Carriage of Antibiotic Resistant Bacteria and Associated Factors Among Food Handlers in Tamale Metropolis, Ghana: Implications for Food Safety.

Background: Bacteria pathogens constitute a significant proportion of diarrhoea-causing food contaminants. Transmission of antibiotic resistant foodborne pathogens to humans is a major threat to food safety, especially in developing countries where quality hygiene and sanitation facilities are lacking. Factors related to antibiotic use, sanitation and hand hygiene have been associated with the spread of infectious diseases as well as antibiotic resistant bacteria. Proper food handling ensures that food is not contaminated with potential pathogenic bacteria. This study assessed the carriage of antibiotic resistant bacteria and associated factors. Methods: A cross-sectional study was conducted among food handlers who sell ready to eat food in the Tamale metropolis of the Northern Region of Ghana. Food vending stations with huge customer base were randomly selected and the food handlers recruited using written informed consent. Structured questionnaires were used to collect participants sociodemographic details and information on sanitation, hand hygiene practice and antibiotic use. Sterile cotton swabs soaked in phosphate buffered saline was used to swab the palms of participating food handlers for bacteria isolation. All identified bacteria were tested for susceptibility to 12 antibiotics. Results: In all, 406 food handlers participated in this study, the mean (SD) age was 26.5 (2.64) years. Bacteria isolated were predominantly Staphylococci 60 (14.8%) and Escherichia coli 54 (13.3%). All the isolates were resistant to at least one antibiotic tested. The isolates showed high resistance to broad-spectrum antibiotics such as ampicillin (40.0%-75.0%), tetracycline (40.0%-80.0%), amoxiclav (20.0%-80.0%) and chloramphenicol (7.7%-50.0%). Logistic regression model revealed that the carriage of antibiotic resistant bacteria by food handlers was significantly associated with age, educational level, years on the job, training in food preparation, hygiene practice, water source, type of toilet facility used and antibiotic use. Conclusion: Street food handlers could be potential sources of food-borne transmission of antibiotic resistant bacteria.

Predictors of the onset of neonatal sepsis at the Neonatal Intensive Care Unit of a tertiary hospital in Ghana: A cross-sectional study.

Background and Aim: Neonatal sepsis is a systemic inflammatory response to infection during the first 4 weeks of an infant's life. It is a significant cause of neonatal morbidity and mortality in low- and middle-income countries. This study aimed to determine the predictors of the onset of sepsis at the Neonatal Intensive Care Unit of the Tamale Teaching Hospital, Ghana. Methods: A cross-sectional study was conducted among 275 mothers and their singleton neonates diagnosed clinically with sepsis. A univariate and multivariate logistic regression analysis adjusted for maternal occupational status was performed to determine the maternal and neonatal predictors of early-onset (EOS) and late-onset sepsis (LOS), respectively. Results: Single motherhood (AOR = 1.882, 95% CI = 0.926-3.822, p = .08) and home delivery (AOR = 3.667, 95% CI = 0.584-23.026, p = .17) were predictors of EOS, with single motherhood being the predictor for LOS (AOR = 2.906, 95% CI = 0.715-11.805, p = .14) in a univariate analysis. When maternal occupation was adjusted for in a multivariate analysis, single mother (AOR = 2.167, 95% CI = 1.010-4.648, p = .04) was the main predictor of EOS, with low neonatal birth weight being the main predictor of LOS (AOR = 0.193, 95% CI = 0.038-0.971, p = .04). Conclusion: Maternal marital status is a significant predictor of both EOS and LOS, with predictors of EOS being lower gestational age and low birth weight, while for LOS, low birth weight is the main predictor. Findings from this study can serve as a commencement point for developing predictive models for the onset of sepsis in neonates in the study facility.

Drivers of household antibiotic use in urban informal settlements in Northern Ghana: Implications for antimicrobial resistance control.

