The BLOODSAFE program: Building the future of access to safe blood in Sub-Saharan Africa.

BACKGROUND: The supply of blood in many low- and middle-income nations in Sub-Saharan Africa (SSA) does not meet the patient care needs. Lack and delay of blood transfusion cause harm to patients and slow the rate of progress in other parts of the health system. Recognizing the power of implementation science, the BLOODSAFE Program was initiated which supports three SSA research study teams and one data coordinating center (DCC) with the goal to improve access to safe blood transfusion in SSA. STUDY DESIGN AND METHODS: The study team in Ghana is focusing on studying and decreasing iron deficiency in blood donors and evaluating social engagement of blood donors through different approaches. The study team in Kenya is building a "vein to vein" workflow model to elucidate and devise strategies to overcome barriers to blood donation and improve infrastructural components of blood product production and use. The Malawi team is studying the infectious disease ramifications of blood donation as well as blood donor retention strategies aimed at blood donors who commence their donation career in secondary schools. RESULTS AND DISCUSSION: Together the project teams and the DCC work as a consortium to support each other through a shared study protocol that will study donor motivations, outcomes, and adverse events across all three countries. The BLOODSAFE Program has the potential to lead to generalizable improvement approaches for increasing access to safe blood in SSA as well as mentoring and building the research capacity and careers of many investigators.

Degradation and accumulation rates of fresh human excreta during vermicomposting by Eisenia fetida and Eudrilus eugeniae.

This study was carried out to assess the degradation and accumulation rates of fresh human excreta and how addition of anal cleansing materials affect performance during vermicomposting by Eisenia fetida and Eudrilus eugeniae. Vermicomposting setups consisting of two transparent containers (length 0.27 m, breadth 0.17 m and depth 0.12 m) stacked on top of each other were installed and operated under laboratory conditions. Earthworms, Eisenia fetida and Eudrilus eugeniae, were obtained from Green Cycle Technologies Limited in Accra, Ghana and the species verified and cultured before use. Fresh human excreta for feeding the experimental setups was collected from an Enviro-loo public toilet and 13 g applied to the setups daily. Similar setups were fed with 0.3 g of anal cleansing material in addition to the fresh excreta. A setup without any earthworms (NW) was set up as a control. Physicochemical characteristics of vermicompost accumulating in the setups were determined weekly for 28 days using standard laboratory procedures while the sludge accumulated in the various setups were weighed and recorded daily. One-way analysis of variance (ANOVA) and Post-hoc LSD tests were conducted to determine whether the differences in results between the two earthworm species and among setups with and without anal cleansing materials were statistically significant (p ≤ 0.05). The study showed 12.3% and 26.2% reduction in volatile solids in EE (Eudrilus eugeniae and excreta only) and EF (Eisenia fetida and excreta only) while ash content increased indicating good degradation. The percentage mass reductions recorded at the end of the fourth week were 67.5%, 58.8% and 40.5% in systems EE, EF and NW respectively, while reductions of 73.7% and 68.5% were realized in EEA (Eudrilus eugeniae with excreta and toilet paper) and EFA (Eisenia fetida with excreta and toilet paper) respectively. There was greater amount of sludge accumulated in systems without earthworms, 0.00020 m3 (59.5%) in NW, than in systems with earthworms where 0.00011 m3 (32.5%) and 0.00014 m3 (41.2%) were recorded for EE and EF respectively. The rate of accumulation in vermibeds EE and EF was relatively higher than in vermibeds with excreta and toilet paper (EEA and EFA). EEA and EFA recorded accumulation rates of 0.00009 m3 (26.3%) and 0.00011 m3 (31.5%) respectively. Complete removal of helminth eggs was not achieved in any of the treatment systems.

Presentation and survival of multiple myeloma patients in Ghana: a review of 169 cases.

BACKGROUND: Africans have an increased risk for multiple myeloma (MM) compared to other races. Reports from Africa are few and involve small cohorts, but suggest significant epidemiological and clinical differences from Caucasian patients. OBJECTIVE: This report describes the clinic-pathological features of MM patients in Ghana at diagnosis, and the factors affecting their survival. METHODS: A retrospective review of 169 MM cases diagnosed in a Ghanaian tertiary hospital from 2002-2016. RESULTS: Median age was 58 years, with 29% ≤50 years. One-third presented >12 months after onset of symptoms, which included bone pain (96%), anaemia (67%), weight loss (55%) and fractures (44%). Myeloma-related tissue impairment included hypercalcaemia (36%), renal impairment (33%), severe anaemia (52%) and osteolytic lesions (76%); 51.3% of patients were diagnosed in ISS Stage III. Median survival was 33 months; 1-year and 5-year overall survival were 51.6% and 15.5%, respectively. Neither the age at diagnosis nor the duration of symptoms prior to diagnosis correlated with prognosis. Median survival improved with early ISS stage, haemoglobin >8g/dL, plasmacytosis <20%, and normal creatinine and calcium levels. CONCLUSION: Early onset and late stage presentation are common at diagnosis of MM patients in Ghana, but do not affect survival. Studies into genetic associations are recommended. FUNDING: None.

Bloodstream infections in patients with malignancies: implications for antibiotic treatment in a Ghanaian tertiary setting.

BACKGROUND: Bloodstream infections (BSI) remain a major cause of mortality in patients with malignancies. We present the first report on the microbiological profile of bacteraemia and fungaemia among cancer patients in Ghana. METHODS: From January 2010 through December 2013, we retrospectively analyzed the spectrum of bloodstream pathogens in cancer patients from Korle-Bu Teaching Hospital, Ghana--focusing on multidrug resistant isolates (MDRs). RESULTS: Overall BSI were confirmed in 22% (n = 93/453) of total blood cultures. Our data highlights a co-dominance of Gram-negative (n = 49/93, 52.6%) and Gram-positive (n = 40/93, 43.0%) bacteria with the former less likely to infect children than adults [odds ratio (OR), 0.56; 95% confidence interval (CI) 0.14-0.91; p value = 0.027]. Staphylococcus epidermidis was the most isolated bacteria (30.1%; n = 28/93). About 61% (n = 25/41) of Enterobacteriaceae isolates were resistant to cefotaxime; a majority (n = 24/25, 96%) of which were MDRs and mostly susceptible to amikacin and levofloxacin. Four (80 %) penicillin resistant streptococci were found; 2 of which were MDRs and sensitive to erythromycin and cefuroxime. Methicillin resistant Staphylococcus aureus and vancomycin resistant enterococci were not identified. In multivariate analysis, the Enterobacteriaceae compared to other organisms were significantly associated with multidrug resistance (adjusted OR, 33.6; 95% CI 6.41-88.73; p value 0.001). CONCLUSION: MDRs, especially cefotaxime resistant Enterobacteriaceae, are common among patients with cancer in our institution but vary among different patient populations. The results show that empiric antibiotic treatment for cancer patients cannot be done effectively without regard for selective antimicrobial use based on local epidemiologic data.

Chronic myeloid leukemia in an adult ghanaian with sporadic neurofibromatosis 1.

Patients with neurofibromatosis type 1 (NF1), a common, progressive, autosomal dominant neurocutaneous disorder, are predisposed to malignancies. Several types of hematologic malignancies have been described in them. However, to date there has been no report to the best of our knowledge of a patient with NF1 developing chronic myeloid leukemia (CML). We present an adult Ghanaian with NF1, who subsequently developed CML. Relevance of the case report is discussed.