Epidemiological overlaps in COVID-19 and malaria within healthcare and community settings of Southern Ghana.

Background: COVID-19 disruptions including lockdowns and prioritization of COVID-19 control programs in Africa in 2020-2022 contributed to reductions in malaria control activities including malaria diagnosis, treatment and resistance monitoring. This study investigated the malaria burden and distribution on the background of active transmission of SARS-CoV-2 in Southern Ghana; utilizing community health education and medical screening (CHEMS) approach to determine epidemiological overlaps in COVID-19 and malaria. Methods: Between October-December 2022, prospective cross-sectional surveys, with CHEMS were conducted in Greater Accra and Central regions, where 994 participants enrolled either at a hospital or community setting provided demographic and clinical data including history of clinical malaria infection and antimalarial treatment in the past 2 weeks. Of this study population, 953 provided nasal/throat swabs for COVID-19 RT-PCR testing, with a subset of 136 participants also providing finger-prick blood for malaria RDT testing. Results: The study population comprised of 73.6% adults, with 54.6% COVID-19 vaccination rate. Overall, 18.1% of participants had a history of clinical malaria, which was associated (adjusted odds ratio > 1.50, p-value ≤0.022) with COVID-19 symptoms and positivity, study area and hospital setting, suggestive of overlaps in the epidemiological risk for malaria. On a background of widespread SARS-CoV-2 infections (12-37%), malaria parasitaemia was detected in 6%, with 2% being co-infections with SARS-CoV-2. Among the malaria positives, 9.5% had a history of antimalarial treatment, which suggested that their infections were recrudescent parasitaemia. Conclusion: The epidemiological and clinical overlap between malaria and COVID-19 within the hospital and community settings underscores the need for accurate case diagnosis to inform effective clinical treatments. Innovative surveillance programs, with community engagement are needed to maximize control interventions including treatment of asymptomatic malaria infections.

Abnormal spirometric patterns and respiratory symptoms in HIV patients with no recent pulmonary infection in a periurban hospital in Ghana.

BACKGROUND: Human immunodeficiency virus (HIV) infection is associated with chronic airway obstruction, even in patients who have achieved viral suppression from combination antiretroviral treatment (cART). Spirometry is a supplementary test that aids in diagnosing pulmonary dysfunction in people living with HIV. AIM: To compare the prevalence of spirometric abnormalities among cART-treated HIV patients and cART-naïve HIV patients with non-HIV controls with no recent history of pulmonary infection in a peri-urban hospital in Ghana. METHODS: In a case-control design, spirometry was performed in 158 cART-treated HIV patients, 150 cART-naïve HIV patients and 156 non-HIV controls. Clinical, sociodemographic data and respiratory symptoms were collected using a structured questionnaire. Spirometric abnormalities were categorised as obstructive (OSP) or restrictive (RSP) spirometric patterns based on the Cameroonian reference equation. RESULTS: The prevalence of OSP was higher in the cART-treated and cART-naïve HIV patients compared to non-HIV controls (13.9% vs 10.7% vs 5.1% respectively, p = 0.026), whereas that of RSP was similar among the study groups. Respiratory symptoms were common among cART-treated and cART-naïve HIV patients compared to non-HIV controls (48.1% vs 40% vs 19.2% respectively, p < 0.001). The major factors associated with OSP were female gender [OR (95% CI) = 2.46 (1.09-5.13), p = 0.031], former cigarette smoking [1.92 (1.04-3.89), p < 0.001], exposure to medium-to-high levels of biomass [3.07 (1.16-8.73), p = 0.019], presence of a respiratory symptom [1.89 (1.11-5.08), p = 0.029] and unemployment [3.26 (1.19-8.95), p = 0.042]. The major determinants of RSP were age, female gender [1.74 (1.05-4.29), p = 0.041], former cigarette smoking [2.31 (1.27-6.77), p < 0.001] and medium-to-high biomass exposure [1.58 (1.06-5.37), p = 0.043]. CONCLUSION: In HIV patients without any recent pulmonary infection in a peri-urban area of Ghana, there was a higher prevalence of OSP among cART-treated and cART naïve HIV patients compared to the non-HIV control. However, the prevalence of RSP was similar among HIV patients and non-HIV controls.

Trends in viral load suppression among HIV patients on antiretroviral therapy (ART) at Asante Mampong Municipal Hospital, Ghana: 2019-2023.

