Obesity in urban civil servants in Ghana: association with pre-adult wealth and adult socio-economic status.

OBJECTIVE: To investigate the distribution of obesity and its association with pre-adult wealth and adult socio-economic factors in urban Ghanaian civil servants. STUDY DESIGN: Cross-sectional study of urban civil servants. METHODS: A total of 1015 (615 men and 400 women) civil servants aged 25 years and above employed in seven central government ministries and departments in Accra, Ghana were studied (participation rate 82.7%). RESULTS: The prevalence of obesity [body mass index (BMI) > or =30.0 kg/m(2)] was 10% in men and 36% in women. Men of higher pre-adult or current socio-economic position generally had higher mean BMI and waist circumference. In women, however, the mean waist circumference was higher in those of lower socio-economic position (lower education, less pre-adult wealth), but mean BMI did not differ significantly between socio-economic groups. There was a positive graded association between pre-adult and adult levels of wealth (determined by the availability of selected household amenities) and the risk of obesity in men (P-trend=0.003), but weak suggestions of an inverse association between adult level of wealth and obesity in women under 45 years of age. CONCLUSIONS: The high prevalence of obesity in this population indicates the need for appropriate interventions for its prevention and treatment. Programmes and interventions to control obesity need to address different needs of men and women in the various social strata, and must not be limited to adults.

Prevalence and pattern of strabismus in Ilorin.

BACKGROUND: There is a paucity of studies devoted exclusively to strabismus in children. OBJECTIVE: To determine the prevalence, and pattern of presentation of strabismus among a group of Nigerian school children. METHODS: A cross sectional survey was carried out among primary school children in Ilorin South Local Government Area in Nigeria. Twenty-one public primary schools grouped into three zones of seven schools each were selected for screening using a cluster random sampling technique. RESULTS: A total 7,288 children were screened (3766 boys and 3522 girls). This yielded 32 cases of strabismus (19 males and 13 females). Their age ranged from two to sixteen years (mean, 9.5 + or - 6.0 years). The prevalence of esotropia 0.14%. (95% CI, 0.029%-0.31%) and that of exotropia 0.14%. (95% CI, 0.13%-0.15%). Congenital estropia and accommodative esotropia constituted 50.0% and 18.8% of cases respectively while, exotropia constituted 31.3%. CONCLUSION: The prevalence of strabismus is low in the study population as has been found in other studied. Like most studies on strabismus; estropia is the most common variety seen.

Ecological Study of HIV Infection and Hypertension in Sub-Saharan Africa: Is There a Double Burden of Disease?

METHODS: Data on prevalence of hypertension were derived from a systematic search of literature published between 1975 and 2014 with corresponding national estimates on HIV prevalence and antiretroviral therapy (ART) coverage from the Demographic and Health Surveys and the joint United Nations Programme on HIV/AIDS databases. National estimates on gross national income (GNI) and under-five mortality were obtained from the World Bank database. Linear regression analyses using robust standard errors (allowing for clustering at country level) were carried out for associations of age-standardised hypertension prevalence ratios (standardized to rural Uganda's hypertension prevalence data) with HIV prevalence, adjusted for national indicators, year of study and sex of the study population. RESULTS: In total, 140 estimates of prevalence of hypertension representing 25 nations were sex-and area-matched with corresponding HIV prevalence. A two-fold increase in HIV prevalence was associated with a 9.29% increase in age, sex and study year-adjusted prevalence ratio for hypertension (95% CI 2.0 to 16.5, p = 0.01), which increased to 16.3% (95% CI 9.3 to 21.1) after adjusting for under-five mortality, GNI per capita and ART coverage. CONCLUSIONS: Countries with a pronounced burden of HIV may also have an increased burden of non-communicable diseases such as hypertension with potential economic and health systems implications.

Surveillance of Bacterial Pathogens of Diarrhoea in Two Selected Sub Metros Within the Accra Metropolis.

