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Tiedje KE, Oduro AR, Agongo G, Anyorigiya T, Azongo D, Awine T, Ghansah A, Pascual M, Koram KA, Day KP. Seasonal Variation in the Epidemiology of Asymptomatic Plasmodium falciparum Infections across Two Catchment Areas in Bongo District, Ghana. Am J Trop Med Hyg 2017; 97:199-212. [PMID: 28719306 DOI: 10.4269/ajtmh.16-0959] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Understanding the epidemiology of asymptomatic Plasmodium falciparum infections is critical for countries to move toward malaria elimination. Using different methods for parasite detection, we evaluated how seasonality, spatial location, and other factors affect the age-specific epidemiology of asymptomatic malaria in Bongo District, Ghana. Asymptomatic prevalence by microscopy decreased significantly from 42.5% at the end of the wet to 27.5% at the end of the dry season (P < 0.001). Using the 18S rRNA polymerase chain reactions (PCRs), all microscopy-negative samples were screened and prevalence of submicroscopic infections also decreased significantly from the wet (55.4%) to the dry (20.7%) season (P < 0.001). Combining detection methods, 74.4% and 42.5% of the population in the wet and dry seasons, respectively, had evidence of a P. falciparum infection. Interestingly in those > 20 years of age, we found evidence of infection in 64.3% of the population in the wet and 27.0% in the dry season. Using both microscopy and PCR, the asymptomatic P. falciparum reservoir peaks at the end of the wet season and infections in all age groups constitute the reservoir of malaria infection. At the end of the wet season, spatial heterogeneity in the prevalence and density of P. falciparum infections was observed between the two catchment areas surveyed in Bongo District. These results indicate that if elimination is to succeed, interventions will need to target not just P. falciparum infections in children but also in adults, and be implemented toward the end of the dry season in this area of West Africa.
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Affiliation(s)
- Kathryn E Tiedje
- Department of Microbiology, New York University, New York, New York.,School of BioSciences, Bio21 Institute/University of Melbourne, Melbourne, Australia
| | | | | | | | | | | | - Anita Ghansah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Mercedes Pascual
- Santa Fe Institute, Sante Fe, New Mexico.,Department of Ecology and Evolution, University of Chicago, Chicago, Illinois
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Karen P Day
- Department of Microbiology, New York University, New York, New York.,School of BioSciences, Bio21 Institute/University of Melbourne, Melbourne, Australia
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Chatio S, Aborigo R, Adongo PB, Anyorigiya T, Dalinjong PA, Akweongo P, Oduro A. Factors influencing adverse events reporting within the health care system: the case of artemisinin-based combination treatments in northern Ghana. Malar J 2016; 15:125. [PMID: 26921239 PMCID: PMC4769557 DOI: 10.1186/s12936-016-1172-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 02/17/2016] [Indexed: 11/19/2022] Open
Abstract
Background The use of artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria was a policy recommended by World Health Organization. In 2004, Ghana changed her first-line anti-malarial drug policy to use ACT. This study examined factors affecting adverse events reporting in northern Ghana after the introduction of ACT. Methods This was a qualitative study based on sixty in-depth interviews with health workers, chemical shop owners and patients with malaria who were given ACT at the health facilities. Purposive sampling method was used to select study participants. The interviews were transcribed, coded into themes using Nvivo 9 software. The thematic analysis framework was used to analyse the data. Results Study respondents reported body weakness and dizziness as the most frequent side effects they had experienced from the used of ACT. Other side effects they reported were swollen testes, abdominal pain and shivering. These side effects were mostly associated with the use of artesunate-amodiaquine compared to other artemisinin-based combinations. Patients were not provided information about the side effects of the drugs and so did not report when they experienced them. Also long queues at health facilities and unfriendly health worker attitude were the main factors affecting adverse events reporting. Other factors such as wrong use of ACT at home, farming and commercial activities also affected effective adverse events reporting in the study area. Conclusion Patients’ lack of knowledge and health sector drawbacks affected side effect reporting on ACT. Intensive health education on likely side effects of ACT should be provided to patients by health workers. Also, improving health worker attitude toward clients will encourage patients to visit the health facilities when they react negatively to ACT and, subsequently, will improve on adverse events reporting.