BACKGROUND: The Joint United Nations Programme on Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) (UNAIDS) aims to eradicate AIDS by 2030 through 95:95:95 targets: identifying 95% of persons living with HIV (PLHIV), initiating 95% of those identified on antiretroviral therapy (ART), and ensuring that 95% of those initiated on ART are virally suppressed. Virally suppressed patients pose minimal risk of HIV transmission. ART aims to suppress the HIV-viral load (VL) and increase immunity, reducing morbidity and mortality. This study aimed to determine the trends in VL suppression among HIV patients on ART from 2019 to 2023 at Asante Mampong Municipal Hospital. METHODS: This study adopted a retrospective Hospital-based design in which secondary data from 842 patients on ART from 2019 to 2023 were used. The study design specifically involved conducting serial cross-sectional studies to measure the prevalence of VL suppression each year from 2019 to 2023. This approach allowed the researchers to analyse the annual prevalence of VL suppression among study participants without following individual participants longitudinally throughout the entire period. The data were analysed via STATA version 17.0. Chi-square and logistic regressions were used to determine the associations between VL suppression and the independent variables at p < 0.05 and 95% confidence intervals (CIs). RESULTS: In 2019, VL suppression was 79.6%, decreasing to 40.0% in 2020 and then rising to 82.7% in 2021, dropping to 67.8% in 2022 and 66.7% in the first quarter of 2023. Clients aged 40-49, 50-59, and 60-69 years were more likely to have VL suppression [aOR = 4.4 (1.36-14.25), p = 0.013], [aOR = 5.5 (1.65-18.39), p = 0.006] and [aOR = 5.0 (1.42-17.46), p = 0.012], respectively. Clients who were consistently on the same type of ART for more than a year were more likely to have VL suppression [aOR = 10.6 (4.18-26.76), p < 0.001]. CONCLUSION: VL suppression was low among patients. Advanced age and being on the same ART for more than 12 months were significantly associated with VL suppression. Health promotion activities are needed for people who have been suppressed to maintain and achieve a lifetime undetectable VL, targeting the younger age group.

A comprehensive lifestyle index and its associations with DNA methylation and type 2 diabetes among Ghanaian adults: the rodam study.

BACKGROUND: A series of modifiable lifestyle factors, such as diet quality, physical activity, alcohol intake, and smoking, may drive the rising burden of type 2 diabetes (T2DM) among sub-Saharan Africans globally. It is unclear whether epigenetic changes play a mediatory role in the associations between these lifestyle factors and T2DM. We assessed the associations between a comprehensive lifestyle index, DNA methylation and T2DM among Ghanaian adults. METHODS: We used whole-blood Illumina 450 k DNA methylation data from 713 Ghanaians from the Research on Obesity and Diabetes among African Migrants (RODAM) study. We constructed a comprehensive lifestyle index based on established cut-offs for diet quality, physical activity, alcohol intake, and smoking status. In the T2DM-free discovery cohort (n = 457), linear models were fitted to identify differentially methylated positions (DMPs) and differentially methylated regions (DMRs) associated with the lifestyle index after adjustment for age, sex, body mass index (BMI), and technical covariates. Associations between the identified DMPs and the primary outcome (T2DM), as well as secondary outcomes (fasting blood glucose (FBG) and HbA1c), were determined via logistic and linear regression models, respectively. RESULTS: In the present study population (mean age: 52 ± 10 years; male: 42.6%), the comprehensive lifestyle index showed a significant association with one DMP annotated to an intergenic region on chromosome 7 (false discovery rate (FDR) = 0.024). Others were annotated to ADCY7, SMARCE1, AHRR, LOXL2, and PTBP1 genes. One DMR was identified and annotated to the GFPT2 gene (familywise error rate (FWER) from bumphunter bootstrap = 0.036). None of the DMPs showed significant associations with T2DM; directions of effect were positive for the DMP in the AHRR and inverse for all the other DMPs. Higher methylation of the ADCY7 DMP was associated with higher FBG (p = 0.024); LOXL2 DMP was associated with lower FBG (p = 0.023) and HbA1c (p = 0.049); and PTBP1 DMP was associated with lower HbA1c (p = 0.002). CONCLUSIONS: In this explorative epigenome-wide association study among Ghanaians, we identified one DMP and DMR associated with a comprehensive lifestyle index not previously associated with individual lifestyle factors. Based on our findings, we infer that lifestyle factors in combination, affect DNA methylation, thereby influencing the risk of T2DM among Ghanaian adults living in different contexts.