BACKGROUND: In recent years, many localities within the Greater Accra Region (GAR) have witnessed several episodes of cholera outbreaks, with some deaths. Compared to previous epidemics, which usually followed heavy rains, recent outbreaks show no seasonality. OBJECTIVES: To investigate infective bacterial diseases in selected sub metros within the GAR. METHODS: We used existing disease surveillance systems in Ghana, and investigated all reported cases of diarrhoea that met our case-definition. A three-day training workshop was done prior to the start of study, to sensitize prescribers at the Korle-Bu Polyclinic and Maamobi General hospital. A case-based investigation form was completed per patient, and two rectal swabs were taken for culture at the National Public Health and Reference Laboratory. Serotyping and antibiogram profiles of identified bacteria were determined. Potential risk factors were also assessed using a questionnaire. RESULTS: Between January and June 2012, a total of 361 diarrhoeal cases with 5 deaths were recorded. Out of a total of 218 rectal swabs cultured, 71 (32.6%) Vibrio cholerae O1 Ogawa serotypes, and 1 (0.5%) Salmonella (O group B) were laboratory confirmed. No Shigella was isolated. The Vibrio cholerae isolates were susceptible to ciprofloxacin and tetracycline. Greater than 80% of patients reported having drank sachet water 24 h prior to diarrhoea onset, and many (144/361) young adults (20-29 years) reported with diarrhoea. CONCLUSION: Enhanced surveillance of diarrhoeal diseases (enteric pathogens) within cholera endemic regions, will serve as an early warning signal, and reduce fatalities associated with infective diarrhoea.

Synthesis and binding-analysis of 5E-[19-(2-bromoacetoxy)methyl]25-hydroxyvitamin D3 and 5E-25-hydroxyvitamin D3-19-methyl[(4-azido-2-nitro)phenyl]glycinate: novel C19-modified affinity and photoaffinity analogs of 25-hydroxyvitamin D3.

Synthesis of novel C19-modified affinity and photoaffinity analogs of vitamin D3 and 25-hydroxyvitamin D3(25-OH-D3) is described. A key step in the synthesis is a Horner-Emmons reaction between C19-nor-cyclovitamin D3-C19-ketone or C19-nor-25-hydroxy-cyclovitamin D3-C19-ketone and diethyl cyanomethylphosphonate. Competitive radioligand binding assays with human serum vitamin D-binding protein (DBP) and 5E-[19-(2-bromoacetoxy)methyl]25-hydroxyvitamin D3 and 5E-25-hydroxyvitamin D3-19-methyl[(4-azido-2-nitro)phenyl]-glycinate, 25-OH-D3-analogs containing affinity and photoaffinity probes at C19-position, demonstrated that these compounds displaced radiolabeled 25-OH-D3 from the binding pocket of DBP in a dose-dependent manner. Thus, these affinity and photoaffinity analogs are potentially useful in determining the ligand binding site topographies of DBP and possibly the vitamin D receptor.

C-6 functionalized analogs of 25-hydroxyvitamin D3 and 1alpha,25-dihydroxyvitamin D3: synthesis and binding analysis with vitamin D-binding protein and vitamin D receptor.

In this article, we describe the development of a general synthetic strategy to functionalize the C-6 position of vitamin D3 and its biologically important metabolites, i.e. 25-hydroxyvitamin D3 (25-OH-D3) and 1alpha,25-dihydroxyvitamin D3 [1,25(OH)2D3]. We employed Mazur's cyclovitamin D method to synthesize vitamin D3 analogs with several functionalities at the C-6 position. In addition, we synthesized 6-(3-hydroxypropyl) and 6-[(2-bromoacetoxy)propyl] derivatives of 25-OH-D3 15 and 16, respectively, and 6-(3-hydroxypropyl) derivative of 1,25(OH)2D3 17. Competitive binding assays of 15-17 with human serum vitamin D-binding protein showed that all these analogs specifically bound to this protein, although with significantly lower affinity than the 25-OH-D3, the strongest natural binder, but with comparable affinity with 1,25(OH)2D3, the hormone. On the other hand, 6-[3-hydroxypropyl], 1alpha,25-dihydroxyvitamin D3 17 did not show any specific binding for recombinant nuclear vitamin D receptor. These results indicated that the region containing the C-6 position of the parent seco-steroid [1,25(OH)2D3] may be an important recognition marker towards vitamin D receptor binding. Information, delineated in this article, will be important for evaluating structure-activity relationship in synthetic analogs of vitamin D and its metabolites.