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Affiliation(s)
- Samuel Chatio
- Navrongo Health Research Centre, P.O Box 114, Navrongo, Ghana.
| | - Raymond Aborigo
- Navrongo Health Research Centre, P.O Box 114, Navrongo, Ghana.
| | - Philip Baba Adongo
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
| | | | | | - Patricia Akweongo
- School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
| | - Abraham Oduro
- Navrongo Health Research Centre, P.O Box 114, Navrongo, Ghana.
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Mukanga D, Tiono AB, Anyorigiya T, Källander K, Konaté AT, Oduro AR, Tibenderana JK, Amenga-Etego L, Sirima SB, Cousens S, Barnish G, Pagnoni F. Integrated community case management of fever in children under five using rapid diagnostic tests and respiratory rate counting: a multi-country cluster randomized trial. Am J Trop Med Hyg 2015; 87:21-29. [PMID: 23136274 PMCID: PMC3748518 DOI: 10.4269/ajtmh.2012.11-0816] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 11/25/2022] Open
Abstract
Evidence on the impact of using diagnostic tests in community case management of febrile children is limited. This effectiveness trial conducted in Burkina Faso, Ghana, and Uganda, compared a diagnostic and treatment package for malaria and pneumonia with presumptive treatment with anti-malarial drugs; artemisinin combination therapy (ACT). We enrolled 4,216 febrile children between 4 and 59 months of age in 2009–2010. Compliance with the malaria rapid diagnostic test (RDT) results was high in the intervention arm across the three countries, with only 4.9% (17 of 344) of RDT-negative children prescribed an ACT. Antibiotic overuse was more common: 0.9% (4 of 446) in Uganda, 38.5% (114 of 296) in Burkina Faso, and 44.6% (197 of 442) in Ghana. Fever clearance was high in both intervention and control arms at both Day 3 (97.8% versus 96.9%, P = 0.17) and Day 7 (99.2% versus 98.8%, P = 0.17). The use of diagnostic tests limits overuse of ACTs. Its impact on antibiotic overuse and on fever clearance is uncertain.
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Affiliation(s)
- David Mukanga
- *Address correspondence to David Mukanga, School of Public Health, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda. E-mail:
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Duffy CW, Assefa SA, Abugri J, Amoako N, Owusu-Agyei S, Anyorigiya T, MacInnis B, Kwiatkowski DP, Conway DJ, Awandare GA. Comparison of genomic signatures of selection on Plasmodium falciparum between different regions of a country with high malaria endemicity. BMC Genomics 2015; 16:527. [PMID: 26173872 PMCID: PMC4502944 DOI: 10.1186/s12864-015-1746-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 03/06/2015] [Accepted: 07/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genome wide sequence analyses of malaria parasites from widely separated areas of the world have identified contrasting population structures and signatures of selection. To compare relatively closely situated but ecologically contrasting regions within an endemic African country, population samples of Plasmodium falciparum clinical isolates were collected in Ghana from Kintampo in the central forest-savannah area, and Navrongo in a drier savannah area ~350 km to the north with more seasonally-restricted transmission. Parasite DNA was sequenced and paired-end reads mapped to the P. falciparum reference genome. RESULTS High coverage genome wide sequence data for 85 different clinical isolates enabled analysis of 121,712 single nucleotide polymorphisms (SNPs). The local populations had similar proportions of mixed genotype infections, similar SNP allele frequency distributions, and eleven chromosomal regions had elevated integrated haplotype scores (|iHS|) in both. A between-population Rsb metric comparing extended haplotype homozygosity indicated a stronger signal within Kintampo for one of these regions (on chromosome 14) and in Navrongo for two of these regions (on chromosomes 10 and 13). At least one gene in each of these identified regions is a potential target of locally varying selection. The candidates include genes involved in parasite development in mosquitoes, members of variant-expressed multigene families, and a leading vaccine-candidate target of immunity. CONCLUSIONS Against a background of very similar population structure and selection signatures in the P. falciparum populations of Ghana, three narrow genomic regions showed evidence indicating local differences in historical timing or intensity of selection. Sampling of closely situated populations across heterogeneous environments has potential to refine the mapping of important loci under temporally or spatially varying selection.
