Evaluation of the malaria surveillance system - Adaklu District, Volta Region, Ghana, 2019.

Objectives: We evaluated the malaria surveillance system in Adaklu District of the Volta Region of Ghana to determine if the system was meeting its objectives and assessed its usefulness and attributes. Study design: Descriptive cross-sectional design was used in evaluating the surveillance system. Methods: We interviewed stakeholders using a semi-structured questionnaire on case detection and reporting. We assessed the system attributes using the Centers for Disease Control and Prevention updated guidelines for evaluating public health surveillance systems. We extracted and reviewed malaria surveillance data from the District Health Management Information System 2. Summary statistics and direct content analysis were performed on quantitative and qualitative data respectively. Results: Of the 80,441 suspected malaria cases recorded in Adaklu District from 2014 to 2018, 47,917 (59.6%) cases were confirmed. The system was meeting its objective of detecting malaria cases and monitoring trends in the population however, the system missed an epidemic in August 2016. Data generated from the surveillance system is used by the NMCP to aid in the distribution of logistics such as LLINs, RDT test kits, and track malaria control progress in the district. Staff at all levels were able to detect, confirm, treat and report malaria. All sub-districts/health facilities reported to the district and reports were all accurate and timely. The predictive value positive was 62.9%. Conclusions: The malaria surveillance system in Adaklu District was useful and meeting its set objective of monitoring trends of malaria in the population. It was simple, flexible, acceptable and representative; however, the system was not detecting epidemics. The District Health Management Team should set alert and epidemic thresholds to help detect promptly epidemics of malaria in the district.

Risk factors, ascribed causes and effects of obstetric fistula among women in northern Ghana: a case control studies

Background: Obstetric fistula is a demoralizing maternal morbidity. In Ghana, majority of the fistula occur in the northern sector. This study sought to identify the risk factors, ascribed causes and effect of obstetric fistula. Methods: A matched case control study was conducted from April to June 2013. The fistula patients were taken from the Fistula Centre in Tamale whiles the controls were from the Tamale Teaching hospital. Eligible cases were confirmed fistula patients admitted for fistula repair while controls were women who have delivered but without obstetric fistula. Cases and controls were matched on year, region and district of index delivery. Results: the following factors were associated with obstetric fistula; age below 20 years, total labour duration more than 24 hours, height 150 cm and below, still birth, operative delivery, residence in a rural area and lack of formal education. Divorce rate among cases over the period was 55.3% while that among the controls was 2.3%. About 20% of cases were likely to be currently using alcoholic beverages compared to 6% in controls (OR=5.3, 95% CI= 1.4 ­19.7). 40% of cases currently have no living child compared to 2% of controls. Majority of fistula patients blame lack of health facilities and an act of God as a cause of fistula. Conclusions: Majority of women who suffer obstetric fistula are young, poor, of short stature, illiterate and resident in remote areas. There is widespread lack of understanding of the causes of Obstetric fistula among women

THE PREVALENCE OF TUBERCULOSIS IN CATTLE AND THEIR HANDLERS IN NORTH TONGU, VOLTA REGION, GHANA.

BACKGROUND: The need to understand the contribution of bovine tuberculosis (BTB) to the general tuberculosis burden in a poor resource setting is paramount. The aim of this study is to determine the burden of BTB among herdsmen and cattle in the North Tongu district of Volta Region in Ghana. MATERIALS AND METHODS: A cross- sectional study was conducted in the North Tongu District of the Volta Region between the period of October 2011- March 2012. A well-structured questionnaire was used to collect socio-demographic information and possible risk factor information on cattle from participants. Sputum samples from 68 herdsmen and blood samples from 200 cattle belonging to these herdsmen were also collected. Sputum samples were analyzed using Ziehl- Neelsen staining while Anigen Rapid BTB Test was used for Cattle blood samples. RESULTS: Ninety percent (61/68) of respondents were also found to consume fresh milk while 84% (57/68) do not use protective clothing. Of a total of 1580 cattle owned by the herdsmen, 200 cattle consisting of 14 bulls and 186 cows were screened where the prevalence of bovine TB was 19% (38/200) and those affected were all females. All (100%) human sample tested negative for Acid-Fast Bacilli (AFB). However, the seropositivity of cattle and kraal density were statistically associated (p= 0.001). CONCLUSION: Bovine TB is prevalent in cattle in North Tongu district. Although herdsmen indulge in risky lifestyles that expose them to BTB, a zero prevalence of BTB was observed, further study is envisaged using a larger sample size.

