiaquine (AS–AQ) and artemether–lumefantrine (AL) in 10 sentinel sites across the country. Methods The study was a one-arm, prospective, evaluation of the clinical, parasitological, and haematological responses to directly observed treatment with AS–AQ and AL among children 6 months to 9 years old with uncomplicated falciparum malaria. The WHO 2009 protocol on surveillance of anti-malaria drug efficacy was used for the study with primary outcomes as prevalence of day 3 parasitaemia and clinical and parasitological cure rates on day 28. Secondary outcomes assessed included patterns of fever and parasite clearance as well as changes in haemoglobin concentration. Results Day 3 parasitaemia was absent in all sites following treatment with AS–AQ whilst only one person (0.2%) was parasitaemic on day 3 following treatment with AL. Day 28 PCR-corrected cure rates following treatment with AS–AQ ranged between 96.7% (95% CI 88.5–99.6) and 100%, yielding a national rate of 99.2% (95% CI 97.7–99.7). Day 28 PCR-corrected cure rates following treatment with AL ranged between 91.3% (95% CI 79.2–97.6) and 100%, yielding a national rate of 96% (95% CI 93.5–97.6). Prevalence of fever declined by 88.4 and 80.4% after first day of treatment with AS–AQ and AL, respectively, whilst prevalence of parasitaemia on day 2 was 2.1% for AS–AQ and 1.5% for AL. Gametocytaemia was maintained at low levels (< 5%) during the 3 days of treatment. Post-treatment mean haemoglobin concentration was significantly higher than pre-treatment concentration following treatment with either AS–AQ or AL. Conclusions The therapeutic efficacy of AS–AQ and AL is over 90% in sentinel sites across Ghana. The two anti-malarial drugs therefore remain efficacious in the treatment of uncomplicated malaria in the country and continue to achieve rapid fever and parasite clearance as well as low gametocyte carriage rates and improved post-treatment mean haemoglobin concentration. Electronic supplementary material The online version of this article (10.1186/s12936-019-2848-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Abuaku
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Accra, Ghana.
| | - Nancy O Duah-Quashie
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Accra, Ghana
| | - Lydia Quaye
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Accra, Ghana
| | - Sena A Matrevi
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Accra, Ghana
| | - Neils Quashie
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Accra, Ghana.,Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, P. O. Box GP4236, Accra, Ghana
| | - Akosua Gyasi
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | | | - Keziah Malm
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - Kwadwo Koram
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Accra, Ghana
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14
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Slater HC, Ross A, Felger I, Hofmann NE, Robinson L, Cook J, Gonçalves BP, Björkman A, Ouedraogo AL, Morris U, Msellem M, Koepfli C, Mueller I, Tadesse F, Gadisa E, Das S, Domingo G, Kapulu M, Midega J, Owusu-Agyei S, Nabet C, Piarroux R, Doumbo O, Doumbo SN, Koram K, Lucchi N, Udhayakumar V, Mosha J, Tiono A, Chandramohan D, Gosling R, Mwingira F, Sauerwein R, Paul R, Riley EM, White NJ, Nosten F, Imwong M, Bousema T, Drakeley C, Okell LC. The temporal dynamics and infectiousness of subpatent Plasmodium falciparum infections in relation to parasite density. Nat Commun 2019; 10:1433. [PMID: 30926893 PMCID: PMC6440965 DOI: 10.1038/s41467-019-09441-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/07/2019] [Indexed: 02/08/2023] Open
Abstract
Malaria infections occurring below the limit of detection of standard diagnostics are common in all endemic settings. However, key questions remain surrounding their contribution to sustaining transmission and whether they need to be detected and targeted to achieve malaria elimination. In this study we analyse a range of malaria datasets to quantify the density, detectability, course of infection and infectiousness of subpatent infections. Asymptomatically infected individuals have lower parasite densities on average in low transmission settings compared to individuals in higher transmission settings. In cohort studies, subpatent infections are found to be predictive of future periods of patent infection and in membrane feeding studies, individuals infected with subpatent asexual parasite densities are found to be approximately a third as infectious to mosquitoes as individuals with patent (asexual parasite) infection. These results indicate that subpatent infections contribute to the infectious reservoir, may be long lasting, and require more sensitive diagnostics to detect them in lower transmission settings. The role of subpatent infections for malaria transmission and elimination is unclear. Here, Slater et al. analyse several malaria datasets to quantify the density, detectability, course of infection and infectiousness of subpatent infections.
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Affiliation(s)
- Hannah C Slater
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, W2 1PG, UK.
| | - Amanda Ross
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, 4002, Switzerland.,University of Basel, Basel, 4001, Switzerland
| | - Ingrid Felger
- University of Basel, Basel, 4001, Switzerland.,Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, 4002, Switzerland
| | - Natalie E Hofmann
- University of Basel, Basel, 4001, Switzerland.,Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, 4002, Switzerland
| | - Leanne Robinson
- Vector-borne Diseases Unit, Papua New Guinea Institute for Medical Research, Madang, Papua New Guinea.,Division of Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville, 3052, VIC, Australia.,Medical Biology, University of Melbourne, Melbourne, 3010, VIC, Australia.,Disease Elimination, Burnet Institute, Melbourne, 3004, VIC, Australia
| | - Jackie Cook
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Bronner P Gonçalves
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Anders Björkman
- Malaria Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Andre Lin Ouedraogo
- Département de Sciences Biomédicales, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, 01 BP 2208, Burkina Faso.,Institute for Disease Modeling, Intellectual Ventures, Bellevue, 98005, Washington, USA
| | - Ulrika Morris
- Malaria Research, Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Mwinyi Msellem
- Department of Training and Research, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Cristian Koepfli
- Population Health and Immunity Division, Walter and Eliza Hall Institute, Melbourne, 3052, Victoria, Australia.,Department of Biological Sciences, University of Notre Dame, Indiana, 46556, USA
| | - Ivo Mueller
- Division of Population Health and Immunity, The Walter and Eliza Hall Institute of Medical Research, Parkville, 3052, VIC, Australia.,Department of Parasites and Insect Vectors, Institut Pasteur, Paris, 75015, France.,Medical Biology, University of Melbourne, Melbourne, 3010, VIC, Australia
| | - Fitsum Tadesse
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, 6525, The Netherlands.,Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Institute of Biotechnology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Smita Das
- Diagnostics Program, PATH, Seattle, Washington, 98121, United States of America
| | - Gonzalo Domingo
- Diagnostics Program, PATH, Seattle, Washington, 98121, United States of America
| | - Melissa Kapulu
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK.,KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya, Centre for Genomics and Global Health, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Janet Midega
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, UK.,KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya, Centre for Genomics and Global Health, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, UK
| | - Seth Owusu-Agyei
- Institute of Health, University of Health and Allied Sciences, Hohoe, PMB 31, Ghana
| | - Cécile Nabet
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP- HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Parasitologie-Mycologie, Paris, 75646, France
| | - Renaud Piarroux
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP- HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Parasitologie-Mycologie, Paris, 75646, France
| | - Ogobara Doumbo
- Malaria Research and Training Centre, Parasitic Diseases Epidemiology Department, UMI 3189, University of Sciences, Technique and Technology, Bamako, Mali
| | - Safiatou Niare Doumbo
- Malaria Research and Training Centre, Parasitic Diseases Epidemiology Department, UMI 3189, University of Sciences, Technique and Technology, Bamako, Mali
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Naomi Lucchi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Global Health, Centers for Disease Control and Prevention, Atlanta, 30030, GA, United States of America
| | - Venkatachalam Udhayakumar
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Global Health, Centers for Disease Control and Prevention, Atlanta, 30030, GA, United States of America
| | - Jacklin Mosha
- National Institute for Medical Research, Mwanza Medical Research Centre, Mwanza, Tanzania
| | - Alfred Tiono
- Department of Biomedical Sciences, Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, 01 BP 2208, Burkina Faso
| | - Daniel Chandramohan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Roly Gosling
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, San Francisco, 94158, CA, United States
| | - Felista Mwingira
- Biological Sciences Department, Dar es Salaam University College of Education, P. O. Box 2329, Dar es Salaam, Tanzania
| | - Robert Sauerwein
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, 6525, The Netherlands
| | - Richard Paul
- Institut Pasteur de Dakar, Laboratoire d'Entomologie Médicale, Dakar, Senegal
| | - Eleanor M Riley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.,The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, UK
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7FZ, UK.,Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Francois Nosten
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7FZ, UK.,Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Mallika Imwong
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.,Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Teun Bousema
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.,Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, 6525, The Netherlands
| | - Chris Drakeley
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Lucy C Okell
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, W2 1PG, UK
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15
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Amratia P, Psychas P, Abuaku B, Ahorlu C, Millar J, Oppong S, Koram K, Valle D. Characterizing local-scale heterogeneity of malaria risk: a case study in Bunkpurugu-Yunyoo district in northern Ghana. Malar J 2019; 18:81. [PMID: 30876413 PMCID: PMC6420752 DOI: 10.1186/s12936-019-2703-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/02/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bayesian methods have been used to generate country-level and global maps of malaria prevalence. With increasing availability of detailed malaria surveillance data, these methodologies can also be used to identify fine-scale heterogeneity of malaria parasitaemia for operational prevention and control of malaria. METHODS In this article, a Bayesian geostatistical model was applied to six malaria parasitaemia surveys conducted during rainy and dry seasons between November 2010 and 2013 to characterize the micro-scale spatial heterogeneity of malaria risk in northern Ghana. RESULTS The geostatistical model showed substantial spatial heterogeneity, with malaria parasite prevalence varying between 19 and 90%, and revealing a northeast to southwest gradient of predicted risk. The spatial distribution of prevalence was heavily influenced by two modest urban centres, with a substantially lower prevalence in urban centres compared to rural areas. Although strong seasonal variations were observed, spatial malaria prevalence patterns did not change substantially from year to year. Furthermore, independent surveillance data suggested that the model had a relatively good predictive performance when extrapolated to a neighbouring district. CONCLUSIONS This high variability in malaria prevalence is striking, given that this small area (approximately 30 km × 40 km) was purportedly homogeneous based on country-level spatial analysis, suggesting that fine-scale parasitaemia data might be critical to guide district-level programmatic efforts to prevent and control malaria. Extrapolations results suggest that fine-scale parasitaemia data can be useful for spatial predictions in neighbouring unsampled districts and does not have to be collected every year to aid district-level operations, helping to alleviate concerns regarding the cost of fine-scale data collection.