The impact of the RTS,S malaria vaccine on uncomplicated malaria: evidence from the phase IV study districts, Upper East Region, Ghana, 2020-2022.

BACKGROUND: The RTS,S malaria vaccine has been prequalified for use in endemic settings prioritizing areas with moderate to high disease transmission. The impact of a vaccine at the population level may differ from observations during clinical trial due to programmatic, and individual-related factors, among others. The objective of this study was to assess the impact of the RTS,S malaria vaccine on uncomplicated malaria among children aged 12-59 months in the Phase IV study districts, Upper East Region, Ghana. METHODS: A retrospective study was conducted using routine malaria surveillance data for the period 2020-2022. The burden of uncomplicated malaria was compared between the implementing (Kasena Nankana East and West districts) and comparator areas (Builsa North and South districts). The impact of RTS,S malaria vaccine was assessed by estimating the percentage reduction in uncomplicated malaria and incidence averted in the implementing area, accounting for the effect of confounders. RESULTS: Over 50,000 episodes of uncomplicated malaria among children aged 12-59 months were included in the study. Uncomplicated malaria was reduced by 33% (95%CI 29-36) over the entire study period, but the malaria incidence averted declined from 324/1,000 (95% CI 298-339; p < 0.0001) in 2020 to 287/1000 (95% CI 274-299; p < 0.0001) in 2022. CONCLUSION: The RTS,S malaria vaccine significantly reduced the burden of uncomplicated malaria among children aged 12-59 months in the implementing area. The sequential marginal declines in malaria incidence averted over the study period might be due to waning of protective immunity and acquisition of natural immunity as children age. Strengthening uptake of the currently recommended vaccines and other malaria control interventions is required to improve public health impact.

Developing guidelines for nursing management of epilepsy in Ghanaian schools.

BACKGROUND: The absence of guidelines for the nursing management of individuals living with epilepsy, who are students in Ghana, has resulted in the high dropout rates of such students. It is our hope, that in the near future, these individuals living with epilepsy will receive the needed attention, experience less stigmatization and discrimination. This, we expect, will result in better retention of such students in schools, improved academic performance and successful graduation. To achieve this, there is the need to develop appropriate guidelines and implement same for their benefit. In line with this, the study aims to develop guidelines for nurses to manage individuals living with epilepsy in Ghanaian schools. METHODOLOGY: Qualitative approach will be adopted to conduct this study in two phases. In the first phase, a case study design will be deployed in the Twifo Atti-Morkwa District of the Central Region of Ghana. The case is the nursing management of individuals living with epilepsy within the school context, and the sources of information will be the general nurses, psychiatric, or community psychiatric nurses working at the schools. Within the context of the case, parents or guardians of individuals living with epilepsy in the schools as well as their teachers will be included in the study. Data will be collected through individual interviews for nurses and parents while focus group discussions will be used for the teachers. Thematic analysis will be used to analyze the data. In the second phase, guidelines will be developed using the modified e-Delphi Technique. The study will be piloted in the Komenda-Edina-Eguafo-Abrem Municipality of the Central Region of Ghana. Ethics approval for this study has been obtained from the Ethical Review Committee of the University of Pretoria in South Africa. Additionally, Administrative approvals have been obtained from the Ghana Education Service. DISCUSSION: The guidelines developed will form the basis for nursing management of individuals living with epilepsy in Ghanaian schools. This will help to improve educational outcomes for the individuals living with epilepsy.

Prevalence of suicide ideation and its associated risk factors among undergraduate students of the university for development studies, Tamale.

BACKGROUND: Suicide and its associated risk factors are of public health importance across the globe. The affected persons are mostly the youth. Empirical research in this crucial area of public health is generally lacking, especially among undergraduate university students in Ghana. This study sought to determine the prevalence of suicide ideation, and its associated risk factors that statistically predict suicide ideation among undergraduate students. METHODS: A descriptive cross-sectional quantitative survey was conducted. A structured online questionnaire was used to elicit information on the prevalence of suicide ideation and its correlates. A systematic sampling technique was used to sample 400 respondents. Of this number, 53.25% were male and 46.75% were female. Data were analyzed using SPSS v26. Results were presented in charts, tables, and cross-tabulations. A regression analysis was also done to model suicide ideation with socio-demographic variables. RESULTS: The prevalence of suicide ideation among participants was 24.5%. Significant risk factors for suicide ideation found in the study were academic stress and victimization. Suicide ideation was predicted with statistical significance by the presence of victimization (OR = 3), and academic stress (OR = 2). CONCLUSION: The prevalence of suicide ideation among participants is real and will need combined efforts of university management and, the counseling unit to put in place interventions that will help avert suicide ideation and its dreaded squeal of completed suicide.