Background: Urban informal settlements have been described as the epicenters of frequent antibiotic misuse, which has local and global consequences on the goals of antimicrobial stewardship. The aim of this study was to assess the relationship between knowledge, attitude, and practices of antibiotic use among households in urban informal settlements in the Tamale metropolis of Ghana. Method: This study was a prospective cross-sectional survey of the two major informal settlements in the Tamale metropolis, namely Dungu-Asawaba and Moshie Zongo. In all, 660 households were randomly selected for this study. Households with an adult and at least a child under 5 years old were randomly chosen. An adult with knowledge of household healthcare practices was selected  to respond to a structured questionnaire. Results: In all, 291 (44.1%) of the 660 households reported taking at least one type of antibiotic within the last month before the study and 30.9% (204/660) had used antibiotics without a prescription. Information on which antibiotics to use was obtained mostly from friends/family members 50 (24.5%) and were commonly purchased from a medical store or a pharmacy 84 (41.2%), saved up from a previously used antibiotic 46 (22.5%), a friend/family members 38 (18.6%), and drug hawkers 30 (14.7%). Amoxicillin 95 (26.0%) was the most frequently used antibiotic and the commonest indication for antibiotics use was diarrhea 136 (37.9%). Female respondents (odds ratio [OR] = 3.07; 95% confidence interval [CI] = 2.199-4.301; p < 0.0001), larger households (OR = 2.02; 95% CI = 1.337-3.117; p = 0.0011) and those with higher monthly household income (OR = 3.39; 95% CI = 1.945-5.816; p < 0.0001) were more likely to have good knowledge of appropriate antibiotic use and antibiotic resistance. Furthermore, bad attitudes influenced participants' use of antibiotics without prescription (OR = 2.41; 95% CI = 0.432-4.05; p = 0.0009). Conclusion: This study exposes the drivers of inappropriate use of antibiotics at the household level, particularly in urban informal settlements. Policy interventions aimed at controlling the indiscriminate use of antibiotics in such settlements could improve the responsible use of antibiotics. Keywords: antibiotic resistance, informal settlements, Tamale, Ghana.

Bacteriological Profile and Antibiotic Susceptibility Patterns of Sepsis-Causing Bacteria at the Neonatal Intensive Care Unit of a Tertiary Health Care Facility in Ghana.

Background: Neonatal sepsis is a clinical emergency that requires sound evaluation supported by accurate laboratory analysis and timely clinical intervention for its management. This study, therefore, was conducted to identify bacteria causing neonatal sepsis and their susceptibility to the commonly prescribed antibiotic at the Neonatal Intensive Care Unit of a tertiary health care facility in the Northern Region of Ghana. Methods: Neonatal biodata were collected from patient folders, after which identification, isolation, and susceptibility of isolated bacteria to prescribed anti-bacterial (Kirby-Bauer disk diffusion method) were carried out on single venipuncture blood samples aseptically drawn from 275 neonates clinically diagnosed with sepsis. Results: 275 neonates took part in the study, of which 218 (79.3%) presented with early-onset sepsis (EOS) and 57 (20.7%) with late-onset sepsis (LOS). The laboratory results confirmed a septicemia prevalence of 70.3% among neonates clinically diagnosed with sepsis. Preterm delivery (P = .01), hypothermia (P = .001), and delivery at the tertiary healthcare facility were significantly associated with EOS (P < .000), while low birth weight (P = .012), duration of hospital stay (P = .001), and delivery at the tertiary healthcare facility (P < .000) were found to be significantly associated with LOS. Gram-positive cocci constituted 54.9% (107), with Gram-negative constituting 45.1% (88) of all the bacteria isolates. Coagulase-negative staphylococcus (CoNS) 70.1% (75) and Klebsiella species 39.8% (35) were the dominant Gram-positive and Gram-negative isolates, respectively. 57.8% and 55.8% of CoNS isolates were susceptible to ampicillin and amoxicillin/clavulanic acid, respectively. 93.5% of CoNS and all the isolated Staphylococcus aureus and Klebsiella species were susceptible to amikacin. Conclusions: Coagulase-negative staphylococcus (CoNS) and Klebsiella species were the predominant Gram-positive and negative sepsis-causing agents at the NICU, respectively. Amikacin exhibited the highest sensitivity to Gram-positive and negative causative agents, making it a strong candidate for consideration in the facility's empirical treatment of neonatal sepsis.

Assessment of NSAIDs as potential inhibitors of the fatty acid amide hydrolase I (FAAH-1) using three different primary fatty acid amide substrates in vitro.