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Affiliation(s)
- Craig W Duffy
- Pathogen Molecular Biology Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - Samuel A Assefa
- Pathogen Molecular Biology Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - James Abugri
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Box LG 54, Volta Road, Legon, Accra, Ghana. .,Department of Applied Chemistry and Biochemistry, University for Development Studies, Tamale, Ghana.
| | | | - Seth Owusu-Agyei
- Pathogen Molecular Biology Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK. .,Kintampo Health Research Centre, Kintampo, Ghana.
| | | | | | - Dominic P Kwiatkowski
- Wellcome Trust Sanger Institute, Hinxton, UK. .,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.
| | - David J Conway
- Pathogen Molecular Biology Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - Gordon A Awandare
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Box LG 54, Volta Road, Legon, Accra, Ghana.
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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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Oduro AR, Anyorigiya T, Adjuik M, Afful TM, Anto F, Atuguba F, Owusu-Agyei S, Hodgson A. A randomized, comparative study of two regimens of β-artemether for the treatment of uncomplicated,Plasmodium falciparummalaria, in northern Ghana. Annals of Tropical Medicine & Parasitology 2013; 98:433-40. [PMID: 15257791 DOI: 10.1179/000349804225003532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In Ghana, wide-spread resistance to chloroquine has necessitated the drug's replacement as the first-line treatment for malaria, both to increase the likelihood of cure and to reduce transmission. To see if beta-artemether could be a suitable alternative to chloroquine, 223 adults (aged > or = 15 years) with uncomplicated, Plasmodium falciparum malaria were each given a total dose of 480 mg beta-artemether over 4 or 5 days. The patients were randomly allocated to receive an initial, loading dose of 80 or 160 mg, and were checked on days 1, 2, 3, 4 (or 5), 7 and 14, for fever clearance and any adverse events. Blood samples collected on days 0, 4 (or 5), 7 and 14 were smeared so that levels of parasitaemia could be evaluated. Haemoglobin concentrations on days 0 and 14 were also determined. In terms of the clinical cure 'rates' estimated in the intention-to-treat analysis (92.5% v. 97.4%) and the evaluability analysis (98.9% v. 100%), and of the frequency of parasitological cure by day 14 (97.0% v. 96.5%), the patients given an initial dose of 80 mg were similar to those given 160 mg as the loading dose. The regimen with the 160-mg loading dose appears as safe and as effective as the regimen with an initial dose of 80 mg. Since the regimen with the higher loading dose is shorter and involves fewer treatments than the other regimen, it would probably be associated with better compliance.
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Affiliation(s)
- A R Oduro
- Navrongo Health Research Centre, P. O. Box 114, Navrongo, Ghana and Navrongo War Memorial Hospital, P. O. Box 34, Navrongo, Ghana.
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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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Ghansah A, Rockett KA, Clark TG, Wilson MD, Koram KA, Oduro AR, Amenga-Etego L, Anyorigiya T, Hodgson A, Milligan P, Rogers WO, Kwiatkowski DP. Haplotype analyses of haemoglobin C and haemoglobin S and the dynamics of the evolutionary response to malaria in Kassena-Nankana District of Ghana. PLoS One 2012; 7:e34565. [PMID: 22506028 PMCID: PMC3323552 DOI: 10.1371/journal.pone.0034565] [Citation(s) in RCA: 14] [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: 09/19/2011] [Accepted: 03/02/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Haemoglobin S (HbS) and C (HbC) are variants of the HBB gene which both protect against malaria. It is not clear, however, how these two alleles have evolved in the West African countries where they co-exist at high frequencies. Here we use haplotypic signatures of selection to investigate the evolutionary history of the malaria-protective alleles HbS and HbC in the Kassena-Nankana District (KND) of Ghana. METHODOLOGY/PRINCIPAL FINDINGS The haplotypic structure of HbS and HbC alleles was investigated, by genotyping 56 SNPs around the HBB locus. We found that, in the KND population, both alleles reside on extended haplotypes (approximately 1.5 Mb for HbS and 650 Kb for HbC) that are significantly less diverse than those of the ancestral HbA allele. The extended haplotypes span a recombination hotspot that is known to exist in this region of the genome SIGNIFICANCE Our findings show strong support for recent positive selection of both the HbS and HbC alleles and provide insights into how these two alleles have both evolved in the population of northern Ghana.