Persistent transmission of onchocerciasis in Kwanware-Ottou focus in Wenchi health district, Ghana.

BACKGROUND: This study examined onchocerciasis transmission in Kwanware and Ottou in the Wenchi Health District of Ghana, where persistent onchocercal microfilariae (mf) levels have been reported since 2012. METHODS: This study was conducted from 2019 to 2021 and involved the following: (i) reviewing past records of ivermectin mass drug administration (MDA); (ii) conducting a treatment coverage evaluation survey (CES); (iii) conducting key informant interviews; (iv) prospecting blackfly breeding sites; (v) collecting and dissecting blackflies; and (vi) conducting parasitological and serological surveys. RESULTS: (i) The review indicated ongoing MDA treatment for the past 27 years, with a reported coverage of over 65% in the last 17 yearly rounds; (ii) estimated treatment coverage by the CES in 2019 was 71.3%, with most of those not taking medicine stating that they were not offered; (iii) however, the key informant interviews revealed insufficiencies in reaching a significant number of people for treatment due to remote settlement, mobility, transport logistical issues, failure to register some people for treatment, leading to a false impression of good coverage, and a short distribution time; (iv) the most productive breeding was found within 5 km of Kwanware-Ottou; and (v) blackfly daily biting rates were highest in Kwanware and Ottou, with 199 and 160 bites per day, respectively. Infection in blackflies was found only in Kwanware and Ottou, with infectivity rates of 5.9‰ (per 1000) and 6.7‰, respectively. (vi) The mf prevalence in Ottou and Kwanware, respectively, was 40.0% and 30.0% among adults aged ≥ 20 years, and the anti-(Onchocerca volvulus) Ov16 IgG4 antibodies seroprevalence rates were 8.3% and 13.3% among children aged 5-9 years. These values were reduced to undetectable levels at a radius of 10 km from Ottou. CONCLUSIONS: This study confirms that active onchocerciasis transmission centres on Kwanware/Ottou and is confined to a 10 km radius despite 27 yearly treatment rounds. The main contributing factors are suboptimal coverage and high biting rates. Identifying and targeting such a focus with a combination of interventions will be cost-effective in accelerating onchocerciasis elimination in Ghana.

Patterns of acute chest pain at two tertiary centres in Accra, Ghana.

Objective: To assess the clinical presentation and evaluation of acute life-threatening chest pain in Accra, Ghana. Design: This was a cross-sectional study at the emergency departments of two leading tertiary hospitals in Accra. Settings: The study was conducted at the Korle-Bu Teaching Hospital and the 37 Military Hospital in Accra. Participants: The study participants comprised adult patients aged 18 years and above who presented with acute chest pain at the emergency departments between April and June 2018. Main Outcome: Acute coronary syndrome is the leading life-threatening cause of chest pain with poor pre- and in-hospital care. Results: 232 patients with chest pain were enrolled as respondents aged 18 to 94 years. The prevalence of life-threatening conditions causing chest pain was 31.9% of those who presented with acute chest pain. These included acute coronary syndrome (82.4%), pulmonary embolism (14.9%), and acute chest syndrome (2.7%). A few (6.6%) with life-threatening conditions such as acute coronary syndrome were transported by ambulances, and 44.3% reported to the facility within 2 to 9 days after the onset of chest pain. None of the patients with pulmonary embolism and acute chest syndrome had computer tomography pulmonary angiogram (CTPA) and echocardiogram done, respectively. Conclusion: Our study found that life-threatening conditions amongst patients presenting with acute chest pains are common; however, there is a need to improve pre-hospital care and in-hospital assessment of these cases. Funding: The study was partly funded by the Medtronic Foundation.

A Systematic Review of the Burden of Stroke in Ghana.