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Affiliation(s)
- Punam Amratia
- School of Forest Resources and Conservation, University of Florida, Gainesville, USA. .,Emerging Pathogens Institute, University of Florida, Gainesville, USA.
| | - Paul Psychas
- Emerging Pathogens Institute, University of Florida, Gainesville, USA
| | - Benjamin Abuaku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Justin Millar
- School of Forest Resources and Conservation, University of Florida, Gainesville, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, USA
| | | | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Denis Valle
- School of Forest Resources and Conservation, University of Florida, Gainesville, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, USA
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16
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Sanuade OA, Dodoo FNA, Koram K, de-Graft Aikins A. Prevalence and correlates of stroke among older adults in Ghana: Evidence from the Study on Global AGEing and adult health (SAGE). PLoS One 2019; 14:e0212623. [PMID: 30865654 PMCID: PMC6415815 DOI: 10.1371/journal.pone.0212623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/06/2019] [Indexed: 01/19/2023] Open
Abstract
This study examines the prevalence and correlates of stroke among older adults in Ghana. This cross-sectional study retrieved data from Wave 1 of the World Health Organization (WHO) Survey on Global Ageing and Adult Health (SAGE) conducted between 2007 and 2008. The sample, comprising 4,279 respondents aged 50 years and above, was analysed using descriptive statistics, cross tabulations and Chi-Square tests, and a multivariable binary logistic regression. Respondents ranged in age from 50 to 114 years, with a median age of 62 years. Stroke prevalence was 2.6%, with the correlates being marital status, level of education, employment status, and living with hypertension or diabetes. The results showed that being separated/divorced, having primary and secondary education, being unemployed and living with hypertension and diabetes, significantly increased the odds of stroke prevalence in this population. The results suggest that interventions to reduce stroke prevalence and impact must be developed alongside interventions for hypertension, diabetes and sociodemographic/economic factors such as marital status, level of education, and employment status.
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Affiliation(s)
| | | | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana., Accra, Ghana
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
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Asante-Poku A, Asare P, Baddoo NA, Forson A, Klevor P, Otchere ID, Aboagye SY, Osei-Wusu S, Danso EK, Koram K, Gagneux S, Yeboah-Manu D. TB-diabetes co-morbidity in Ghana: The importance of Mycobacterium africanum infection. PLoS One 2019; 14:e0211822. [PMID: 30730937 PMCID: PMC6366779 DOI: 10.1371/journal.pone.0211822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/21/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Diabetes Mellitus (DM) is a known risk factor for tuberculosis (TB) but little is known on TB-Diabetes Mellitus (TBDM) co-morbidity in Sub-Saharan Africa. METHODS Consecutive TB cases registered at a tertiary facility in Ghana were recruited from September 2012 to April 2016 and screened for DM using random blood glucose and glycated hemoglobin (HbA1c) level. TB patients were tested for other clinical parameters including HIV co-infection and TB lesion location. Mycobacterial isolates obtained from collected sputum samples were characterized by standard methods. Associations between TBDM patients' epidemiological as well as microbiological variables were assessed. RESULTS The prevalence of DM at time of diagnosis among 2990 enrolled TB cases was 9.4% (282/2990). TBDM cases were significantly associated with weight loss, poor appetite, night sweat and fatigue (p<0.001) and were more likely (p<0.001) to have lower lung cavitation 85.8% (242/282) compared to TB Non-Diabetic (TBNDM) patients 3.3% (90/2708). We observed 22.3% (63/282) treatment failures among TBDM patients compared to 3.8% (102/2708) among TBNDM patients (p<0.001). We found no significant difference in the TBDM burden attributed by M. tuberculosis sensu stricto (Mtbss) and Mycobacterium africanum (Maf) and (Mtbss; 176/1836, 9.6% and Maf; 53/468, 11.3%, p = 0.2612). We found that diabetic individuals were suggestively likely to present with TB caused by M. africanum Lineage 6 as opposed to Mtbss (odds ratio (OR) = 1.52; 95% confidence interval (CI): 0.92-2.42, p = 0.072). CONCLUSION Our findings confirms the importance of screening for diabetes during TB diagnosis and highlights the association between genetic diversity and diabetes. in Ghana.
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Affiliation(s)
- Adwoa Asante-Poku
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana
| | - Prince Asare
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana
| | | | - Audrey Forson
- Department of Chest Diseases, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
| | - Pius Klevor
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Isaac Darko Otchere
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Sammy Yaw Aboagye
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Stephen Osei-Wusu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Emelia Konadu Danso
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Sebastien Gagneux
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
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Antwi E, Klipstein-Grobusch K, Browne J, Schielen P, Koram K, Agyepong I, Grobbee D. 165. Improved prediction of gestational hypertension by inclusion of placental growth factor and Pregnancy Associated Plasma Protein-A in a sample of Ghanaian women. Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2018.08.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Rorick MM, Artzy-Randrup Y, Ruybal-Pesántez S, Tiedje KE, Rask TS, Oduro A, Ghansah A, Koram K, Day KP, Pascual M. Signatures of competition and strain structure within the major blood-stage antigen of Plasmodium falciparum in a local community in Ghana. Ecol Evol 2018; 8:3574-3588. [PMID: 29686839 PMCID: PMC5901166 DOI: 10.1002/ece3.3803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/31/2017] [Accepted: 12/06/2017] [Indexed: 11/12/2022] Open
Abstract
The concept of niche partitioning has received considerable theoretical attention at the interface of ecology and evolution of infectious diseases. Strain theory postulates that pathogen populations can be structured into distinct nonoverlapping strains by frequency-dependent selection in response to intraspecific competition for host immune space. The malaria parasite Plasmodium falciparum presents an opportunity to investigate this phenomenon in nature, under conditions of high recombination rate and extensive antigenic diversity. The parasite's major blood-stage antigen, Pf EMP1, is encoded by the hyperdiverse var genes. With a dataset that includes thousands of var DBLα sequence types sampled from asymptomatic cases within an area of high endemicity in Ghana, we address how var diversity is distributed within isolates and compare this to the distribution of microsatellite allelic diversity within isolates to test whether antigenic and neutral regions of the genome are structured differently. With respect to var DBLα sequence types, we find that on average isolates exhibit significantly lower overlap than expected randomly, but that there also exists frequent pairs of isolates that are highly related. Furthermore, the linkage network of var DBLα sequence types reveals a pattern of nonrandom modularity unique to these antigenic genes, and we find that modules of highly linked DBLα types are not explainable by neutral forces related to var recombination constraints, microsatellite diversity, sampling location, host age, or multiplicity of infection. These findings of reduced overlap and modularity among the var antigenic genes are consistent with a role for immune selection as proposed by strain theory. Identifying the evolutionary and ecological dynamics that are responsible for the nonrandom structure in P. falciparum antigenic diversity is important for designing effective intervention in endemic areas.