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Affiliation(s)
- Anita Ghansah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
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Anto F, Asoala V, Anyorigiya T, Oduro A, Adjuik M, Akweongo P, Aborigo R, Bimi L, Amankwa J, Hodgson A. Simultaneous administration of praziquantel, ivermectin and albendazole, in a community in rural northern Ghana endemic for schistosomiasis, onchocerciasis and lymphatic filariasis. Trop Med Int Health 2011; 16:1112-9. [DOI: 10.1111/j.1365-3156.2011.02814.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Oduro AR, Fryauff DJ, Koram KA, Rogers WO, Anto F, Atuguba F, Anyorigiya T, Adjuik M, Ansah P, Hodgson A, Nkrumah F. Sulfadoxine-pyrimethamine-based intermittent preventive treatment, bed net use, and antenatal care during pregnancy: demographic trends and impact on the health of newborns in the Kassena Nankana District, northeastern Ghana. Am J Trop Med Hyg 2010; 83:79-89. [PMID: 20595482 DOI: 10.4269/ajtmh.2010.10-0066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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
Demographics and health practices of 2,232 pregnant women in rural northeastern Ghana and characteristics of their 2,279 newborns were analyzed to determine benefits associated with intermittent preventive treatment (IPTp), antenatal care, and/or bed net use during pregnancy. More than half reported bed net use, 90% reported at least two antenatal care visits, and > 82% took at least one IPTp dose of sulfadoxine-pyrimethamine. Most used a bed net and IPTp (45%) or IPTp alone (38%). Low birth weight (< 2,500 grams) characterized 18.3% of the newborns and was significantly associated with female sex, Nankam ethnicity, first-born status, and multiple births. Among newborns of primigravidae, IPTp was associated with a significantly greater birth weight, significantly fewer low birth weight newborns, improved hemoglobin levels, and less anemia. Babies of multigravidae derived no benefit to birth weight or hemoglobin level from single or multiple doses of sulfadoxine-pyrimethamine during pregnancy. No differences or benefits were seen when a bed net was the only protective factor.
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Anto F, Asoala V, Anyorigiya T, Oduro A, Adjuik M, Owusu-Agyei S, Dery D, Bimi L, Hodgson A. Insecticide resistance profiles for malaria vectors in the Kassena-Nankana district of Ghana. Malar J 2009; 8:81. [PMID: 19389257 PMCID: PMC2685403 DOI: 10.1186/1475-2875-8-81] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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: 11/17/2008] [Accepted: 04/23/2009] [Indexed: 11/13/2022] Open
Abstract
Background Malaria is a major public health problem in Ghana. The current strategy of the National Malaria Control Programme is based on effective case management and the use of insecticide treated bed nets among vulnerable groups such as children under-five years of age and pregnant women. Resistance to pyrethroids by Anopheles gambiae s.l. and Anopheles funestus has been reported in several African countries including neighbouring Burkina Faso. Methods Indoor resting Anopheles mosquitoes were collected. Blood-fed and gravid females were allowed to oviposit, eggs hatched and larvae reared to 1–3 days old adults and tested against permethrin 0.75%, deltamethrin 0.05%, cyfluthrin 0.15%, lambdacyhalothrin 0.1% and DDT 4%, based on WHO methodology. PCR analyses were carried out on a sub-sample of 192 of the An. gambiae for sibling species complex determination. Resistance to pyrethroids and DDT was determined by genotyping the knock-down resistance kdr gene mutations in the study area. Results A total of 9,749 1–3 days-old F1 female Anopheles mosquitoes were exposed to the insecticides. Among the pyrethroids, permethrin, 0.75% had the least knockdown effect, whilst cyfluthrin 0.15%, had the highest knock-down effect. Overall, no difference in susceptibility between An. gambiae 93.3% (95% CI: 92.5–94.1) and An. funestus 94.5% (95% CI: 93.7–95.3) was observed when exposed to the pyrethroids. Similarly, there was no difference in susceptibility between the two vector species (An. gambiae = 79.1% (95% CI: 76.6–81.8) and An. funestus = 83.5% (95% CI: 80.2–86.4) when exposed to DDT. Overall susceptibility to the insecticides was between 80% and 98%, suggesting that there is some level of resistance, except for cyfluthrin 0.15%. The kdr PCR assay however, did not reveal any kdr mutations. The analysis also revealed only the molecular M (Mopti) form. Conclusion The findings in this study show that An. gambiae and An. funestus, the main malaria vector mosquitoes in the Kassena-Nankana district are susceptible to the insecticides being used in the treatment of bed nets in the malaria control programme. There is however, the need for continuous monitoring of the pyrethroids as the efficacy is not very high.
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Affiliation(s)
- Francis Anto
- Navrongo Health Research Centre, Navrongo Health Research Centre, Ghana Health Service, P O Box 114, Navrongo, Upper East Region, Ghana.