Background: Stroke is considered a significant public health concern in sub-Saharan Africa and Ghana due to its impact on quality of life. However, there is a lack of comprehensive pooled data on the prevalence and incidence rates of stroke in Ghana. Updating this information would help inform decision-making bodies on measures to reduce the burden of stroke in Ghana. This systematic review is aimed at critically appraising evidence gathered from studies done in Ghana on the prevalence and incidence rates of stroke among the Ghanaian population. Method: Four databases (CINAHL via EBSCOhost, Web of Science, MEDLINE via PubMed, and PsycINFO via EBSCOhost) were searched, for articles published between May 2000 and May 2020 on stroke burden. The search was constrained to studies conducted in Ghana and published in English that have been peer reviewed. Cochrane risk of bias tool was used to assess the quality of evidence. Meta-analysis was conducted to estimate the pooled stroke prevalence and incidence in the country. Results: A total of three studies that documented 12,974 stroke cases in 1,197,498 participants based on the inclusion criteria were reviewed. The meta-analysis revealed that the overall national prevalence and incidence rate of stroke for the country were 7.96% and 1.17%, respectively, calculated at 95% confidence intervals. Conclusion: According to the review findings, the incidence and prevalence rates of stroke are high in Ghana or among the Ghanaian population, and they are increasing.

Knowledge of diabetes mellitus complication prevention among patients in the central region of Ghana.

Diabetes Mellitus (DM) is a serious worldwide health issue that has put pressure on the global economy. The study examined the knowledge of complication prevention among patients living with Diabetes Mellitus (DM) in Ghana. The research was a quantitative study which involved the use of descriptive cross-sectional survey design. In all, 301 DM patients were included in the study. Data were processed using the Statistical Package for the Social Sciences (SPSS) version 25. The study recorded 66.12% (n = 199) good knowledge level. Therefore, educational intervention programme should be organized by the health professionals at Twifo-Atti Morkwa hospital so every DM patient would have optimum knowledge about the disease that would ensure prevention of the DM complications.

Thyroid dysfunction among patients assessed by thyroid function tests at a tertiary care hospital: a retrospective study.

Introduction: previous studies in African populations have not extensively described the spectrum of thyroid dysfunction using the profile of thyroid hormones. Although iodine deficiency is a common thyroid disorder in Africa, it does not represent the entire spectrum of thyroid dysfunction seen in patients. This retrospective study aimed to describe the spectrum of thyroid dysfunction among patients seen at the Korle-Bu Teaching Hospital (KBTH), a tertiary care hospital in Accra, Ghana. Methods: a retrospective analysis of medical records of all consultations on thyroid disorders seen at the Internal Medicine Department of KBTH between January 2019 and December 2021 was conducted. Information on patient demographics, and thyroid hormone profiles (triiodothyronine - FT3, thyroxine - FT4, and thyroid stimulating hormone - TSH) were extracted and subjected to descriptive statistics. The thyroid hormone profiles of the subjects were analyzed and classified into thyroid dysfunction categories using guidelines from the American Thyroid Association (ATA). Results: out of the 215 patients with thyroid disorders enrolled, 85.1% (n=183) were females and 14.9% (n=32), were males. The mean age of patients was 45±14 years, with most of the patients within the age range of 31-50 years (49.3%; n=106). The most reported thyroid function dysfunction was primary hyperthyroidism (57.7%), followed by primary hypothyroidism (22.3%), subclinical hyperthyroidism (9.3%), euthyroid sick syndrome (6.5%), and subclinical hypothyroidism (4.6%) respectively. Conclusion: primary hyperthyroidism was the most commonly diagnosed thyroid dysfunction. Hyperthyroidism has been associated with cardiac morbidity and mortality. Timely interventions are required to reduce the morbidity risks and burden associated with the hyperthyroid state.

Factors associated with sexual violence against reproductive-age women in Ghana: A multilevel mixed-effects analysis.

