Prevalence of non-tuberculous mycobacteria among previously treated TB patients in the Gulf of Guinea, Africa.

Objective: Differentiation between non-tuberculous mycobacteria (NTM) and Mycobacterium tuberculosis complex (MTBC) is crucial for case management with the appropriate antimycobacterials. This study was undertaken in three West and Central African countries to understand NTM associated with pulmonary tuberculosis in the sub-region. Methods: A collection of 503 isolates (158 from Cameroon, 202 from Nigeria and 143 from Ghana) obtained from solid and liquid cultures were analysed. The isolates were tested for drug susceptibility, and MTBC were confirmed using IS6110. All IS6110-negative isolates were identified by 65-kilodalton heat shock protein (hsp65) gene amplification, DNA sequencing and BLAST analysis. Results: Overall, the prevalence of NTM was 16/503 (3.2%), distributed as 2/202 (1%) in Nigeria, 2/158 (1.3%) in Cameroon and 12/143 (8.4%) in Ghana. The main NTM isolates included 5/16 (31.3%) M. fortuitum, 2/16 (12.5%) M. intracellulare and 2/16 (12.5%) M. engbaekii. Eight (57.1%) of the 14 previously treated patients harboured NTM (odds ratio 0.21, 95% confidence interval 0.06-0.77; P=0.021). Three multi-drug-resistant strains were identified: M. engbaekii, M. fortuitum and M. intracellulare. Conclusion: NTM were mainly found among individuals with unsuccessful treatment. This highlights the need for mycobacterial species differentiation using rapid molecular tools for appropriate case management, as most are resistant to routine first-line antimycobacterials.

The CannTeen study: verbal episodic memory, spatial working memory, and response inhibition in adolescent and adult cannabis users and age-matched controls.

BACKGROUND: Preclinical and human studies suggest that adolescent cannabis use may be associated with worse cognitive outcomes than adult cannabis use. We investigated the associations between chronic cannabis use and cognitive function in adolescent and adult cannabis users and controls. We hypothesised user-status would be negatively associated with cognitive function and this relationship would be stronger in adolescents than adults. METHODS: As part of the 'CannTeen' project, this cross-sectional study assessed cognitive performance in adolescent cannabis users (n = 76; 16-17-year-olds), adolescent controls (n = 63), adult cannabis users (n = 71; 26-29-year-olds) and adult controls (n = 64). Users used cannabis 1-7 days/week. Adolescent and adult cannabis users were matched on cannabis use frequency (4 days/week) and time since last use (2.5 days). Verbal episodic memory (VEM) was assessed using the prose recall task, spatial working memory (SWM) was assessed using the spatial n-back task, and response inhibition was assessed with the stop-signal task. Primary outcome variables were: delayed recall, 3-back discriminability, and stop signal reaction time, respectively. RESULTS: Users had worse VEM than controls (F(1,268) = 7.423, p = 0.007). There were no significant differences between user-groups on SWM or response inhibition. Null differences were supported by Bayesian analyses. No significant interactions between age-group and user-group were found for VEM, SWM, or response inhibition. CONCLUSIONS: Consistent with previous research, there was an association between chronic cannabis use and poorer VEM, but chronic cannabis use was not associated with SWM or response inhibition. We did not find evidence for heightened adolescent vulnerability to cannabis-related cognitive impairment.

Economic evaluations of interventions against influenza at workplaces: systematic review.