Ghana's burden of chronic non-communicable diseases: future directions in research, practice and policy.

The prevalence of major chronic non-communicable diseases and their risk factors has increased over time and contributes significantly to the Ghana's disease burden. Conditions like hypertension, stroke and diabetes affect young and old, urban and rural, and wealthy and poor communities. The high cost of care drives the poor further into poverty. Lay awareness and knowledge are limited, health systems (biomedical, ethnomedical and complementary) are weak, and there are no chronic disease policies. These factors contribute to increasing risk, morbidity and mortality. As a result chronic diseases constitute a public health and a developmental problem that should be of urgent concern not only for the Ministry of Health, but also for the Government of Ghana. New directions in research, practice and policy are urgently needed. They should be supported by active partnerships between researchers, policymakers, industry, patient groups, civil society, government and development partners.

Lay representations of chronic diseases in Ghana: implications for primary prevention.

BACKGROUND: Ghana's health system is ill-equipped to tackle the country's double burden of infectious and chronic diseases. The current focus is on empowering lay communities to adopt healthy practices to prevent chronic diseases. Understanding how individuals make sense of health, illness and chronic illnesses is an important first step to developing practical interventions. METHODS: Six focus group discussions with lay people (N= 51) in Accra, Nkoranza and Kintampo to explore: (1) knowledge of prevalent chronic diseases in Ghana; (2) chronic disease causal theories; and (3) chronic disease treatment. RESULTS: Nineteen conditions were listed cumulatively. Diabetes and hypertension were listed by all groups. Rural groups included HIV/AIDS on their list as well as diseases with alleged spiritual roots, in particular epilepsy and sickle cell disease. Multiple causal theories were presented for diabetes and hypertension; cancers were attributed to toxic foods; asthma attributed to environmental pollution. Biomedical care was preferred by the majority. Lay representations were drawn from multiple sources: medical professionals and chronically ill individuals were the most legitimate knowledge sources. CONCLUSION: This study provides insights on how lay representations of common chronic diseases and their major risk factors provide public health specialists with the conceptual tools to develop primary prevention strategies. The first challenge will be to train health experts to provide accurate information in practical language that lay people can understand and apply to their daily lives. A second challenge will be to develop sustainable behaviour-change interventions. Best practices from other African countries can inform interventions in Ghana.

A review of population-based studies on hypertension in Ghana.

BACKGROUND: Hypertension is becoming a common health problem worldwide with increasing life expectancy and increasing prevalence of risk factors. Epidemiological data on hypertension in Ghana is necessary to guide policy and develop effective interventions. METHODS: A review of population-based studies on hypertension in Ghana was conducted by a search of the PUBMED database, supplemented by a manual search of bibliographies of the identified articles and through the Ghana Medical Journal. A single reviewer extracted data using standard data collection forms. RESULTS: Eleven studies published on hypertension with surveys conducted between 1973 and 2009 were identified. The prevalence of hypertension was higher in urban than rural areas in studies that covered both types of area and increased with increasing age (prevalence ranging from 19.3% in rural to 54.6% in urban areas). Factors associated with high blood pressure included increasing body mass index, increased salt consumption, family history of hypertension and excessive alcohol intake. The levels of hypertension detection, treatment and control were generally low (control rates ranged from 1.7% to 12.7%). CONCLUSION: An increased burden of hypertension should be expected in Ghana as life expectancy increases and with rapid urbanisation. Without adequate detection and control, this will translate into a higher incidence of stroke and other adverse health outcomes for which hypertension is an established risk factor. Prevention and control of hypertension in Ghana is thus imperative and any delays in instituting preventive measures would most likely pose a greater challenge on the already overburdened health system.