BACKGROUND: Sexual violence against women is a pervasive public health challenge and human rights violation, with global prevalence rates of approximately one in three women affected, notably prevalent in African countries. Understanding its multifaceted determinants is crucial for developing targeted intervention strategies. Thus, this study aimed to investigate factors associated with sexual violence against reproductive-age ever-married women in Ghana. METHODS: A weighted sample of 3,816 reproductive-age ever-married women from the 2022 Ghana Demographic and Health Survey (DHS) was included. To accommodate the hierarchical nature of the DHS data and the binary outcome variable 'sexual violence', a multilevel mixed-effect logistic regression model was employed. The deviance value was utilized for selecting the best-fitted model. In the multivariable multilevel binary logistic regression analysis, adjusted odds ratios (AORs) along with their respective 95% confidence intervals (CIs) were utilized to gauge the association strength, with statistical significance set at a p-value < 0.05. RESULT: The prevalence of sexual violence was found to be 8.80% (95% CI: 7.94-9.74). Factors positively associated with sexual violence included women's decision-making autonomy (AOR = 1.39, 95% CI: 1.08-1.74), husband/partner's alcohol consumption (AOR = 3.88, 95% CI: 2.98-5.06), sex of household head (AOR = 1.31, 95% CI: 1.02-1.68), and justification of beating (AOR = 1.35, 95% CI: 1.01-1.81). Conversely, women's age showed a negative association with sexual violence (AOR = 0.68, 95% CI: 0.48-0.98). CONCLUSION: In conclusion, prioritizing initiatives that empower women in decision-making roles, provide support for those struggling with alcohol consumption, and raise awareness about its impact on interpersonal relationships and the risk of sexual violence is essential. Furthermore, addressing harmful gender norms, particularly those justifying violence, and considering demographic characteristics are vital components of comprehensive strategies to prevent and mitigate sexual violence.

Adherence to Hygiene Protocols and Doxycycline Therapy in Ameliorating Lymphatic Filariasis Morbidity in an Endemic Area Post-Interruption of Disease Transmission in Ghana.

Filarial lymphedema (LE) remains a significant global problem despite the progress made toward elimination of lymphatic filariasis (LF). In Ghana, the main approach to LF is preventive chemotherapy, but this has minimal impact on individuals who have already developed LE. In 2018-2020, a 24-month randomized, double-blind, placebo-controlled trial was conducted to evaluate the efficacy of stringent hygiene measures using the Essential Package of Care with or without additional administration of doxycycline (DOX) to improve filarial leg LE. This study enrolled 356 participants with LE stages 1-3 from two districts in the Upper East Region of Ghana. In addition to regular training on appropriate care for their affected legs, participants were randomized to receive 6 weeks of either 200 mg/day DOX (n = 117), 100 mg/day DOX (n = 120), or matching placebo (n = 119). Participants were seen every 2 months, with clinical measurements done at 6, 12, 18, and 24 months to assess the status of affected legs. There was a trend toward later appearance of acute attacks after DOX, but surprisingly, DOX showed no effect on LE stage progression. In all groups, leg LE improvement was more common (DOX 200 mg: n = 23 [20%]; DOX 100 mg: n = 23 [19.5%]; placebo: n = 32 [27.4%]) than LE worsening (DOX 200 mg: n = 2 [1.7%]; DOX 100 mg: n = 3 [2.5%]; placebo: n = 2 [1.7%]). Overall, these data show a strong benefit from adherence to a strict hygiene protocol, with some added potential benefit for DOX in preventing acute attacks.

Impact of COVID-19 lockdown measures on mother and child health - the case of Ghana.

BACKGROUND: The lockdown measures in response to the coronavirus disease (COVID-19) have led to a wide range of unintended consequences for women and children. Until the outbreak of COVID-19, attention was on reducing maternal and infant mortality due to pregnancy and delivery complications. The aim of this study was to interrogate the impact of lockdown measures on women and children in two contrasting districts in Ghana - Krobo Odumase and Ayawaso West Wuogon. METHODS: This study adopted the mixed-method approach using both qualitative and quantitative data. The qualitative study relied on two data collection methods to explore the impacts of COVID-19 control measures on women and children in Ghana. These were: Focus Group Discussions (FGDs; n = 12) and Key Informant Interviews (KIIs; n = 18). The study complemented the qualitative data with survey data - household surveys (n = 78) which were used to support the nutrition and school closure data; and policy data gathered from government websites consisting of government responses to COVID-19. The qualitative data was analysed using the thematic approach with codes generated apriori with the NVIVO software. The quantitative data used percentages and frequencies. RESULTS: Engagements with participants in the study revealed that the lockdown measures implemented in Ghana had consequences on child and maternal health, and the health care system as a whole. Our study revealed, for example, that there was a decrease in antenatal and postnatal attendance in hospitals. Childhood vaccinations also came to a halt. Obesity and malnutrition were found to be common among children depending on the location of our study participants (urban and rural areas respectively). Our study also revealed that TB, Malaria and HIV treatment seeking reduced due to the fear of going to health facilities since those ailments manifest similar symptoms as COVID 19. CONCLUSION: Government responded to COVID-19 using different strategies however the policy response resulted in both intended and unintended consequences especially for women and children in Ghana. It is recommended that national policy directions should ensure the continuous provision of child and maternal healthcare services which are essential health services during lockdowns.