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Oduro AR, Aborigo RA, Amugsi D, Anto F, Anyorigiya T, Atuguba F, Hodgson A, Koram KA. Understanding and retention of the informed consent process among parents in rural northern Ghana. BMC Med Ethics 2008; 9:12. [PMID: 18565230 PMCID: PMC2443367 DOI: 10.1186/1472-6939-9-12] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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: 05/21/2007] [Accepted: 06/19/2008] [Indexed: 11/23/2022] Open
Abstract
Background The individual informed consent model remains critical to the ethical conduct and regulation of research involving human beings. Parental informed consent process in a rural setting of northern Ghana was studied to describe comprehension and retention among parents as part of the evaluation of the existing informed consent process. Methods The study involved 270 female parents who gave consent for their children to participate in a prospective cohort study that evaluated immune correlates of protection against childhood malaria in northern Ghana. A semi-structured interview with questions based on the informed consent themes was administered. Parents were interviewed on their comprehension and retention of the process and also on ways to improve upon the existing process. Results The average parental age was 33.3 years (range 18–62), married women constituted a majority (91.9%), Christians (71.9%), farmers (62.2%) and those with no formal education (53.7%). Only 3% had ever taken part in a research and 54% had at least one relation ever participate in a research. About 90% of parents knew their children were involved in a research study that was not related to medical care, and 66% said the study procedures were thoroughly explained to them. Approximately, 70% recalled the study involved direct benefits compared with 20% for direct risks. The majority (95%) understood study participation was completely voluntary but only 21% recalled they could withdraw from the study without giving reasons. Younger parents had more consistent comprehension than older ones. Maternal reasons for allowing their children to take part in the research were free medical care (36.5%), better medical care (18.8%), general benefits (29.4%), contribution to research in the area (8.8%) and benefit to the community (1.8%). Parental suggestions for improving the consent process included devoting more time for explanations (46.9%), use of the local languages (15.9%) and obtaining consent at home (10.3%). Conclusion Significant but varied comprehension of the informed consent process exists among parents who participate in research activities in northern Ghana and it appears the existing practices are fairly effective in informing research participants in the study area.
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Affiliation(s)
- Abraham R Oduro
- Navrongo health research centre, Ghana health service, Box 114, Navrongo, Ghana.
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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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Oduro AR, Koram KA, Rogers W, Atuguba F, Ansah P, Anyorigiya T, Ansah A, Anto F, Mensah N, Hodgson A, Nkrumah F. Severe falciparum malaria in young children of the Kassena-Nankana district of northern Ghana. Malar J 2007; 6:96. [PMID: 17662142 PMCID: PMC1950879 DOI: 10.1186/1475-2875-6-96] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [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: 01/12/2007] [Accepted: 07/27/2007] [Indexed: 11/22/2022] Open
Abstract
Study design Severe falciparum malaria in children was studied as part of the characterization of the Kassena-Nankana District Ghana for future malaria vaccine trials. Children aged 6–59 months with diagnosis suggestive of acute disease were characterized using the standard WHO definition for severe malaria. Results Of the total children screened, 45.2% (868/1921) satisfied the criteria for severe malaria. Estimated incidence of severe malaria was 3.4% (range: 0.4–8.3%) cases per year. The disease incidence was seasonal: 560 cases per year, of which 70.4% occurred during the wet season (June-October). The main manifestations were severe anaemia (36.5%); prolonged or multiple convulsions (21.6%); respiratory distress (24.4%) and cerebral malaria (5.4%). Others were hyperpyrexia (11.1%); hyperparasitaemia (18.5%); hyperlactaemia (33.4%); and hypoglycaemia (3.2%). The frequency of severe anaemia was 39.8% in children of six to 24 months of age and 25.9% in children of 25–60 months of age. More children (8.7%) in the 25–60 months age group had cerebral malaria compared with 4.4% in the 6–24 months age group. The overall case fatality ratio was 3.5%. Cerebral malaria and hyperlactataemia were the significant risk factors associated with death. Severe anaemia, though a major presentation, was not significantly associated with risk of death. Conclusion Severe malaria is a frequent and seasonal childhood disease in northern Ghana and maybe an adequate endpoint for future malaria vaccine trials.