Prevalence of human papillomavirus genotypes among women with cervical cancer in Ghana.

BACKGROUND: Human Papillomavirus (HPV) infections have been shown to be a necessary risk factor for the development of cervical cancer. However, HPV genotype distribution varies geographically, both in type and relative prevalence. In order to ensure a successful introduction of available vaccines, there is the need to identify pre-vaccination HPV genotype prevalence in Ghana and the extent of single and multiple-infections. METHODS: Paraffin-embedded cervical tissues of 256 confirmed cervical cancer cases diagnosed at the Korle-Bu Teaching Hospital during the period January 2004 to December 2006 were selected after hematoxylin and eosin staining and confirmation. Following a heat-proteinase K-based tissue lysis, HPV was detected and typed by a nested-multiplex PCR assay using an E6/E7 consensus primer and type-specific primers. RESULTS: Of the 256 cases, 230 (89.8 %, 95 % CI 85.7-93.4 %) were positive for HPV DNA. HPV18 (47.4 %), HPV59 (42.2 %), HPV45 (37.4 %) and HPV16 (9.0 %) were the four common HPV genotypes detected. A total of 110 (47.8 %) of the 230 HPV DNA positive tissues, were infected by a single HPV genotype while the other 120 (52.2 %) were infected by multiple HPV genotypes. A significant association was determined between each of the following HPV genotypes and multiple-infection; HPV18 (OR = 6.97; 95 % CI, 3.89-12.50), HPV59 (OR = 9.56; 95 % CI, 5.57-20.02) and HPV45 (OR = 1.94; 95 % CI, 1.12-3.35). CONCLUSION: The prevalence of the following high risk HPV genotypes (HPV18, HPV59, HPV45) were relatively high among the cases of cervical cancers reported at this hospital in Ghana during the study period. Additionally, there was a high frequency of HPV multiple-infections among these cases.

Improving medical records filing in a municipal hospital in Ghana.

BACKGROUND: Medical records are kept in the interest of both the patient and clinician. Proper filing of patient's medical records ensures easy retrieval and contributes to decreased patient waiting time at the hospital and continuity of care. This paper reports on an intervention study to address the issue of misfiling and multiple patient folders in a health facility. DESIGN: Intervention study. SETTING: Municipal Hospital, Goaso, Asunafo North District, Brong Ahafo Region, Ghana. METHODS: Methods employed for data collection were records review, direct observation and tracking of folders. Interventions instituted were staff durbars, advocacy and communication, consultations, in-service trainings, procurement and monitoring. Factors contributing to issuance of multiple folders and misfiling were determined. Proportion of multiple folders was estimated. RESULTS: Results revealed direct and indirect factors contributing to issuance of multiple patient folders and misfiling. Interventions and monitoring reduce acquisition of numerous medical folders per patient and misfiling. After the intervention, there was significant reduction in the use of multiple folders (i.e., overall 97% reduction) and a high usage of single patient medical folders (i.e., 99%). CONCLUSION: In conclusion, a defined medical records filing system with adequate training, logistics and regular monitoring and supervision minimises issuance of multiple folders and misfiling.

Laboratory diagnosis of dual HIV-1/HIV-2 infection in Ghanaian patients.