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Affiliation(s)
- Mary M Rorick
- Department of Ecology and Evolution University of Chicago Chicago IL USA.,Department of Biology University of Utah Salt Lake City UT USA
| | - Yael Artzy-Randrup
- Theoretical Ecology Group Institute for Biodiversity and Ecosystem Dynamics University of Amsterdam Amsterdam The Netherlands
| | - Shazia Ruybal-Pesántez
- School of Biosciences Bio21 Institute The University of Melbourne Melbourne Vic. Australia.,Department of Microbiology New York University New York NY USA
| | - Kathryn E Tiedje
- School of Biosciences Bio21 Institute The University of Melbourne Melbourne Vic. Australia.,Department of Microbiology New York University New York NY USA
| | - Thomas S Rask
- School of Biosciences Bio21 Institute The University of Melbourne Melbourne Vic. Australia.,Department of Microbiology New York University New York NY USA
| | | | - Anita Ghansah
- Noguchi Memorial Institute for Medical Research University of Ghana Legon Ghana
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research University of Ghana Legon Ghana
| | - Karen P Day
- School of Biosciences Bio21 Institute The University of Melbourne Melbourne Vic. Australia.,Department of Microbiology New York University New York NY USA
| | - Mercedes Pascual
- Department of Ecology and Evolution University of Chicago Chicago IL USA.,The Santa Fe Institute Santa Fe NM USA
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Akuffo R, Armah G, Clemens M, Kronmann KC, Jones AH, Agbenohevi P, Sagoe K, Puplampu N, Talla Nzussouo N, Ampofo W, Koram K, Duplessis C, Dueger E. Prevalence of enteric infections among hospitalized patients in two referral hospitals in Ghana. BMC Res Notes 2017; 10:292. [PMID: 28716138 PMCID: PMC5514524 DOI: 10.1186/s13104-017-2621-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/12/2017] [Indexed: 01/30/2023] Open
Abstract
Background Diarrhea is an important cause of morbidity and mortality worldwide. In Africa and Ghana in particular, it is estimated to contribute directly to 19 and 25% of pediatric mortality among children under 5 years, respectively. Methods Surveillance for hospitalized acute diarrheal illness was initiated in November 2010 through October 2012 in a referral hospital in southern Ghana, and a teaching hospital in northern Ghana. Consenting hospitalized patients who met a standardized case definition for acute diarrheal illness provided demographic and epidemiologic data. Stool samples were collected and tested by culture for bacteria and by enzyme immunoassays for a panel of viruses and parasites. Results A total of 429 patients were enrolled; 216 (50.3%) were under 5 years, and 221 (51.5%) were females. Stool samples were received from 153 patients. Culture isolates included Shigella sp., Salmonella spp., Plesiomonas sp. and Vibrio cholerae. Of 147 samples tested for viruses, 41 (27.9%) were positive for rotaviruses, 11 (7.5%) for astroviruses, 10 (6.8%) for noroviruses, and 8 (5.4%) for adenoviruses. Of 116 samples tested for parasitic infections; 4 (3.4%) were positive for Cryptosporidium sp. and 3 (2.6%) for Giardia lamblia. Of the enrolled patients, 78.8% had taken antibiotics prior to sample collection. Conclusions Diarrheal pathogens were identified across all ages, however, predominantly (81%) in the children under 5 years of age. This study also detected high antibiotic use which has the potential of increasing antibiotic resistance. The most common enteric pathogen detected (49.4%) was rotavirus. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2621-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Akuffo
- Noguchi Memorial Institute for Medical Research, Accra, Ghana. .,Global Disease Detection & Response Program (GDDRP), U.S. Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt. .,Global Disease Detection (GDD) Egypt Regional Center, U.S. Naval Medical Research Unit No. 3, NAMRU-3, PSC 452, P.O Box 5000, Foster city, FPO, AE 09835-9998, USA.
| | - G Armah
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - M Clemens
- Global Disease Detection & Response Program (GDDRP), U.S. Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt.,Global Disease Detection (GDD) Egypt Regional Center, U.S. Naval Medical Research Unit No. 3, NAMRU-3, PSC 452, P.O Box 5000, Foster city, FPO, AE 09835-9998, USA
| | - K C Kronmann
- U.S. Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana.,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - A H Jones
- Global Disease Detection & Response Program (GDDRP), U.S. Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt.,Global Disease Detection (GDD) Egypt Regional Center, U.S. Naval Medical Research Unit No. 3, NAMRU-3, PSC 452, P.O Box 5000, Foster city, FPO, AE 09835-9998, USA
| | | | - K Sagoe
- Tamale Teaching Hospital, Tamale, Ghana
| | - N Puplampu
- U.S. Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana
| | - N Talla Nzussouo
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Ampofo
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - K Koram
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - C Duplessis
- U.S. Naval Medical Research Unit No. 3, Ghana Detachment, Accra, Ghana
| | - E Dueger
- Global Disease Detection & Response Program (GDDRP), U.S. Naval Medical Research Unit No. 3 (NAMRU-3), Cairo, Egypt.,Global Disease Detection (GDD) Egypt Regional Center, U.S. Naval Medical Research Unit No. 3, NAMRU-3, PSC 452, P.O Box 5000, Foster city, FPO, AE 09835-9998, USA.,U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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21
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Ntiri MP, Duque J, McMorrow ML, Frimpong JA, Parbie P, Badji E, Nzussouo NT, Benson EM, Adjabeng M, Dueger E, Widdowson MA, Dawood FS, Koram K, Ampofo W. Incidence of medically attended influenza among residents of Shai-Osudoku and Ningo-Prampram Districts, Ghana, May 2013 - April 2015. BMC Infect Dis 2016; 16:757. [PMID: 27964716 PMCID: PMC5155389 DOI: 10.1186/s12879-016-2078-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/29/2016] [Indexed: 12/04/2022] Open
Abstract
Background Influenza vaccination is recommended by the World Health Organization for high risk groups, yet few data exist on influenza disease burden in West Africa. Methods We estimated medically attended influenza-associated illness rates among residents of Shai-Osudoku and Ningo Pram-Pram Districts (SONPD), Ghana. From May 2013 to April 2015, we conducted prospective surveillance for severe acute respiratory illness (SARI) and influenza-like illness (ILI) in 17 health facilities. In 2015, we conducted a retrospective assessment at an additional 18 health facilities to capture all SONPD SARI and ILI patients during the study period. We applied positivity rates to those not tested to estimate total influenza cases. Results Of 612 SARI patients tested, 58 (9%) were positive for influenza. The estimated incidence of influenza-associated SARI was 30 per 100,000 persons (95% CI: 13-84). Children aged 0 to 4 years had the highest influenza-associated SARI incidence (135 per 100,000 persons, 95% CI: 120-152) and adults aged 25 to 44 years had the lowest (3 per 100,000 persons, 95% CI: 1-7) (p < 0.01). Of 2,322 ILI patients tested, 407 (18%) were positive for influenza. The estimated incidence of influenza-associated ILI was 844 per 100,000 persons (95% CI: 501-1,099). The highest incidence of influenza-associated ILI was also among children aged 0 to 4 years (3,448 per 100,000 persons, 95% CI: 3,727 – 3,898). The predominant circulating subtype during May to December 2013 and January to April 2015 was influenza A(H3N2) virus, and during 2014 influenza B virus was the predominant circulating type. Conclusions Influenza accounted for 9% and 18% of medically attended SARI and ILI, respectively. Rates were substantive among young children and suggest the potential value of exploring the benefits of influenza vaccination in Ghana, particularly in this age group. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2078-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Preko Ntiri
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Jazmin Duque
- Battelle Atlanta, Atlanta, Georgia, USA. .,Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-A32, Atlanta, GA, 30329, USA.
| | - Meredith L McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-A32, Atlanta, GA, 30329, USA.,U.S. Public Health Service, Rockville, Maryland, USA
| | | | - Prince Parbie
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Edem Badji
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ndahwouh Talla Nzussouo
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-A32, Atlanta, GA, 30329, USA.,CTS Global Inc, El Segundo, California, USA
| | - Eve-Marie Benson
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Erica Dueger
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-A32, Atlanta, GA, 30329, USA
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-A32, Atlanta, GA, 30329, USA
| | - Fatimah S Dawood
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS-A32, Atlanta, GA, 30329, USA.,U.S. Public Health Service, Rockville, Maryland, USA
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - William Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Otchere ID, Harris SR, Busso SL, Asante-Poku A, Osei-Wusu S, Koram K, Parkhill J, Gagneux S, Yeboah-Manu D. The First population structure and comparative genomics analysis of Mycobacterium africanum strains from Ghana reveals higher diversity of Lineage 5. Int J Mycobacteriol 2016; 5 Suppl 1:S80-S81. [PMID: 28043631 DOI: 10.1016/j.ijmyco.2016.09.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 09/20/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE/BACKGROUND Mycobacterium africanum (MAF) remains an important TB causing pathogen in West Africa; however, little is known about its population structure and actual diversity which may have implications for diagnostics and vaccines. We carried out comparative genomics analysis of candidate Mycobacterium tuberculosis (MTB) and MAF using whole genome sequencing. METHODS Clinical MTB complex strains (n=187) comprising L4 (n=22), L5 (n=126), and L6 (n=39) isolated over 8years from Ghana were whole genome sequenced. The reads were mapped onto a reference genome for phylogenetic and functional genomics analysis. A maximum likelihood tree with 100 bootstraps was constructed from the single nucleotide polymorphisms (SNPs) found using RAxML and clustered with hierBAPS. A total of 147 (18 L4, 36 L6, and 93 L5) of the genomes were de novo assembled and annotated for comparative pangenome analysis using Roary. RESULTS The population structure of MAF revealed at least five clusters of L5 as compared to three for L6. We also identified a group of three multi-drug-resistants (MDRs) within a single cluster of L5 strains from Southern Ghana isolated in 2013. Among the global collection of MTB complex, there were four Ghana-specific L5 clusters of which one (L5.1.1) had traits of clonal expansion. From the 5947pan genes extracted from the collection, 3215 (54.1%) were core to all the 147 genomes whereas 719 (12.1%) were found in single genomes. Most of the variable genes were PE-PGRS/PPE (1,281) duplicates of other genes (431). The genome degradation was more pronounced in Lineages 4 and 6 as compared to Lineage 5. We identified the absence of some unique genes among specific lineages and/or clades with possible clinical implications. For example, mpt64 and mlaD encoding respectively an immunogenic protein and a mammalian cell entry protein were missing from all L6 genomes. In addition, all L5 strains had an amino acid substitution I43N within the mpt64 gene. Analysis of SNPs within some genes encoding proteins for substrate metabolism, ion transport and secretory systems showed higher proportion of SNPs among L6 compared to L5 and L4. We also identified a number of lineage/sublineage specific SNPs and indels that may be utilized in rapid PCR based genotyping of MTB complex. CONCLUSION This work emphasizes on the possibility that the mpt64-based rapid diagnostic kit would not be effective in MAF endemic settings. More mutations in ESAT-6 secretory system of MAF compared to MTB sensu stricto can affect efficacy of ESAT-6-based vaccines in the future.
