Strengthening surveillance in Ghana against public health emergencies of international concern.

Among western African countries, the Republic of Ghana has maintained an economic growth rate of 5% since the 1980s and is now categorized as a middle-income country. However, as with other developing countries, Ghana still has challenges in the effective implementation of surveillance for infectious diseases. Facing public health emergencies of international concern (PHEIC), it is crucial to establish a reliable sample transportation system to the referral laboratory. Previously, surveillance capacity in Ghana was limited based on Integrated Disease Surveillance and Response, and therefore the "Surveillance and Laboratory Support for Emerging Pathogens of Public Health Importance in Ghana (SLEP)" was introduced to strengthen diarrhea surveillance. The SLEP project started with a sentinel diarrhea survey supported by SATREPS/JICA in collaboration with National Public Health Reference Laboratory (NHPRL) and Noguchi Memorial Institute of Medicine (NMIMR). The base-line survey revealed the limited capacity to detect diarrhea pathogens and to transfer samples from health centers to NHPRL. The involvement of private clinic/hospital facilities into the surveillance network is also crucial to strengthen surveillance in Ghana. The strong and interactive relationship between the two top referral laboratories, NHPRL under the Ministry of Health NMIMR and under the Ministry of Education, enables Ghana Health Services and is critical for the rapid response against PHEIC. In future, we hope that the outcome of the SLEP surveillance project could contribute to building a surveillance network with more timely investigation and transfer of samples to referral labs.

Gut microbiota signature of pathogen-dependent dysbiosis in viral gastroenteritis.

Acute gastroenteritis associated with diarrhea is considered a serious disease in Africa and South Asia. In this study, we examined the trends in the causative pathogens of diarrhea and the corresponding gut microbiota in Ghana using microbiome analysis performed on diarrheic stools via 16S rRNA sequencing. In total, 80 patients with diarrhea and 34 healthy adults as controls, from 2017 to 2018, were enrolled in the study. Among the patients with diarrhea, 39 were norovirus-positive and 18 were rotavirus-positive. The analysis of species richness (Chao1) was lower in patients with diarrhea than that in controls. Beta-diversity analysis revealed significant differences between the two groups. Several diarrhea-related pathogens (e.g., Escherichia-Shigella, Klebsiella and Campylobacter) were detected in patients with diarrhea. Furthermore, co-infection with these pathogens and enteroviruses (e.g., norovirus and rotavirus) was observed in several cases. Levels of both Erysipelotrichaceae and Staphylococcaceae family markedly differed between norovirus-positive and -negative diarrheic stools, and the 10 predicted metabolic pathways, including the carbohydrate metabolism pathway, showed significant differences between rotavirus-positive patients with diarrhea and controls. This comparative study of diarrheal pathogens in Ghana revealed specific trends in the gut microbiota signature associated with diarrhea and that pathogen-dependent dysbiosis occurred in viral gastroenteritis.

Diet diversity was limited in Malawi resulting in stunting despite availability of foods in markets.

BACKGROUND: Stunting, the most common type of malnutrition, has been a big burden for developing countries such as the Republic of Malawi. The state of malnutrition and the eating behavior of children were surveyed at the border between Malawi and Zambia using anthropometrical measurements and Household Diet Diversity Scores. METHODS: Two rural sites were chosen to compare the impact of empowering communities with nutritional knowledge. Children between 6 months and 5 years old were randomly recruited to evaluate nutritional status. Their caregivers were interviewed to collect Household Dietary Diversity Scores. RESULTS: Nutritional knowledge at the site where intervention had occurred was higher than at the site where intervention had not yet occurred. However, stunting prevalence at the site where intervention occurred was not statistically lower than site that had not experienced intervention. The Household Dietary Diversity Scores study revealed that some kinds of food groups were almost absent such as organ meat (kidney, liver, and heart), and dairy products but that cereals, spices, and other vegetables were almost 100% taken at both sites, and distance from market was not associated with diet diversity. CONCLUSIONS: The fact that food diversity was not associated with distance from market would explain the limited food accessibility and poor utilization. Although animal resource foods are available at market, they were not been consumed. The profound challenge lays in their accessibility and utilization. A successful project would aim to introduce vitamin A-rich vegetables and would explore the sustainable production of animal resource foods in the community.