OBJECTIVE: To determine the true prevalence of HIV dual infections in a previously characterised HIV seropositive patient group due to inconsistencies between different diagnostic methods. DESIGN: A cross-sectional study of an HIV seropositive group with different diagnostic methods. SETTING: Three hospitals in the Northern, Ashanti and Greater Accra Regions of Ghana. SUBJECTS: One hundred and forty five HIV infected patients/individuals sampled from June to September 2002. MAIN OUTCOME MEASURES: Using serological and molecular methods, the seropositive status of HIV-infected patients, previously determined by a preliminary screening process, was confirmed and discrepancies noted. The data was used to propose a more accurate laboratory diagnosis of HIV dual infections involving HIV-1 and HIV-2. RESULTA: HIV-1 infections were mostly accurately detected, but difficulties were encountered in diagnosing HIV-2 infections. To achieve a positive detection on confirmatory immunoblots, antibody concentration in some samples tested was enhanced by using larger volumes. In other cases, diagnosis of HIV infections by PCR, especially HIV-2, was possible only after increasing the DNA template or MgCl2 concentrations. Such samples would otherwise have been inaccurately scored for HIV infections. CONCLUSION: Based on the results of this study, we propose that the accurate diagnosis of HIV dual infections, especially HIV-2 component, must use an algorithm that involves PCR. Our results however underscore conclusions of a previous study that most dually seroreactive samples are predominantly HIV-1 infections with crossreactivity to HIV-2 antigens.

Molecular variability analysis of five new complete cacao swollen shoot virus genomic sequences.

Cacao swollen shoot virus (CSSV), a member of the family Caulimovi-ridae, genus Badnavirus occurs in all the main cacao-growing areas of West Africa. We amplified, cloned and sequenced complete genomes of five new isolates, two originating from Togo and three originating from Ghana. The genome of these five newly sequenced isolates all contain the five putative open reading frames I, II, III, X and Y described for the first sequenced CSSV isolate, Agou1 originating from Togo. Their genomes have been aligned with the genome of Agou1. The nucleotide and amino acid sequence identities between isolates have been calculated and a phylogenetic analysis has been made including other pararetroviruses. Maximum nucleotide sequence variability between complete genomes of CSSV isolates was 29.4%. Geographical differentiation between isolates appears more important than differentiation between mild and severe isolates. ORF X differs greatly in size and sequence between the Togolese isolates Nyongbo2 and Agou1, and the four other isolates, its functional role is therefore clearly questionable.

Emergency vaccination against epidemic meningitis in Ghana: implications for the control of meningococcal disease in West Africa.

BACKGROUND: Recurrent epidemics of meningococcal disease have been reported throughout the African meningitis belt since description of the disease in 1912. Meningooccal polysaccharide vaccines can effectively prevent disease but the optimum strategy for their use in this setting has been controversial. We used data from an outbreak of meningococcal disease in northern Ghana in 1997 to assess the potential effect of different vaccination strategies. METHODS: We identified all reported cases of meningococcal meningitis and estimated the number of cases and deaths that could have been prevented by vaccination through use of a simple mathematical model. We then assessed the potential effect of different vaccination strategies and the burden of these strategies on the public-health system. FINDINGS: In the three affected regions in northern Ghana there were 18703 cases and 1356 deaths reported between November, 1996, and May, 1997. Vaccination began in the third week of February and continued to April, reaching 72% of the at-risk population and preventing an estimated 23% of cases and 18% of deaths. A strategy of routine childhood and adult immunisation would have prevented 61% of cases had this same rate of vaccine coverage been achieved and maintained before the epidemic. If vaccination had started after the onset of the epidemic in January, as currently advocated by WHO guidelines, a similar proportion (61%) of cases could have been prevented. INTERPRETATION: Prevention of epidemics of meningococal disease in west Africa will be difficult until long-lasting conjugate vaccines capable of interrupting transmission of Neisseria meningitidis can be incorporated into routine infant-immunisation schedules. Until then, the strategy of surveillance and response advocated by WHO is as effective and more practical than a strategy of routine childhood and adult vaccination with currently available polysaccharide vaccines.