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Affiliation(s)
- Isaac D Otchere
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana; Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana.
| | - Simon R Harris
- Wellcome Trust Sanger Institute, Genome Campus, Cambridge University, Cambridge, UK
| | - Sanches L Busso
- Wellcome Trust Sanger Institute, Genome Campus, Cambridge University, Cambridge, UK
| | - Adwoa Asante-Poku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Stephen Osei-Wusu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana; Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Julian Parkhill
- Wellcome Trust Sanger Institute, Genome Campus, Cambridge University, Cambridge, UK
| | | | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Otchere ID, Asante-Poku A, Osei-Wusu S, Baddoo A, Sarpong E, Ganiyu AH, Aboagye SY, Forson A, Bonsu F, Yahayah AI, Koram K, Gagneux S, Yeboah-Manu D. Detection and characterization of drug-resistant conferring genes in Mycobacterium tuberculosis complex strains: A prospective study in two distant regions of Ghana. Tuberculosis (Edinb) 2016; 99:147-154. [PMID: 27450017 PMCID: PMC4978697 DOI: 10.1016/j.tube.2016.05.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/26/2016] [Accepted: 05/28/2016] [Indexed: 11/29/2022]
Abstract
We spoligotyped and screened 1490 clinical Mycobacterium tuberculosis complex strains from Northern and Greater Accra regions of Ghana against INH and RIF using the microplate alamar blue phenotypic assay. Specific drug resistance associated genetic elements of drug resistant strains were analyzed for mutations. A total of 111 (7.5%), 10 (0.7%) and 40 (2.6%) were mono-resistant to INH, RIF, and MDR, respectively. We found the Ghana spoligotype to be associated with drug resistance (INH: 22.1%; p = 0.0000, RIF: 6.2%; p = 0.0103, MDR: 4.6%; p = 0.0240) as compared to the Cameroon spoligotype (INH: 6.7%, RIF: 2.4%, MDR: 1.6%). The propensity for an isolate to harbour katG S315T mutation was higher in M. tuberculosis (75.8%) than Mycobacterium africanum (51.7%) (p = 0.0000) whereas the opposite was true for inhApro mutations; MAF (48.3%) compared to MTBSS (26.7%) (p = 0.0419). We identified possible novel compensatory INH resistance mutations in inhA (G204D) and ahpCpro (-88G/A and -142G/A) and a novel ndh mutation K32R. We detected two possible rpoC mutations (G332R and V483G), which occurred independently with rpoB S450L, respectively. The study provides the first evidence that associate the Ghana spoligotype with DR-TB and calls for further genome analyses for proper classification of this spoligotype and to explore for fitness implications and mechanisms underlying this observation.
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Affiliation(s)
- I D Otchere
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana; Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - A Asante-Poku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - S Osei-Wusu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - A Baddoo
- Chest Clinic, Korle-BU Teaching Hospital, Accra, Ghana
| | - E Sarpong
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - A H Ganiyu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - S Y Aboagye
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - A Forson
- Chest Clinic, Korle-BU Teaching Hospital, Accra, Ghana
| | - F Bonsu
- Ghana Health Service, Ministry of Health, Accra, Ghana
| | - A I Yahayah
- Chest Department, Tamale Teaching Hospital, Tamale, Ghana
| | - K Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - S Gagneux
- Swiss TPH, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - D Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
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Oduro AR, Maya ET, Akazili J, Baiden F, Koram K, Bojang K. Monitoring malaria using health facility based surveys: challenges and limitations. BMC Public Health 2016; 16:354. [PMID: 27102913 PMCID: PMC4840858 DOI: 10.1186/s12889-016-2858-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/11/2016] [Indexed: 11/30/2022] Open
Abstract
Background Health facility data are more readily accessible for operational planning and evaluation of disease control programmes. The importance, potential challenges and limitations of using facility based survey as an alternative tool for monitoring changes in local malaria epidemiology were examined. Methods The study involved six areas within the administrative divisions of The Gambia. The areas were selected to reflect socioeconomic and malaria transmission intensities across the country. The study design involved an age stratified cross sectional surveys that were conducted during the wet season in 2008 and in the 2009 during the dry season. Participants were patients attending clinics in six health centres and the representative populations from the catchment communities of the health centres. Results Overall participants’ characteristics were mostly not comparable in the two methodological approaches in the different seasons and settings. More females than males were enrolled (55.8 vs. 44.2 %) in all the surveys. Malaria infection was higher in the surveys in health centres than in the communities (p < 0.0001) and also in males than in females (OR = 1.3; p < 0.001). Males were less likely than females to sleep under an insecticide treated net in the communities (OR = 1.6; 95 % CI 1.3, 1.9) and in the health centres (OR = 1.3; 95 % CI 1.1, 1.5). Representativeness of the ethnic groups was better in the health centre surveys than in the community surveys when compared to the 2003 national population census in The Gambia. Conclusion Health facility based survey though a potential tool for monitoring changes in the local epidemiology of malaria will require continuous validation of the facility and participants sociodemograhic characteristics as these may change over time. The effects of health seeking practices on service utilization and health facility surveys as an approach will also need continuous review.
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Affiliation(s)
- Abraham Rexford Oduro
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana. .,School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Ghana. .,Research and Development Division, Ghana Health Service, PMB, Accra, Ghana.
| | - Ernest Tei Maya
- School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Ghana
| | - James Akazili
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Frank Baiden
- Research and Development Division, Ghana Health Service, PMB, Accra, Ghana
| | - Kwadwo Koram
- Noguchi Memorial Institute of Medical Research, P. O. Box LG 581, Legon, Ghana
| | - Kalifa Bojang
- Medical Research Council Unit, P. O. Box 273, Banjul, The Gambia
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Abuaku B, Duah N, Quaye L, Quashie N, Malm K, Bart-Plange C, Koram K. Therapeutic efficacy of artesunate-amodiaquine and artemether-lumefantrine combinations in the treatment of uncomplicated malaria in two ecological zones in Ghana. Malar J 2016; 15:6. [PMID: 26728096 PMCID: PMC4700572 DOI: 10.1186/s12936-015-1080-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/29/2015] [Indexed: 11/25/2022] Open
Abstract
Background Case management based on prompt diagnosis and adequate treatment using artemisinin-based combination therapy (ACT) remains the main focus of malaria control in Ghana. As part of routine surveillance on the therapeutic efficacy of ACT in Ghana, the efficacy of amodiaquine-artesunate (AS-AQ) and artemether-lumefantrine (AL) were studied in six sentinel sites representing the forest and savannah zones of the country. Methods Three sites representing the two ecological zones studied AS-AQ whilst the other three sites studied AL. In each site, the study was a one-arm prospective evaluation of the clinical, parasitological, and haematological responses to directly observed therapy for uncomplicated malaria with either AS-AQ or AL among children aged 6 months and 9 years. The WHO 2009 protocol for monitoring anti-malarial drug efficacy was used for the study between July 2013 and March 2014. Results Per-protocol analyses on day 28 showed an overall PCR-corrected cure rate of 100 % for AS-AQ and 97.6 % (95 % CI 93.1, 99.5) for AL: 97.2 % (95 % CI 92.0, 99.4) in the forest zone and 100 % in the savannah zone. Kaplan–Meier survival analysis showed similar outcomes. Prevalence of fever decreased by about 75 % after the first day of treatment with each ACT in the two ecological zones. No child studied was parasitaemic on day 3, and gametocytaemia was generally maintained at low levels (<5 %). Post-treatment mean haemoglobin concentrations significantly increased in the two ecological zones. Conclusions Therapeutic efficacy of AS-AQ and AL remains over 90 % in the forest and savannah zones of Ghana. Additionally, post-treatment parasitaemia on day 3 is rare suggesting that artemisinin is still efficacious in Ghana.