BACKGROUND: The burden of influenza is mostly felt by employees and employers because of increased absenteeism rates, loss of productivity and associated direct costs. Even though interventions against influenza among working adults are effective, patronage and compliance to these measures especially vaccination are low compared to other risk groups. AIMS: This study was aimed to assess evidence of economic evaluations of interventions against influenza virus infection among workers or in the workplace setting. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline for systematic reviews was followed. Three databases, PubMed, Web of Science and EconLit, were searched using keywords to identify relevant articles from inception till 25 October 2020. Original peer-reviewed papers that conducted economic evaluations of influenza interventions using cost-benefit, cost-effectiveness or cost-utility analysis methods focused on working-age adults or work settings were eligible for inclusion. Two independent teams of co-authors extracted and synthesized data from identified studies. RESULTS: Twenty-four articles were included: 21 were cost-benefit analyses and 3 examined cost-effectiveness analyses. Two papers also presented additional cost-utility analysis. Most of the studies were pharmaceutical interventions (n = 23) primarily focused on vaccination programs while one study was a non-pharmaceutical intervention examining the benefit of paid sick leave. All but two studies reported that interventions against influenza virus infection at the workplace were cost-saving and cost-effective regardless of the analytic approach. CONCLUSIONS: Further cost-effectiveness research in non-pharmaceutical interventions against influenza in workplace settings is warranted. There is a need to develop standardized methods for reporting economic evaluation methods to ensure comparability and applicability of future research findings.

Characteristics and trait preferences of West African Dwarf goat keepers in Ghana.

A study was conducted to evaluate the characteristics of West African Dwarf (WAD) goat keepers and their trait preferences as part of a broader phenotypic characterisation work with the aim of providing information for improving the household management, conservation and productivity of the breed in Ghana. A total of 384 respondent households were selected from four agro-ecological zones in the middle belt and southern part of the country for questionnaire administration and direct observation of animals under field conditions. The results showed that there are slightly more women (54.2%) keeping WAD goats than men (45.8%) and fall within the economically active population of youthful and middle age categories (53.9%). A majority of these goat keepers were married (73.8%) and educated (87.3%) in one way or the other. They obtained their starter or foundation stock mainly from neighbours (80.5%) and the open market (16.0%). The average flock size from the households sampled was 7.9 ± 1.5, whereas the flock structure constituted 56.1% adult females, 27.5% adult intact males, 1.2% castrates and 15.2% kids of both sexes. Survivability, fast growth rate and larger litter size were the farmers' most preferred quantitative traits, whereas most of these respondents preferred to keep WAD goats which do not have qualitative traits such as horn, wattle and beard. From the findings of the research, it was concluded that the favourable socio-economic characteristics of WAD goat keepers could sustain intensification and increase the productivity of the breed when given the necessary input assistance along the goat value chain. The primary objective of WAD goat farmers is to produce matured animals for various purposes and the breeding goal for a WAD goat breeding programme would be to increase survival, growth rate and litter size of light coat (white, grey and light brown) goats. Finally, most farmers lack knowledge on the significance of tropically beneficial qualitative traits such as horn, wattle, beard and light coat colouration on the survivability, climate adaptability or resilience and productivity of their goats. Educating farmers on the importance of conserving and inclusion of animals possessing such traits in their selection practices under the Government's Rearing for Food and Jobs Initiative is therefore suggested.

Morphometric characterization and differentiation of West African Dwarf goat populations in Ghana.

A study was carried out to characterize and differentiate four West African Dwarf goat populations on the basis of morphometric traits and also predict their body weights using linear body measurements. A total of 384 goats were sampled from four agro-ecological zones from the middle belt and southern part of Ghana. The morphometric traits examined for phenotypic differentiation using univariate and multivariate analysis were body weight, body length, withers height, chest girth, chest depth, shoulder point width, rump length, rump width, head length, head width, shin circumference, horn length, ear length, tail length, and hair length. Results obtained showed that agro-ecological zone and age significantly (p < 0.05) influenced the performance of most traits. The phenotypic correlations among the traits were low to high (0.06-0.67) indicating linear relationships among these traits which may be caused by both genetic and environmental factors. The regression analysis also revealed that a single trait which may be used to predict the body weight of male West African Dwarf goats of ages 1-4 years is chest/heart girth and that of female counterparts is withers height. All the populations were significantly (p < 0.0001) distant (differentiated) from each other, but the largest (4.62) estimated Mahalanobis distance (D2) was between West African Dwarf goat populations in the transitional zone P1 and the rainforest P3 while the least (1.61) was observed between transitional zone P1 and semi-deciduous forest zone P2. The highest similarity between individuals within population was found in the rainforest P3 (79.76%) and the lowest in the transitional zone P1 (47.13%). The three canonical components (Can1, Can2, and Can3) explained the total (100%) between-population variation in morphometric traits. However, in partitioning of the variance, the first two canonical components (Can1 and Can2) accounted for cumulative proportion of 84.35% of between-population variance. In order of importance, tail length, head length, ear length, shin circumference, head width, and shoulder point width were the most discriminating variables responsible for the variations among the four goat populations. In conclusion, morphometric variations exist among West African Dwarf goat populations of Ghana. Yet, further studies on molecular genetic diversity of the populations are recommended to support a sustainable breed improvement strategy. Also, equations have been developed that can be used to reliably predict the body weight of WAD goats and future research should also focus on developing single variable weight estimator measuring tapes based only on either the chest girth, withers height, or body length prediction equations for farmers to use in the absence of weighing scale.