Stroke in Ashanti region of Ghana.

OBJECTIVE: To determine the morbidity and mortality in adult in-patients with stroke admitted to the Komfo Anokye Teaching Hospital (KATH). METHODS: A retrospective study of in-patients with stroke admitted to the KATH, from January 2006 to december 2007 was undertaken. Data from admission and discharge registers were analysed to determine stroke morbidity and mortality. RESULTS: Stroke constituted 9.1% of total medical adult admissions and 13.2% of all medical adult deaths within the period under review. The mean age of stroke patients was 63.7 (95% ci=62.8, 64.57) years. Males were younger than females. The overall male to female ratio was 1:0.96, and the age-adjusted risk of death from stroke was slightly lower for females than males (relative risk= 0.88; 95% ci=0.79, 1.02, p=0.08). The stroke case fatality rate was 5.7% at 24 hours, 32.7% at 7 days, and 43.2% at 28 days. CONCLUSION: Stroke constitutes a significant cause of morbidity and mortality in Ghana. Major efforts are needed in the prevention and treatment of stroke. Population-based health education programs and appropriate public health policy need to be developed. This will require a multidisciplinary approach of key players with a strong political commitment. There is also a clear need for further studies on this topic including, for example, an assessment of care and quality of life after discharge from hospital. The outcomes of these studies will provide important information for the prevention efforts.

Socioeconomic position and hypertension: a study of urban civil servants in Ghana.

BACKGROUND: The association of socioeconomic position and cardiovascular disease risk factors in low- and middle-income countries has not been as consistent as that reported from high-income countries. METHODS: A cross-sectional study of 1015 participants from seven civil service departments in Accra, Ghana, was conducted in 2006. Hypertension was diagnosed when the mean of a second and third blood pressure reading on each of two visits 3 weeks apart was > or =140/90 mmHg or where participants were already diagnosed and on antihypertensive drugs. Socioeconomic measures considered were education, early life and adult wealth and civil service employment grade. RESULTS: The age-adjusted prevalence of hypertension was lowest in participants of lower socioeconomic position (OR 21.9%; 95% CI 16.3 to 27.5) and highest in those of highest socioeconomic position (OR 31.8%; 95% CI 23.4 to 40.2) with inconsistent patterns among participants in the intermediate socioeconomic groups. Participants in the highest employment grade category were more likely to have hypertension than those in the lowest category (OR 1.91; 95% CI 1.14 to 3.20). There was a positive graded association between adult wealth and hypertension, with more assets associated with a greater risk (p trend 0.008). This trend was partly explained by body mass index differences. Blood pressure control among those with diagnosed hypertension was generally poor across the socioeconomic strata. CONCLUSIONS: In low-income countries such as Ghana, there is a need to promote primary prevention of hypertension across the socioeconomic strata, with a focus on weight control among civil servants of higher socioeconomic position, and better hypertension control in those with hypertension.

Development of an affinity-driven cross-linker: isolation of a vitamin D receptor associated factor.

A vitamin D analogue containing an affinity and a photoaffinity probe (affinity-driven cross-linker, Double Label) was synthesized. An unknown factor, associated with vitamin D receptor (VDR), was isolated from rat liver nuclear extract using a GST-VDR-ligand-binding domain fusion protein (GST-VDR-LBD), affinity labeled with Double Label, and protein-protein cross-linking by photolysis.

Probing the vitamin D sterol-binding pocket of human vitamin D-binding protein with bromoacetate affinity labeling reagents containing the affinity probe at C-3, C-6, C-11, and C-19 positions of parent vitamin D sterols.