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Affiliation(s)
- Abraham R Oduro
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Kwadwo A Koram
- Noguchi Memorial Institute for Medical Research, UG, Box 25, Legon, Accra, Ghana
| | - William Rogers
- Naval Medical Research Centre, Malaria Program, Silver Spring, Maryland, USA
| | - Frank Atuguba
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Patrick Ansah
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | | | - Akosua Ansah
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Francis Anto
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Nathan Mensah
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Abraham Hodgson
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana
| | - Francis Nkrumah
- Noguchi Memorial Institute for Medical Research, UG, Box 25, Legon, Accra, Ghana
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15
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Aduro AR, Owusu-Agyei S, Anyorigiya T, Adjuik M, Hodgson A. Efficacy and acceptability of oral artemether (Artemos<sup>TM</sup>) for the treatment of acute uncomplicated malaria in Ghana. Ghana Med J 2006. [DOI: 10.4314/gmj.v38i2.36000] [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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16
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Anto F, Aryeetey ME, Anyorigiya T, Asoala V, Kpikpi J. The relative susceptibilities of juvenile and adult Bulinus globosus and Bulinus truncatus to the molluscicidal activities in the fruit of Ghanaian Blighia sapida, Blighia unijugata and Balanites aegyptiaca. Ann Trop Med Parasitol 2005; 99:211-7. [PMID: 15814040 DOI: 10.1179/136485905x24229] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The relative susceptibilities of juvenile (2- to 3-week-old) and adult (5- to 7-week-old) Bulinus globosus and Bu. truncatus to the molluscicidal activities of aqueous preparations of the powdered, dried fruits of Blighia sapida, Bl. unijugata and Balanites aegyptiaca were investigated under laboratory conditions. For the extract prepared from the freeze-dried, semi-ripe fruits of Bl. sapida, the concentrations killing 95% of the snails after an exposure for 24 h (LC95) were, respectively, 232.7 and 161.2 ppm for the juveniles and adults of Bu. globosus and 187.6 and 140.2 ppm for the juveniles and adults of Bu. truncatus. The corresponding values for Bl. unijugata were 136.9 and 98.7 ppm for Bu. globosus and 132.2 and 98.5 ppm for Bu. truncatus, respectively. Extracts of the freeze-dried, ripe fruit of Ba. aegyptiaca were much more active, however, giving LC95 of just 16.9 and 19.7 ppm for the juveniles and adults of Bu. globosus, and 14.2 and 12.0 ppm for the juveniles and adults of Bu. truncatus, respectively. In general, similar results were obtained when the fruit were oven-dried rather than freeze-dried but the potency of Balanites extracts produced from oven-dried fruit was relatively low. That the juvenile snails appeared less susceptible than the adults to the molluscicidal activity in each Blighia extract is interesting. This observation may have implications for snail control, in terms of the optimal frequency, timing and concentration of molluscicides applied in a particular habitat.
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Affiliation(s)
- F Anto
- Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana.
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17
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Oduro AR, Anyorigiya T, Hodgson A, Ansah P, Anto F, Ansah NA, Atuguba F, Mumuni G, Amankwa J. A randomized comparative study of chloroquine, amodiaquine and sulphadoxine-pyrimethamine for the treatment of uncomplicated malaria in Ghana. Trop Med Int Health 2005; 10:279-84. [PMID: 15730512 DOI: 10.1111/j.1365-3156.2004.01382.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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: 11/28/2022]
Abstract
The study examined the efficacy of chloroquine (CQ), amodiaquine (AQ) and sulphadoxine-pyrimethamine (SP) for the treatment of uncomplicated Plasmodium falciparum malaria in Ghana. A total of 351 children were randomized to receive either of the three study drugs. Patients were evaluated using the WHO 14-day in vivo antimalarial testing guidelines. The 14-day adequate clinical and parasitological response analysis revealed that CQ, 46.7% (95% CI 37.5, 56.0) has the least efficacy compared with AQ, 86.1% (95% CI 78.3, 91.8) and SP, 77.6% (95% CI 68.9, 84.8). Late parasite failures were also lower and similar in the AQ and SP (9.6% and 10.3%) than in the CQ (32.5%) group. However, CQ and AQ groups showed better fever clearance compared with SP throughout except for day 7 and after when possibly due to its significant late clinical failures, clearance by CQ was lower. Our findings suggest that CQ is no longer useful in Ghana and should be replaced as a first-line treatment of malaria. Replacement of CQ preferably with AQ combination treatment will be an effective and an affordable alternative for the treatment of uncomplicated malaria.
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