Genomic analysis of Enterobacteriaceae from colorectal cancer patients at a tertiary hospital in Ghana: a case-control study.

Colorectal cancer (CRC) is a severe gastrointestinal cancer and a leading cause of cancer-related deaths in Ghana. The potential role of gut Enterobacteriaceae in the increasing incidence of CRC in Ghana is yet to be thoroughly investigated. In this study, Enterobacteriaceae from CRC patients and healthy control participants were analyzed by whole genome sequencing to identify genomic features that are associated with CRC. Socio-demographic data showed a significant association between age and alcohol consumption and CRC. Escherichia coli was the most abundant Enterobacteriaceae isolated from the study participants and they were predominantly intestinal commensals. Escherichia coli isolates belonging to phylogroup D encoded the highest number of virulence genes. The agn43 and int genes were widespread in Escherichia coli isolates from the CRC patients. Multilocus sequence types of potentially pathogenic Escherichia coli from the CRC patients also encoded genes involved in aggregation, adherence and biofilm formation. The ampC2 and ampH antimicrobial resistance genes were also widespread in the genome of the Escherichia coli isolates. This study highlights the virulence tendencies of Escherichia coli from CRC patients and their ability to transfer virulence determinants to other Enterobacteriaceae residing in the gut.

Reducing stunting and underweight through mother's birth spacing: evidence from Ghana.

BACKGROUND: Researchers over the years have underscored the role of birth spacing on maternal health, however, inadequate maternal repletion due to shorter birth intervals could also affect the health of the child. Even so, limited studies exist on the linkage between birth spacing and child nutrition. This study examines the association between birth spacing and child stunting and underweight using the 2014 Ghana Demographic and Health Survey. METHODS: The study sourced data on 1, 904 children less than 59 months from the 2014 Ghana Demographic and Health Survey. The study employed bivariate analysis and logistic regressions to establish the association between birth spacing, and child stunting and underweight. RESULTS: The analyses reveal that childbirth spacing between 24 and 35 months (OR = 0.62, 95% CI: 0.38-0.99; p < 0.05), 36 to 47 months (OR = 0.42, 95% CI: 0.25-0.70; p < 0 0.01), and beyond 47 months (OR = 0.47, 95% CI: 0.28-0.78; p < 0.01) have lower odds of child stunting than children with birth spacing less than 24 months. Children with birth spacing between 24 and 35 months (OR = 0.53, 95% CI: 0.29-0.98; p < 0.05), 36 to 47 months (OR = 0.44, 95% CI: 0.22-0.90; p < 0.01) and beyond 47 months (OR = 0.49, 95% CI: 0.26-0.94; P < 0.05) have lower odds of being underweight than those with birth spacing less than 24 months. CONCLUSION: The study reveals that mothers with a birth spacing of at least two to three years compared to their counterparts with less than two years of birth spacing have lower odds of having a stunted and underweight child under age five. The study recommends that Ghana Health Service and other healthcare providers should educate mothers on the gains of birth spacing of at least two years on their children.

Absence of measurable quantities of Candida auris and Cryptococcus spp. in the gut microbiota of Ghanaian individuals with and without HIV infection as confirmed by applying multiple real-time PCR assays.

Introduction. Fungal infections are relevant health risks for individuals with acquired immunodeficiency in the resource-limited tropics, but available surveillance data are scarce. For Candida auris and Cryptococcus spp., the evolution from environmental reservoirs to human pathogens causing life-threatening diseases is currently discussed as a public health concern in the context of climate change and limited treatment options.Gap statement. Uncovering the gastrointestinal tract as an epidemiological niche of fungi emerging from the environment into individuals for whom fungal infections are not diagnosed.Aim. To contribute to data on the local epidemiology of C. auris and Cryptococcus spp. in Western African Ghana by analysing gastrointestinal samples of Ghanaian individuals.Methodology. Four real-time PCR assays targeting C. auris and five real-time PCR assays targeting Cryptococcus spp. were applied with stool samples of 875 non-age-stratified Ghanaian HIV patients and 30 Ghanaian control individuals without known HIV infection. Also, 664 samples from Ghanaian children under 2 years of age were investigated. The true abundance of the target micro-organism was considered as unlikely in the case of one or fewer positive signals, likely in the case of two to three positive signals and highly likely in the case of four or more positive signals per sample in the real-time PCR assays.Results. The combined application of sensitive, target-specific real-time PCR assays indicates that neither C. auris, Cryptococcus neoformans complex nor Cryptococcus gattii complex were part of the gut microbiota of Ghanaian individuals with or without HIV infection.Conclusion. Despite the significant disease burden from these pathogens in immunosuppressed Ghanaian individuals, detection from gastrointestinal samples was unlikely, which should be taken into account when discussing screening strategies for these fungi of public health concern. In contrast, the detection of these fungi from such samples should not routinely be considered as commensal colonization flora.