BACKGROUND: Pain relief remains a major subject of inadequately met need of patients. Therapeutic agents designed to treat pain and inflammation so far have low to moderate efficiencies with significant untoward side effects. FAAH-1 has been proposed as a promising target for the discovery of drugs to treat pain and inflammation without significant adverse effects. FAAH-1 is the primary enzyme accountable for the degradation of AEA and related fatty acid amides. Studies have revealed that the simultaneous inhibition of COX and FAAH-1 activities produce greater pharmacological efficiency with significantly lowered toxicity and ulcerogenic activity. Recently, the metabolism of endocannabinoids by COX-2 was suggested to be differentially regulated by NSAIDs. METHODS: We analysed the affinity of oleamide, arachidonamide and stearoylamide at the FAAH-1 in vitro and investigated the potency of selected NSAIDs on the hydrolysis of endocannabinoid-like molecules (oleamide, arachidonamide and stearoylamide) by FAAH-1 from rat liver. NSAIDs were initially screened at 500 µM after which those that exhibited greater potency were further analysed over a range of inhibitor concentrations. RESULTS: The substrate affinity of FAAH-1 obtained, increased in a rank order of oleamide < arachidonamide < stearoylamide with resultant Vmax values in a rank order of arachidonamide > oleamide > stearoylamide. The selected NSAIDs caused a concentration-dependent inhibition of FAAH-1 activity with sulindac, carprofen and meclofenamate exhibiting the greatest potency. Michaelis-Menten analysis suggested the mode of inhibition of FAAH-1 hydrolysis of both oleamide and arachidonamide by meclofenamate and indomethacin to be non-competitive in nature. CONCLUSION: Our data therefore suggest potential for study of these compounds as combined FAAH-1-COX inhibitors.

Clinical Characteristics, Medication Prescription Pattern, and Treatment Outcomes at the Neonatal Intensive Care Unit of a Tertiary Health-Care Facility in Ghana.

OBJECTIVE: Neonates are more susceptible to infections, as well as medication toxicities. This study, therefore, sought to describe the clinical characteristics, medication prescription pattern, and treatment outcomes for neonates admitted to the neonatal intensive care unit (NICU) of a tertiary health-care facility in Ghana. METHODS: A retrospective cross-sectional study was conducted to ascertain clinical records, conditions for admission, spectrum of medications prescribed, and treatment outcomes from neonatal patient folders. FINDINGS: Of 667 folders reviewed (51.4% males and 48.6% female), 61.8% were preterm (mean gestational age: 34.2 ± 3.6 weeks), 64.6% had low birth weight (LBW) (mean birth weight: 2.1 ± 0.9 kg), 90.6% were delivered through spontaneous vaginal delivery, and 57.4% delivered at the tertiary health-care facility. Of the 667 neonates, 70%, 27.1%, and 2.9% were queried with one, two, or three medical conditions, respectively. Respiratory distress, preterm, and pyrexia were common single queried conditions (88.5%). LBW, hypothermia, and single queried medical conditions were associated (P ≤ 0.0001) with preterm male neonates. The mean duration of stay of preterm neonates was 3.5 ± 3.2 days (term babies: 1-2 days [P = 0.0085]). Of 1,565 medications prescribed to the 667 neonates, 67.5% were antibacterial, with gentamicin (53.0%) being the most prescribed. 98.4% of neonates were prescribed at least one medication (i.e., 67.5% were prescribed antibacterial medications, 14.6% supplements, 11.0% bronchodilators, and 7.0% antiseizure); mean medication combination 2.6 ± 0.8 per neonate. Majority (75.4%) of the cases reviewed had treatment success. CONCLUSION: Respiratory distress and preterm deliveries are predominant presenting conditions, with antibacterial medication, mainly gentamicin and ampicillin, on prescription. Treatment success is significantly high at the NICU.

Outcome of patients with buruli ulcer after surgical treatment with or without antimycobacterial treatment in Ghana.

This study assesses the frequency of recurrences and treatment outcome after surgery of buruli ulcer disease (BUD) with or without concomitant antimycobacterial treatment. Of 129 laboratory-confirmed BUD patients who underwent surgery in two treatment centers in Ghana, 79 (61%) were retrieved for follow-up 4-29 months after the initial treatment. Among 7 (9%) recurrent cases no significant association was found between recurrences and clinical or treatment specific factors including antimycobacterial treatment. In 21 (27%) patients, a reduced range of motion (ROM) of one or more joints was detected. Lesions other than nodules, joint involvement, and skin grafting were identified as independent risk factors. Functional limitations hampering daily activities were perceived by 22% of the patients. Compared with other studies the recurrence rate was relatively low, functional limitations were, however, frequent. This emphasizes the need for improvement of pre- and post-treatment wound care as well as rehabilitation programs.