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Affiliation(s)
- Benjamin Abuaku
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana.
| | - Nancy Duah
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana.
| | - Lydia Quaye
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana.
| | - Neils Quashie
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana. .,Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, P. O. Box GP4236, Accra, Ghana.
| | - Keziah Malm
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana.
| | - Constance Bart-Plange
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana.
| | - Kwadwo Koram
- Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana.
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Suzuki M, Tung NH, Kwofie KD, Adegle R, Amoa-Bosompem M, Sakyiamah M, Ayertey F, Owusu KBA, Tuffour I, Atchoglo P, Frempong KK, Anyan WK, Uto T, Morinaga O, Yamashita T, Aboagye F, Appiah AA, Appiah-Opong R, Nyarko AK, Yamaoka S, Yamaguchi Y, Edoh D, Koram K, Ohta N, Boakye DA, Ayi I, Shoyama Y. New anti-trypanosomal active tetracyclic iridoid isolated from Morinda lucida Benth. Bioorg Med Chem Lett 2015; 25:3030-3. [PMID: 26048790 DOI: 10.1016/j.bmcl.2015.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/23/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Abstract
Human African trypanosomiasis (HAT), commonly known as sleeping sickness has remained a serious health problem in many African countries with thousands of new infected cases annually. Chemotherapy, which is the main form of control against HAT has been characterized lately by the viewpoints of toxicity and drug resistance issues. Recently, there have been a lot of emphases on the use of medicinal plants world-wide. Morinda lucida Benth. is one of the most popular medicinal plants widely distributed in Africa and several groups have reported on its anti-protozoa activities. In this study, we have isolated one novel tetracyclic iridoid, named as molucidin, from the CHCl3 fraction of the M. lucida leaves by bioassay-guided fractionation and purification. Molucidin was structurally elucidated by (1)H and (13)C NMR including HMQC, HMBC, H-H COSY and NOESY resulting in tetracyclic iridoid skeleton, and its absolute configuration was determined. We have further demonstrated that molucidin presented a strong anti-trypanosomal activity, indicating an IC50 value of 1.27 μM. The cytotoxicity study using human normal and cancer cell lines indicated that molucidin exhibited selectivity index (SI) against two normal fibroblasts greater than 4.73. Furthermore, structure-activity relationship (SAR) study was undertaken with molucidin and oregonin, which is identical to anti-trypanosomal active components of Alnus japonica. Overlapping analysis of the lowest energy conformation of molucidin with oregonin suggested a certain similarities of aromatic rings of both oregonin and molucidin. These results contribute to the future drug design studies for HAT.
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Affiliation(s)
- Mitsuko Suzuki
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon LG 581, Ghana; Section of Environmental Parasitology, Faculty of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Nguyen Huu Tung
- Faculty of Pharmaceutical Sciences, Nagasaki International University, 2825-7 Huis Ten Bosch, Sasebo, Nagasaki 859-3298, Japan
| | - Kofi D Kwofie
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon LG 581, Ghana
| | - Richard Adegle
- Centre for Scientific Research into Plant Medicine, Mampong-Akuapem 73, Ghana
| | - Michael Amoa-Bosompem
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon LG 581, Ghana
| | - Maxwell Sakyiamah
- Centre for Scientific Research into Plant Medicine, Mampong-Akuapem 73, Ghana
| | - Frederick Ayertey
- Centre for Scientific Research into Plant Medicine, Mampong-Akuapem 73, Ghana
| | | | - Isaac Tuffour
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon LG 581, Ghana
| | - Philip Atchoglo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon LG 581, Ghana
| | | | - William K Anyan
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon LG 581, Ghana
| | - Takuhiro Uto
- Faculty of Pharmaceutical Sciences, Nagasaki International University, 2825-7 Huis Ten Bosch, Sasebo, Nagasaki 859-3298, Japan
| | - Osamu Morinaga
- Faculty of Pharmaceutical Sciences, Nagasaki International University, 2825-7 Huis Ten Bosch, Sasebo, Nagasaki 859-3298, Japan
| | - Taizo Yamashita
- Faculty of Pharmaceutical Sciences, Nagasaki International University, 2825-7 Huis Ten Bosch, Sasebo, Nagasaki 859-3298, Japan
| | - Frederic Aboagye
- Centre for Scientific Research into Plant Medicine, Mampong-Akuapem 73, Ghana
| | | | - Regina Appiah-Opong
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon LG 581, Ghana
| | - Alexander K Nyarko
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon LG 581, Ghana
| | - Shoji Yamaoka
- Section of Environmental Parasitology, Faculty of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Yasuchika Yamaguchi
- Faculty of Pharmaceutical Sciences, Nagasaki International University, 2825-7 Huis Ten Bosch, Sasebo, Nagasaki 859-3298, Japan
| | - Dominic Edoh
- Centre for Scientific Research into Plant Medicine, Mampong-Akuapem 73, Ghana
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon LG 581, Ghana
| | - Nobuo Ohta
- Section of Environmental Parasitology, Faculty of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Daniel A Boakye
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon LG 581, Ghana
| | - Irene Ayi
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon LG 581, Ghana
| | - Yukihiro Shoyama
- Faculty of Pharmaceutical Sciences, Nagasaki International University, 2825-7 Huis Ten Bosch, Sasebo, Nagasaki 859-3298, Japan.
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Hori T, Barnor J, Nguyen Huu T, Morinaga O, Hamano A, Ndzinu J, Frimpong A, Minta-Asare K, Amoa-Bosompem M, Brandful J, Odoom J, Bonney J, Tuffour I, Owusu BA, Ofosuhene M, Atchoglo P, Sakyiamah M, Adegle R, Appiah-Opong R, Ampofo W, Koram K, Nyarko A, Okine L, Edoh D, Appiah A, Uto T, Yoshinaka Y, Uota S, Shoyama Y, Yamaoka S. Procyanidin trimer C1 derived from Theobroma cacao reactivates latent human immunodeficiency virus type 1 provirus. Biochem Biophys Res Commun 2015; 459:288-293. [PMID: 25727021 DOI: 10.1016/j.bbrc.2015.02.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
Despite remarkable advances in combination antiretroviral therapy (cART), human immunodeficiency virus type 1 (HIV-1) infection remains incurable due to the incomplete elimination of the replication-competent virus, which persists in latent reservoirs. Strategies for targeting HIV reservoirs for eradication that involves reactivation of latent proviruses while protecting uninfected cells by cART are urgently needed for cure of HIV infection. We screened medicinal plant extracts for compounds that could reactivate the latent HIV-1 provirus and identified a procyanidin trimer C1 derived from Theobroma cacao as a potent activator of the provirus in human T cells latently infected with HIV-1. This reactivation largely depends on the NF-κB and MAPK signaling pathways because either overexpression of a super-repressor form of IκBα or pretreatment with a MEK inhibitor U0126 diminished provirus reactivation by C1. A pan-PKC inhibitor significantly blocked the phorbol ester-induced but not the C1-induced HIV-1 reactivation. Although C1-induced viral gene expression persisted for as long as 48 h post-stimulation, NF-κB-dependent transcription peaked at 12 h post-stimulation and then quickly declined, suggesting Tat-mediated self-sustainment of HIV-1 expression. These results suggest that procyanidin C1 trimer is a potential compound for reactivation of latent HIV-1 reservoirs.
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Affiliation(s)
| | - Jacob Barnor
- Noguchi Memorial Institute for Medical Research, Ghana
| | | | | | | | - Jerry Ndzinu
- Tokyo Medical and Dental University, Japan; Noguchi Memorial Institute for Medical Research, Ghana
| | | | | | | | | | - John Odoom
- Noguchi Memorial Institute for Medical Research, Ghana
| | - Joseph Bonney
- Noguchi Memorial Institute for Medical Research, Ghana
| | - Isaac Tuffour
- Noguchi Memorial Institute for Medical Research, Ghana
| | | | | | | | | | | | | | | | | | | | - Laud Okine
- Centre for Plant Medicine Research, Ghana
| | | | | | | | | | - Shin Uota
- Tokyo Medical and Dental University, Japan
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Ofori-Adjei D, Koram K. Of cholera and Ebola virus disease in Ghana. Ghana Med J 2014; 48:120. [PMID: 25709119 PMCID: PMC4335441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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de-Graft Aikins A, Kushitor M, Koram K, Gyamfi S, Ogedegbe G. Chronic non-communicable diseases and the challenge of universal health coverage: insights from community-based cardiovascular disease research in urban poor communities in Accra, Ghana. BMC Public Health 2014; 14 Suppl 2:S3. [PMID: 25082497 PMCID: PMC4120153 DOI: 10.1186/1471-2458-14-s2-s3] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rising burden of chronic non-communicable diseases in low and middle income countries has major implications on the ability of these countries to achieve universal health coverage. In this paper we discuss the impact of cardiovascular diseases (CVD) on primary healthcare services in urban poor communities in Accra, Ghana. METHODS We review the evidence on the evolution of universal health coverage in Ghana and the central role of the community-based health planning services (CHPS) programme and the National Health Insurance Scheme in primary health care. We present preliminary findings from a study on community CVD knowledge, experiences, responses and access to services. RESULTS The rising burden of NCDs in Ghana will affect the achievement of universal health coverage, particularly in urban areas. There is a significant unmet need for CVD care in the study communities. The provision of primary healthcare services for CVD is not accessible, equitable or responsive to the needs of target communities. CONCLUSIONS We consider these findings in the context of the primary healthcare system and discuss the challenges and opportunities for strengthening health systems in low and middle-income countries.
