Assessing expanded community wide treatment for schistosomiasis: Baseline infection status and self-reported risk factors in three communities from the Greater Accra region, Ghana

BACKGROUND

This paper reports on the baseline prevalence and associated risk factor findings of a pilot, longitudinal study exploring community-wide treatment of schistosomiasis and soil-transmitted helminthiasis, using albendazole plus praziquantel in the Greater Accra region of Ghana.

METHOD

From three communities, at least, 658 individuals were enrolled into the study via random household selection. Prevalence and intensity of schistosomiasis and STH infection were determined from stool and urine samples with a questionnaire being administered in order to explore other morbidities and risk factors. Factor analysis of household demographic variables was undertaken to generate a socioeconomic score; this was then further categorised into tertiles. Proportional-odds cumulative logit generalised estimating equation (GEE) models were used to investigate categorical ordinal intensity of infection associations with morbidity. Separately, logistic GEE models were used to investigate risk factor associations with infection prevalence.

RESULTS

Both Schistosoma haematobium and S. mansoni were prevalent in the three communities, with the prevalence of S. haematobium ranging from 3.3% (24/679; 95% CI = 1.9-4.7) to 19% (114/632; 95% CI = 15.8-22.2) and S. mansoni ranging from 30% (202/679; 95% CI = 26.5-33.5) to 78.3% (409/536; 95% CI = 74.7-81.9). The total prevalence of STH across all three sites was negligible at 1.3% (24/1847; 95% CI = 0.8-1.9) comprising mainly hookworm (10/1847). Multivariable statistical models indicated males to be 2.3 (95% CI = 1.7-3.3) times more likely to have a high intensity S. mansoni infection and 1.5 (95% CI = 1.1-2) times more likely to have a high intensity of S. haematobium infection compared to females. There was no significant difference in the likelihood of infection with S. mansoni between adults and school age children (SAC), however S. haematobium infections were found to be 2.5 (95% CI = 1.8-3.5) times more likely to occur in school age children than in adults. Multivariable statistical models (adjusted for age and sex) indicated an association between schistosomiasis and a number of self-reported morbidity indicators (notably diarrhoea and blood in stool and urine). Low socio-economic status was also associated with SCH infection (OR: 2; 95% CI = 1.3-3.2).

CONCLUSION

The communities targeted by this study showed a range of Schistosoma prevalence's of infection, from hypo-endemic through to meso-endemic and hyper-endemic. The prevalence of SCH across the different age groups in the study locations highlights the large number of individuals currently being left out of the standard morbidity control method of annual treatment of the SAC.

Microbiological evaluation of ghanaian maize dough co-fermented with cowpea

Fermented maize dough meals form a large proportion of people's diet in Ghana. To enhance the nutritive value of these carbohydrate-rich foods, protein complementation was introduced. In this study, microbial ecology of fermenting maize dough fortified with 20% cowpea was investigated. A total of 106 microbial strains were isolated from different batches of the fermenting dough at periodic intervals. Ten genera of microorganisms namely Lactobacillus, Leuconostoc, Saccharomyces, Debaryomyces, Candida, Bacillus, Micrococcus, Klebsiella, Escherichia and Aspergillus were identified, with lactic acid bacteria species being predominant. A lactic count of log 9.9 cfu/g was obtained at the end of 72 h fermentation relative to log 6.6 cfu/g recorded for aerobic mesophiles. At the 12 h fermentation period, the population of yeasts was less than log 1.0 cfu/g, but gradually rose to log 5.36 cfu/g by 48 h followed a slight decline at the end of 72 h fermentation period (log 4.08 cfu/g). Enteric microorganisms that were isolated from the raw cowpea were less than log 1.0 cfu/g at 12 h of fermentation, while the Aspergillus species were isolated from the raw maize and the dough subjected to drying treatment. The growth of inoculated enteropathogenic E. coli and S. typhimurium was inhibited in the cooked, fermented maize-cowpea dough, and at 72 h, they were not within detectable limit. The study concluded that addition of cowpea at 20% level did not affect the natural fermentation characteristics of the maize dough.

Influence of processing conditions on the nutritive value of Ogi-baba, a Nigerian fermented sorghum gruel

The effect of germination, cowpea fortification and fermentation on the chemical and amino acid composition of ogi-baba, a Nigerian fermented sorghum gruel was investigated. The lowest protein value of 1.4% was obtained in the traditionally prepared sample, while samples prepared from germinated, fortified sorghum had 13%. The ash ranged from 0.9% to above 2%, while the fat was in the range of 1.2% to 2.8%. Generally, fortification, in addition to germination, improved the chemical composition of ogi-baba relative to the control sample. There was improvement in the amino acid profile of all the ogi-baba samples compared to the unprocessed sorghum grains. Lysine, a limiting amino acid in sorghum, increased more than 50% in ogi-baba. However, samples prepared using germinated sorghum without the addition of cowpeas had a lower lysine content.