Study protocol for the development of a real-time interface showing the availability of breast and cervical cancer services in Ghana.

BACKGROUND: The 5-year survival rates for breast and cervical cancers in Ghana are low in comparison to rates in developed countries. This striking disparity is attributed to numerous factors, including limited access and navigability to appropriate services. A one-time cross-sectional, hospital-based survey was performed by the University of Utah in collaboration with Ghana Health Services (GHS) and Health Facilities Regulatory Agency (HeFRA) from November, 2020 to October, 2021 so as to determine existing hospital-based breast and cervical cancer care services capacity and their geographic availability nationwide. This related information remains dynamic in nature and time. The current project employs a public-academic implementation science and research configuration to explore and develop a real-time interface (RTIF) showing the availability of breast and cervical cancer care services at hospital facilities in-country so as to anchor up-to-date data products for the government, private-sector, and patient-centric consumption. METHODS AND ANALYSIS: Multiple methods will be employed to achieve the study objectives between December 2023 to November 2024. The first three objectives shall focus on contextual, needs, and feasibility assessments guided by the domains and constructs within the updated Consolidated Framework for Implementation Research (CFIR) during coding and thematic qualitative analysis. Using purposive sampling, breast and cervical cancer care service stakeholders shall be identified for individual in-depth interviews. The fourth objective will involve creating the RTIF prototype and piloting it in the Eastern Region of Ghana. The final and fifth objective shall employ the systems usability scale (SUS) amongst ten randomly selected individual stakeholders to assess the technical functionality of the interface. A nationwide scale-up shall follow this.

An integrated active case detection and management of skin NTDs in yaws endemic health districts in Cameroon, Côte d'Ivoire and Ghana.

BACKGROUND: Integrated approaches to mapping skin Neglected Tropical Diseases (NTDs) may be cost-effective way to guide decisions on resource mobilization. Pilot studies have been carried out, but large-scale data covering multiple countries endemic for skin NTDs are lacking. Within the LAMP4YAWS project, we collected integrated data on the burden of multiple skin NTDs. METHODS: From March 2021 to March 2023, integrated case searches for yaws alongside other skin conditions were performed in endemic health districts of yaws in Cameroon, Côte d'Ivoire, and Ghana. Integrated activities included training, social mobilization and active case detection. Initial screening involved a brief clinical examination of participants to determine if any skin conditions were suspected. Cases of skin NTDs were then referred to a health facility for appropriate management. RESULTS: Overall 61,080 individuals screened, 11,387 (18.6%) had skin lesions. The majority of individuals (>90%) examined were children aged 15 years old and under. The proportion of serologically confirmed yaws cases was 8.6% (18/210) in Cameroon, 6.8% (84/1232) in Côte d'Ivoire, and 26.8% (440/1643) in Ghana. Other skin conditions based on clinical examination included: scabies, Buruli ulcer, leprosy, lymphatic filariasis (lymphoedema and hydrocele), tungiasis, and fungal infections. The most common conditions were scabies and superficial fungal infections. In Cameroon, scabies and superficial fungal infections accounted for 5.1% (214/4204) and 88.7% (3730/4204) respectively, 25.2% (1285/5095) and 50.4% (2567/5095) in Côte d'Ivoire. In Ghana, 20% (419/2090) of individuals had scabies but superficial fungal infections were not routinely recorded and were reported in only 1.3% (28/2090). Other skin NTDs were less common across all three countries. CONCLUSION: This study confirms that integrated screening allows simultaneous detection of multiple skin NTDs, maximising use of scarce resources.