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Affiliation(s)
- Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, P.O.Box LG96, Legon, Ghana
| | - Mawuli Kushitor
- Regional Institute for Population Studies, University of Ghana, P.O.Box LG96, Legon, Ghana
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, P.O.Box LG581, Legon, Ghana
| | - Stella Gyamfi
- Ussher Polyclinic, Ghana Health Service, P.O.Box GP2105, Accra, Ghana
| | - Gbenga Ogedegbe
- Division of Health and Behavior, Center for Healthful Behavior Change, New York University School of Medicine, New York, NY, USA
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Affiliation(s)
- Brian Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Kwadwo Koram
- Noguchi Memorial Institute of Medical Research, Accra, Ghana
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Asante KP, Owusu-Agyei S, Cairns M, Dodoo D, Boamah EA, Gyasi R, Adjei G, Gyan B, Agyeman-Budu A, Dodoo T, Mahama E, Amoako N, Dosoo DK, Koram K, Greenwood B, Chandramohan D. Placental malaria and the risk of malaria in infants in a high malaria transmission area in ghana: a prospective cohort study. J Infect Dis 2013; 208:1504-13. [PMID: 23908483 DOI: 10.1093/infdis/jit366] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Whether the risk of malaria is increased in infants born to mothers who experience malaria during pregnancy is uncertain. METHODS We investigated malaria incidence among an infant cohort born to 355 primigravidae and 1500 multigravidae with or without placental malaria (PM) in a high malaria transmission area of Ghana. PM was assessed using placental histology. RESULTS The incidence of all episodes of malaria parasitemia or clinical malaria was very similar among 3 groups of infants: those born to multigravidae without PM, multigravidae with PM, and primigravidae with PM. Infants born to primigravidae without PM experienced a lower incidence of malaria parasitemia or clinical malaria than the other 3 groups: adjusted hazard ratio, 0.64 (95% confidence interval [CI], .48-.86, P < .01) and 0.60 (95% CI, .43-.84, P < .01), respectively. The incidence of malaria parasitemia or clinical malaria was about 2 times higher in most poor infants compared to least poor infants. CONCLUSIONS There was no suggestion that exposure to PM directly increased incidence of malaria among infants of multigravidae. In our study area, absence of placental malaria in primigravidae is a marker of low exposure, and this probably explains the lower incidence of malaria-related outcomes among infants of PM-negative primigravidae.
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Oduro A, Anyorigiya T, Anto F, Amenga-Etego L, Ansah N, Atobrah P, Ansah P, Koram K, Hodgson A. A randomized, comparative study of supervised and unsupervised artesunate–amodiaquine, for the treatment of uncomplicated malaria in Ghana. Annals of Tropical Medicine & Parasitology 2013; 102:565-76. [DOI: 10.1179/136485908x337508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Antwi E, Groenwold R, Janssen K, Browne J, Klipstein-Grobusch K, Agyepong I, Koram K, Franx A, Grobbee D. PP081. Predictors of pregnancy induced hypertension in an urban low resource setting. Pregnancy Hypertens 2013; 3:97. [PMID: 26105936 DOI: 10.1016/j.preghy.2013.04.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Hypertensive disorders in pregnancy, including Pregnancy Induced Hypertension (PIH), are important causes of morbidity and mortality in pregnancy. Identifying women at high risk will allow for early management to reduce complications of PIH. OBJECTIVES The objectives were to determine the incidence of PIH among pregnant women and develop risk prediction models for early detection of women at increased risk of PIH. METHODS A longitudinal cohort study involving 2539 pregnant women attending antenatal clinic in the Greater Accra region of Ghana was conducted between February and May 2010. The outcome, PIH, was defined as systolic or diastolic blood pressure BP of 140mmHg or 90mmHg respectively. Logistic regression was used to derive the prediction models and bootstrapping technique was used to internally validate them. A score chart was used to classify pregnant women into low, moderate and high risk of developing PIH. RESULTS The incidence of PIH was 8.0% (95% C.I: 7.98-8.02%) and 10.9% (95% C.I:10.89-10.91%) in nulliparous and multiparous women respectively. Systolic blood pressure, diastolic blood pressure, history of hypertension in parents, family history of diabetes, proteinuria, body mass index (BMI) were among independent predictors in early pregnancy of subsequent PIH. The prognostic performance, estimated by the area under the Receiver Operating Characteristic (ROC) curve, ranged between 0.64 and 0.84 for the models for nulliparous and multiparous. CONCLUSION Using a limited set of maternal characteristics, pregnant women at increased risk of developing PIH can be identified. Categorizing women by risk of PIH and providing tailored antenatal care will minimize complications of PIH.
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Dadzie S, Boakye D, Asoala V, Koram K, Kiszewski A, Appawu M. A community-wide study of malaria reduction: evaluating efficacy and user-acceptance of a low-cost repellent in northern Ghana. Am J Trop Med Hyg 2012; 88:309-14. [PMID: 23249683 DOI: 10.4269/ajtmh.2012.12-0370] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
NO MAS (NM) mosquito repellent was evaluated in two farming villages (4 km apart) in the Kassena Nankana district of northern Ghana. We determined its efficacy against local malaria vectors, degree of user acceptance, and its effect on malaria prevalence in households using insecticide-treated bed nets. The average protective efficacy of NM against Anopheles mosquitoes over 9 hours was 89.6%. Controls averaged 86 bites/person/night versus 9 bites/person/night with the use of NM. Use of repellent was associated with a decrease of absolute malaria prevalence by 19.2% in the repellent village and by 6.5% in the control village (45.5 to 26.3, and 29.5 to 23.0, respectively). The user-acceptance rate of NM repellent was 96.1%. Ten percent (10%) of repellent users reported irritation as the main adverse effect during the period. Eighty-five percent (85%) of the users found the odor of NM appealing and 87% reported no inconvenience in applying the repellent daily.
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Affiliation(s)
- Samuel Dadzie
- Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana.
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Abuaku B, Duah N, Quaye L, Quashie N, Koram K. Therapeutic efficacy of artemether-lumefantrine combination in the treatment of uncomplicated malaria among children under 5 years in 3 ecological zones in Ghana. Malar J 2012. [PMCID: PMC3474131 DOI: 10.1186/1475-2875-11-s1-p107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Tindana P, Bull S, Amenga-Etego L, de Vries J, Aborigo R, Koram K, Kwiatkowski D, Parker M. Seeking consent to genetic and genomic research in a rural Ghanaian setting: a qualitative study of the MalariaGEN experience. BMC Med Ethics 2012; 13:15. [PMID: 22747883 PMCID: PMC3441464 DOI: 10.1186/1472-6939-13-15] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 05/08/2012] [Indexed: 11/11/2022] Open
Abstract
Background Seeking consent for genetic and genomic research can be challenging, particularly in populations with low literacy levels, and in emergency situations. All of these factors were relevant to the MalariaGEN study of genetic factors influencing immune responses to malaria in northern rural Ghana. This study sought to identify issues arising in practice during the enrolment of paediatric cases with severe malaria and matched healthy controls into the MalariaGEN study. Methods The study used a rapid assessment incorporating multiple qualitative methods including in depth interviews, focus group discussions and observations of consent processes. Differences between verbal information provided during community engagement processes, and consent processes during the enrolment of cases and controls were identified, as well as the factors influencing the tailoring of such information. Results MalariaGEN participants and field staff seeking consent were generally satisfied with their understanding of the project and were familiar with aspects of the study relating to malaria. Some genetic aspects of the study were also well understood. Participants and staff seeking consent were less aware of the methodologies employed during genomic research and their implications, such as the breadth of data generated and the potential for future secondary research. Moreover, trust in and previous experience with the Navrongo Health Research Centre which was conducting the research influenced beliefs about the benefits of participating in the MalariaGEN study and subsequent decision-making about research participation. Conclusions It is important to recognise that some aspects of complex genomic research may be of less interest to and less well understood by research participants and that such gaps in understanding may not be entirely addressed by best practice in the design and conduct of consent processes. In such circumstances consideration needs to be given to additional protections for participants that may need to be implemented in such research, and how best to provide such protections. Capacity building for research ethics committees with limited familiarity with genetic and genomic research, and appropriate engagement with communities to elicit opinions of the ethical issues arising and acceptability of downstream uses of genome wide association data are likely to be important.