PIP: This study assessed the potential effects of different vaccination strategies using data from the 1997 meningococcal outbreak in northern Ghana. Since the description of the disease in 1912, recurrent epidemics of meningococcal disease have been reported throughout the African meningitis belt. The use of meningococcal polysaccharide vaccines has been proven to effectively prevent the disease, although the method of vaccine distribution was disputable. Using a simple mathematical model, meningococcal meningitis cases and deaths, which could have been forestalled by vaccination, were identified, and the effect of developed vaccination strategies on the public health system was analyzed. About 18,703 cases and 1356 deaths were reported in 3 regions of northern Ghana between November 1996 and May 1997. Vaccination was conducted between February and April, which covered 72% of the high-risk population and prevented approximately 23% of cases and 18% of deaths. Routine childhood and adult immunization would have prevented 61% of cases had this same rate of vaccine coverage been achieved and maintained before the epidemic. This study suggests that the prevention of the meningococcal disease epidemic in West Africa would be difficult unless long-lasting conjugate vaccines are incorporated into routine infant immunization schedules. For now, the surveillance and response strategies advocated by the WHO serve as an effective and practical intervention.

Descriptive epidemiology of lymphatic filariasis in Ghana.

A national filariasis survey was conducted to determine the prevalence and distribution of Wuchereria bancrofti microfilaraemia and clinical disease associated with lymphatic filariasis in Ghana. Multi-stage systematic sampling was used to select households to be examined in all 10 administrative regions of the country. The results showed a high prevalence of microfilaraemia and disease with considerable regional variation in all the quantities investigated. In general, the disease was more prevalent in the northern guinea savannah and the southern coastal savannah, while the middle forest belt was relatively free. Even within the regions, there was considerable variation in the distribution of the disease. The disease is of potentially major public health significance, particularly in the northern and coastal savannahs, and requires the design and implementation of a control programme.

[Comparison of mortality and morbidity in newborns treated with ambroxol prenatally and postnatally]. / Porównanie smiertelnosci i zachorowalnosci noworodków leczonych Ambroksolem prenatalnie i pourodzeniowo.

The effect of Ambroksol given pre- and postnatal on infant mortality and morbidity was performed. In particular we found a statistically significant differences in reduction of mortality in the group A treated with Ambroksol pre- and postnatal vs. group B treated only postnatal. The other parameters of morbidity had no significantly importance but sepsis, which was more often diagnosed in group A than in group B (17.5% vs. 11.1%). We connect this fact with higher frequency of PROM in the group A.

[Evaluation of ambroxol given prenatally and postnatally on gas exchange in the newborn with respiratory distress syndrome]. / Ocena wplywu ambroksolu podawanego prenatalnie i pourodzeniowo na wymiane gazowa u noworodka z zespolem zaburzen oddychania.

160 newborns were observed to compare the influence of combine treatment with ambroxol (Lasolvan-Boehringer Ingelheim) (antenatal and postnatal) versus postnatal administration of this drug on gas exchange and reduction of ventilatory settings in newborns with RDS. In 53% of cases the preparation was given both: pre- and postnatal and 47% of newborns were treated only postnatal. The results of stimulation of lung maturity "before and after" versus "after" delivery were better in the first group, however in some parameters we did not found statistical differences.

[Evaluation of surfactant administration in neonates with respiratory distress syndrome. III. The role of intra-uterine stimulation on lung maturity]. / Ocena leczenia surfaktantem noworodków z zespolem zaburzen oddychania. III. Rola wewnatrzmacicznej stymulacji dojrzalosci pluc.

Prenatal corticosteroids and exogenous surfactant therapy independently reduce the adds of neonatal death by about 40%. It is not clear however if babies who develop RDS despite prenatal corticosteroid therapy behave differently when later given exogenous surfactant. This paper presents an evaluation of the outcome of babies treated with Curosurf (a porcine surfactant) for RDS depending upon whether they received prenatal corticosteroids (16 babies) or not (11 babies). Although not randomised these two groups of babies appear to be similar in respect of gestational age. However, lower mortality was found in the group treated with prenatal corticosteroids (12.5% vs. 27.2%).