The multiple physiological properties of vitamin D-binding protein (DBP) include organ-specific transportation of vitamin D(3) and its metabolites, manifested by its ability to bind vitamin D sterols with high affinity. In the present investigation we probed the vitamin D sterol-binding pocket of human DBP with affinity labeling analogs of 25-hydroxyvitamin D(3) ¿25-OH-D(3) and 1, 25-dihydroxyvitamin D(3) ¿1,25(OH)(2)D(3) containing bromoacetate alkylating probe at C-3 (A-ring), C-6 (triene), C-11 (C-ring), and C-19 (exocyclic methylene) of the parent sterol. Competitive binding assays with DBP showed approximately 22-, 68-, and 2000-fold decrease in the binding of 1,25(OH)(2)-D(3)-11-BE, 25-OH-D(3)-3-BE, and 25-OH-D(3)-6-BE, respectively, compared to that seen with 25-OH-D(3), while there was no significant difference in the DBP-binding affinity of 25-OH-D(3)-19-BE and 25-OH-D(3). Surprisingly, ¿(14)C25-OH-D(3)-11-BE and ¿(14)C1, 25(OH)(2)-D(3)-19-BE failed to label DBP despite high-affinity DBP-binding, indicating the absence of any nucleophilic amino acid in the vicinity of their bromoacetate moiety to form a covalent bond, while these analogs are inside the binding pocket. In contrast, ¿(14)C25-OH-D(3)-6-BE and ¿(14)C25-OH-D(3)-3-BE specifically labeled DBP. BNPS-skatole digestion of DBP labeled with ¿(14)C25-OH-D(3)-3-BE or ¿(14)C25-OH-D(3)-6-BE produced two peptides (M(r) 17,400 and 33,840), with radioactivity associated with the N- and C-terminal peptides, respectively, raising the possibility that either different areas of the same vitamin D sterol-binding pocket, or different domains of DBP might be labeled by these analogs. Successful affinity labeling of recombinant domain I (1-203) of DBP with both reagents indicated that different areas of the same vitamin D-binding pocket (domain I) were labeled. These affinity analogs are potentially useful for "mapping" the vitamin D sterol-binding pocket and developing a functional model.

Surface recruitment but not activation of integrin alpha IIb beta 3 (GPIIb-IIIa) requires a functional actin cytoskeleton.

Binding of integrin alpha IIb beta 3 (glycoprotein [GP] IIb-IIIa) to soluble fibrinogen requires that the receptor undergo a conformational change (receptor activation), which occurs rapidly in agonist-stimulated platelets. Agonist stimulation of platelets also results in alpha IIb beta 3 recruitment from intracellular membranes (alpha-granules and open canalicular system) to the platelet surface. Once activated and accessible, the receptor can engage, a process that corresponds to the binding of the receptor to its soluble fibrinogen ligand, leading to intracellular signaling reactions and centripetal migration of bound receptor molecules. Because these processes occur concurrently with a marked reorganization of the actin cytoskeleton, we investigated the role of actin in fibrinogen receptor activation and surface recruitment. We used a flow cytometric assay to directly quantitate the binding of alpha IIb beta 3 to fluorescently labeled fibrinogen on the platelet surface. Cytochalasin D, which inhibits elongation of actin filaments, was used to prevent the actin response to platelet agonists. Despite its ability to inhibit the actin response and alpha IIb beta 3 binding to the actin cytoskeleton, cytochalasin D did not alter the agonist-induced intramolecular changes resulting in increased affinity of alpha IIb beta 3 for soluble fibrinogen and therefore did not inhibit ADP-induced aggregation. Thus, disruption of the actin network with cytochalasin D had no effect on the dissociation constant of the complex between activated alpha IIb beta 3 and fibrinogen (Kd = 0.26 to 0.28 mumol/L). However, cytochalasin D suppressed the recruitment of cryptic alpha IIb beta 3 molecules to the platelet surface.(ABSTRACT TRUNCATED AT 250 WORDS)