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Affiliation(s)
- Paulina Tindana
- The Ethox Centre, Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom
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Ibrahim F, Dosoo D, Kronmann KC, Ouedraogo I, Anyorigiya T, Abdul H, Sodiomon S, Owusu-Agyei S, Koram K. Good clinical laboratory practices improved proficiency testing performance at clinical trials centers in Ghana and Burkina Faso. PLoS One 2012; 7:e39098. [PMID: 22768062 PMCID: PMC3387181 DOI: 10.1371/journal.pone.0039098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 05/18/2012] [Indexed: 11/29/2022] Open
Abstract
Background The recent drive towards accreditation of clinical laboratories in Africa by the World Health Organization – Regional Office for Africa (WHO-AFRO) and the U.S Government is a historic step to strengthen health systems, provide better results for patients and an improved quality of results for clinical trials. Enrollment in approved proficiency testing (PT) programs and maintenance of satisfactory performance is vital in the process of accreditation. Passing proficiency testing surveys has posed a great challenge to many laboratories across sub-Saharan Africa. Our study was aimed at identifying the causes of unsatisfactory PT results in clinical research laboratories conducting or planning to conduct malaria vaccine trials sponsored by the National Institutes of Health (NIH). Methodology PT reports for 2009 and 2010 from the College of American Pathologists (CAP) for the laboratories were reviewed as part of the process. Errors accounting for unsatisfactory results were classified into clerical, methodological, technical, problem with PT materials, and random errors. A training program on good clinical laboratory practices (GCLP) was developed for each center to address areas for improvement. Results The major cause of PT failure in the four centers was methodological. The application of GCLP improved the success rate in the PT surveys from 58% in 2009 to 88% in 2010. It also decreased the error rate on PT by 35%. Conclusion A previous report from the CAP- PT participating laboratories indicated that the major causes of error were clerical. These types of errors were predominantly made in laboratories in the US, with much more experience in quality control, and varied significantly from what we found. In our centers in sub-Saharan Africa, methodological errors, and not clerical errors, accounted for the vast majority of errors. A process was started for continuous improvement which has decreased methodological errors by 35%, but more improvement is needed.
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Affiliation(s)
- Faisal Ibrahim
- United States Naval Medical Research Unit -3 Ghana Detachment, Accra, Ghana.
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Asare SY, Paintsil E, Koram K, Atuguba F, Asoala V, Humphries D. Relationship between nutritional status and the prevalence of malaria and anemia among children in the Kassena‐Nankana District of Ghana. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.28.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Kwadwo Koram
- EpidemiologyNoguchi Memorial Institute for Medical ResearchAccraGhana
| | | | | | - Debbie Humphries
- Epidemiology of Microbial DiseasesYale School of Public HealthNew HavenCT
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Yeboah-Manu D, Röltgen K, Opare W, Asan-Ampah K, Quenin-Fosu K, Asante-Poku A, Ampadu E, Fyfe J, Koram K, Ahorlu C, Pluschke G. Sero-epidemiology as a tool to screen populations for exposure to Mycobacterium ulcerans. PLoS Negl Trop Dis 2012; 6:e1460. [PMID: 22253937 PMCID: PMC3254650 DOI: 10.1371/journal.pntd.0001460] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 11/21/2011] [Indexed: 11/23/2022] Open
Abstract
Background Previous analyses of sera from a limited number of Ghanaian Buruli ulcer (BU) patients, their household contacts, individuals living in BU non-endemic regions as well as European controls have indicated that antibody responses to the M. ulcerans 18 kDa small heat shock protein (shsp) reflect exposure to this pathogen. Here, we have investigated to what extent inhabitants of regions in Ghana regarded as non-endemic for BU develop anti-18 kDa shsp antibody titers. Methodology/Principal Findings For this purpose we determined anti-18 kDa shsp IgG titers in sera collected from healthy inhabitants of the BU endemic Densu River Valley and the Volta Region, which was so far regarded as BU non-endemic. Significantly more sera from the Densu River Valley contained anti-18 kDa shsp IgG (32% versus 12%, respectively). However, some sera from the Volta Region also showed high titers. When interviewing these sero-responders, it was revealed that the person with the highest titer had a chronic wound, which was clinically diagnosed and laboratory reconfirmed as active BU. After identification of this BU index case, further BU cases were clinically diagnosed by the Volta Region local health authorities and laboratory reconfirmed. Interestingly, there was neither a difference in sero-prevalence nor in IS2404 PCR positivity of environmental samples between BU endemic and non-endemic communities located in the Densu River Valley. Conclusions These data indicate that the intensity of exposure to M. ulcerans in endemic and non-endemic communities along the Densu River is comparable and that currently unknown host and/or pathogen factors may determine how frequently exposure is leading to clinical disease. While even high serum titers of anti-18 kDa shsp IgG do not indicate active disease, sero-epidemiological studies can be used to identify new BU endemic areas. Sero-epidemiological analyses revealed that a higher proportion of sera from individuals living in the Buruli ulcer (BU) endemic Densu River Valley of Ghana contain Mycobacterium ulcerans 18 kDa small heat shock protein (shsp)-specific IgG than sera from inhabitants of the Volta Region, which was regarded so far as BU non-endemic. However, follow-up studies in the Volta Region showed that the individual with the highest anti-18 kDa shsp-specific serum IgG titer of all participants from the Volta Region had a BU lesion. Identification of more BU patients in the Volta Region by subsequent active case search demonstrated that sero-epidemiology can help identify low endemicity areas. Endemic and non-endemic communities along the Densu River Valley differed neither in sero-prevalence nor in positivity of environmental samples in PCR targeting M. ulcerans genomic and plasmid DNA sequences. A lower risk of developing M. ulcerans disease in the non-endemic communities may either be related to host factors or a lower virulence of local M. ulcerans strains.
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Affiliation(s)
- Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Katharina Röltgen
- Molecular Immunology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - William Opare
- National Buruli Ulcer Control Programme, Disease Control Unit - GHS, Accra, Ghana
| | - Kobina Asan-Ampah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Kwabena Quenin-Fosu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Adwoa Asante-Poku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Edwin Ampadu
- National Buruli Ulcer Control Programme, Disease Control Unit - GHS, Accra, Ghana
| | - Janet Fyfe
- Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Gerd Pluschke
- Molecular Immunology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Kweku MA, Odoom S, Puplampu N, Desewu K, Nuako GK, Gyan B, Raczniak G, Kronmann KC, Koram K, Botero S, Boakye D, Akuffo H. An outbreak of suspected cutaneous leishmaniasis in Ghana: lessons learnt and preparation for future outbreaks. Glob Health Action 2011; 4:GHA-4-5527. [PMID: 21765823 PMCID: PMC3137292 DOI: 10.3402/gha.v4i0.5527] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 05/22/2011] [Accepted: 05/30/2011] [Indexed: 11/14/2022] Open
Abstract
Human cutaneous leishmaniasis (CL) has previously been reported in West Africa, but more recently, sporadic reports of CL have increased. Leishmania major has been identified from Mauritania, Senegal, Mali, and Burkina Faso. Three zymodemes (MON-26, MON-117, and MON-74, the most frequent) have been found. The geographic range of leishmaniasis is limited by the sand fly vector, its feeding preferences, and its capacity to support internal development of specific species of Leishmania. The risk of acquiring CL has been reported to increase considerably with human activity and epidemics of CL have been associated with deforestation, road construction, wars, or other activities where humans intrude the habitat of the vector. In the Ho Municipality in the Volta Region of Ghana, a localised outbreak of skin ulcers, possibly CL, was noted in 2003 without any such documented activity. This outbreak was consistent with CL as evidenced using various methods including parasite identification, albeit, in a small number of patients with ulcers. This paper reports the outbreak in Ghana. The report does not address a single planned study but rather a compilation of data from a number of ad-hoc investigations in response to the outbreak plus observations and findings made by the authors. It acknowledges that a number of the observations need to be further clarified. What is the detailed epidemiology of the disease? What sparked the epidemic? Can it happen again? What was the causative agent of the disease, L. major or some other Leishmania spp.? What were the main vectors and animal reservoirs? What are the consequences for surveillance of the disease and the prevention of its reoccurrence when the communities see a self-healing disease and may not think it is important?
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Affiliation(s)
- Margaret A Kweku
- District Health Directorate, Ghana Health Service, Volta Region, Ghana
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Yeboah-Manu D, Asante-Poku A, Bodmer T, Stucki D, Koram K, Bonsu F, Pluschke G, Gagneux S. Genotypic diversity and drug susceptibility patterns among M. tuberculosis complex isolates from South-Western Ghana. PLoS One 2011; 6:e21906. [PMID: 21779354 PMCID: PMC3133566 DOI: 10.1371/journal.pone.0021906] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 06/14/2011] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to use spoligotyping and large sequence polymorphism (LSP) to study the population structure of M. tuberculosis complex (MTBC) isolates. Methods MTBC isolates were identified using standard biochemical procedures, IS6110 PCR, and large sequence polymorphisms. Isolates were further typed using spoligotyping, and the phenotypic drug susceptibility patterns were determined by the proportion method. Result One hundred and sixty-two isolates were characterised by LSP typing. Of these, 130 (80.25%) were identified as Mycobacterium tuberculosis sensu stricto (MTBss), with the Cameroon sub-lineage being dominant (N = 59/130, 45.38%). Thirty-two (19.75%) isolates were classified as Mycobacterium africanum type 1, and of these 26 (81.25%) were identified as West-Africa I, and 6 (18.75%) as West-Africa II. Spoligotyping sub-lineages identified among the MTBss included Haarlem (N = 15, 11.53%), Ghana (N = 22, 16.92%), Beijing (4, 3.08%), EAI (4, 3.08%), Uganda I (4, 3.08%), LAM (2, 1.54%), X (N = 1, 0.77%) and S (2, 1.54%). Nine isolates had SIT numbers with no identified sub-lineages while 17 had no SIT numbers. MTBss isolates were more likely to be resistant to streptomycin (p<0.008) and to any drug resistance (p<0.03) when compared to M. africanum. Conclusion This study demonstrated that overall 36.4% of TB in South-Western Ghana is caused by the Cameroon sub-lineage of MTBC and 20% by M. africanum type 1, including both the West-Africa 1 and West-Africa 2 lineages. The diversity of MTBC in Ghana should be considered when evaluating new TB vaccines.
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Affiliation(s)
- Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
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Egyir B, Brown C, Wilson M, Koram K. Distribution and Genetic Diversity of Plasmodium falciparum Erythrocyte Binding Antigen 175 and Clinical Outcome of Malaria in the Kassena-Nankana District. Int J Infect Dis 2008. [DOI: 10.1016/j.ijid.2008.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
A total of 198 patients were treated with amodiaquine for uncomplicated malaria. Parasite clearance at day 14 was 85.4 and 48% at day 28.
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Maïga O, Djimdé AA, Hubert V, Renard E, Aubouy A, Kironde F, Nsimba B, Koram K, Doumbo OK, Le Bras J, Clain J. A Shared Asian Origin of the Triple‐MutantdhfrAllele inPlasmodium falciparumfrom Sites across Africa. J Infect Dis 2007; 196:165-72. [PMID: 17538897 DOI: 10.1086/518512] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 01/26/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Usefulness of sulfadoxine-pyrimethamine as first-line therapy for uncomplicated Plasmodium falciparum malaria and intermittent preventive treatment in pregnancy throughout sub-Saharan Africa is compromised by the spread of dhfr alleles associated with pyrimethamine resistance. A predominant haplotype associated with the N51I+C59R+S108N triple-mutant dhfr allele has been reported recently in 4 African countries. A more comprehensive picture of the evolution of this mutant allele in Africa is lacking. METHODS Seventy-five P. falciparum isolates carrying the wild-type dhfr allele and 204 carrying the triple-mutant dhfr allele from 11 African countries were selected. The genetic diversity of the chromosomes bearing these alleles was analyzed with 4 microsatellite markers closely linked to the dhfr gene. RESULTS Seventy-three different 4-locus haplotypes carrying the wild-type dhfr allele were found. By contrast, 175 (85%) of 204 isolates carrying the triple-mutant dhfr allele shared a unique haplotype, identical to the one identified in Thailand. For the remaining triple-mutant isolates and one isolate with the quadruple-mutant dhfr allele (N51I+C59R+S108N+I164L), haplotypes were closely related to the predominant haplotype by mutation or recombination. CONCLUSIONS Migration of parasites carrying an ancestral triple-mutant dhfr allele drives the spread of dhfr alleles associated with pyrimethamine resistance throughout West and Central Africa.
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Abstract
We evaluated prospectively, compliance with the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines on termination of pregnancy (TOP) in a cohort of 340 women referred for termination of pregnancy in 2003 at South Tyneside Foundation Trust. The number of referrals represented one-fifth of all births in our unit during the study period. Teenagers were the largest single group of women requesting termination of pregnancy and the majority were nulliparous. There were 85 women who were seeking a repeat termination of pregnancy. The RCOG minimum referral standard was met in 80% of cases. A good number of women were unsure of their menstrual dates and only 5% had used emergency contraception. A total of 96% were either not using contraception, using condoms or taking oral contraceptives irregularly. A total of 50% of the women attended hospital without a Certificate A being completed by the referring practitioner. Surgical termination was preferred over medical termination in the cohort of women who could exercise a choice. It is possible to comply with the RCOG Termination of Pregnancy guidelines to a large extent in a District General Hospital, with some innovation. Close liaison between General Practitioners, Family Planning Clinics and Acute Hospitals is required. The adoption of agreed referral requirements and pathways would help in the delivery of a high quality service as advocated by the guideline.
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Affiliation(s)
- U Esen
- Department of Obstetrics and Gynaecology, South Tyneside NHS Foundation Trust, Harton Lane, South Shields, UK.
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Quashie NB, Ofori-Adjei D, Duah NO, Koram K. <i>In vitro</i> susceptibility of <i>Plasmodium falciparum</i> isolates to chloroquine and other antimalarial drugs in Ghana. Ghana Med J 2006. [DOI: 10.4314/gmj.v38i4.36009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Arnot DE, Koram K, Kilama W. Malaria vaccine research and testing in Africa. ACTA ACUST UNITED AC 2006; 14:254-6. [PMID: 17040776 DOI: 10.1016/s0169-4758(98)01240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- D E Arnot
- Institute of Cell, Animal and Population Biology, Edinburgh University, Ashworth Laboratories, King's Buildings, West Mains Road, Edinburgh, UK EH9 3JT
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Fryauff DJ, Hanafi HA, Klena JD, Hoel DF, Appawu M, Rogers W, Puplampu N, Odoom S, Kweku M, Koram K, Wilson MD, Raczniak G, Boakye D. Short report: ITS-1 DNA sequence confirmation of Leishmania major as a cause of cutaneous leishmaniasis from an outbreak focus in the Ho district, southeastern Ghana. Am J Trop Med Hyg 2006; 75:502-4. [PMID: 16968929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Affiliation(s)
- David J Fryauff
- Research Science Directorate, Enteric Disease Research Program, Vector Biology Research Program, Ghana Detachment, US Naval Medical Research Unit 3, Cairo, Egypt
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Ampofo W, Torpey K, Mukadi YD, Koram K, Nolan K, Amenyah R, Kaitoo E, Antwi P, Ofori-Adjei D, Lamptey P. Normal CD4+ T Lymphocyte Levels in HIV Seronegative Individuals in the Manya/Yilo Krobo Communities in the Eastern Region of Ghana. Viral Immunol 2006; 19:260-6. [PMID: 16817768 DOI: 10.1089/vim.2006.19.260] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The goal of this study was to determine the normal levels of CD4+ T lymphocytes in healthy individuals who were HIV seronegative in the Manya and Yilo Krobo Districts of Ghana's Eastern Region. This enabled comparisons with normal CD4 count ranges established by the World Health Organization (WHO). The study population consisted of 249 HIV-seronegative clients from a mobile free Voluntary Counseling and Testing (VCT) service in communities of the two districts during a one-month period. The mean CD4 count of these individuals was 1067 cells/microl with women demonstrating higher baseline CD4 counts than men. This study found a WHO comparable HIV seronegative baseline CD4 count as well as gender-based differences in the CD4 count and CD4/CD8 ratio. Establishment of the adult baseline for the country provides important demographic data and indicates the appropriateness of current global treatment guidelines with regards to CD4 levels in Ghana.
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Appawu M, Owusu-Agyei S, Dadzie S, Asoala V, Anto F, Koram K, Rogers W, Nkrumah F, Hoffman SL, Fryauff DJ. Malaria transmission dynamics at a site in northern Ghana proposed for testing malaria vaccines. Trop Med Int Health 2004; 9:164-70. [PMID: 14728621 DOI: 10.1046/j.1365-3156.2003.01162.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We studied the malaria transmission dynamics in Kassena Nankana district (KND), a site in northern Ghana proposed for testing malaria vaccines. Intensive mosquito sampling for 1 year using human landing catches in three micro-ecological sites (irrigated, lowland and rocky highland) yielded 18 228 mosquitoes. Anopheles gambiae s.l. and Anopheles funestus constituted 94.3% of the total collection with 76.8% captured from the irrigated communities. Other species collected but in relatively few numbers were Anopheles pharoensis (5.4%) and Anopheles rufipes (0.3%). Molecular analysis of 728 An. gambiae.s.l. identified Anopheles gambiae s.s. as the most dominant sibling species (97.7%) of the An. gambiae complex from the three ecological sites. Biting rates of the vectors (36.7 bites per man per night) were significantly higher (P<0.05) in the irrigated area than in the non-irrigated lowland (5.2) and rocky highlands (5.9). Plasmodium falciparum sporozoite rates of 7.2% (295/4075) and 7.1% (269/3773) were estimated for An. gambiae s.s. and An. funestus, respectively. Transmission was highly seasonal, and the heaviest transmission occurred from June to October. The intensity of transmission was higher for people in the irrigated communities than the non-irrigated ones. An overall annual entomological inoculation rate (EIR) of 418 infective bites was estimated in KND. There were micro-ecological variations in the EIRs, with values of 228 infective bites in the rocky highlands, 360 in the lowlands and 630 in the irrigated area. Approximately 60% of malaria transmission in KND occurred indoors during the second half of the night, peaking at daybreak between 04.00 and 06.00 hours. Vaccine trials could be conducted in this district, with timing dependent on the seasonal patterns and intensity of transmission taking into consideration the micro-geographical differences and vaccine trial objectives.
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Affiliation(s)
- Maxwell Appawu
- Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana.
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