Genetic and non-genetic factors influencing the performance of the West African Dwarf (WAD) goat kept at the Kintampo Goat Breeding Station of Ghana.

A study was conducted to analyze the effect of genetic and non-genetic factors influencing the growth performance of the West African Dwarf goat. Breed records of 836 kids born by 259 does, and 8 bucks from 2011 to 2017 at the station were used. Growth performance traits studied were birth weight, weaning weight, 6-month body weight, 9-month body weight, yearling weight, and pre-weaning and post-weaning growth rates. The fixed effects of sex of kid (male or female), season of kidding (major, minor, and dry), year of kidding (2011-2017), and type of birth (single, twins, or triplets) on growth performance were determined. Genetic parameters such as heritability and correlations among the traits were also estimated. The non-genetic data (fixed factors) obtained were analyzed using the general linear model procedures of GenStat (Discovery Edition 12). Heritability estimates obtained for the growth traits were 0.45 ± 0.15, 0.57 ± 0.29, 0.04 ± 0.05, 0.74 ± 0.59, 0.49 ± 0.35, 0.55 ± 0.39, and 0.54 ± 0.36, respectively, an indication of high genetic variation existing among the traits (with the exception of 6-month body weight). This could be harnessed and utilized for genetic improvement within the flock. The phenotypic correlation coefficients among the traits ranged from low to high (0.04-0.95), indicating that there is a linear relationship among body traits of the goats which may be caused by either genetic or environmental factors of correlation. The genetic correlations were also medium to high (0.30-0.96). The general implications are that selection for any of these growth traits in a breed improvement programme would have a considerable simultaneous positive impact on each other. The overall birth weight, weaning weight, 6-month body weight, 9-month body weight, yearling weight, and pre- and post-weaning growth rates obtained were 1.48 kg, 5.35 kg, 6.56 kg, 8.30 kg, 10.00 kg, 32.26 g/day, and 19.39 g/day, respectively. These growth performances were found to be significantly influenced by the non-genetic factors studied. There is therefore the need to factor these in future breed improvement programmes to ensure their success.

Historical epidemiology of hepatitis C virus in select countries-volume 4.

Due to the introduction of newer, more efficacious treatment options, there is a pressing need for policy makers and public health officials to develop or adapt national hepatitis C virus (HCV) control strategies to the changing epidemiological landscape. To do so, detailed, country-specific data are needed to characterize the burden of chronic HCV infection. In this study of 17 countries, a literature review of published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates was conducted, and inputs were validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Hong Kong to 2.4% in Taiwan, while the largest viraemic populations were in Nigeria (2 597 000 cases) and Taiwan (569 000 cases). Diagnosis, treatment and liver transplant rates varied widely across the countries included in this analysis, as did the availability of reliable data. Addressing data gaps will be critical for the development of future strategies to manage and minimize the disease burden of hepatitis C.

Detection of adverse events of transfusion in a teaching hospital in Ghana.

BACKGROUND AND OBJECTIVES: Monitoring the whole chain of events from the blood donors to recipients, documenting any undesirable or untoward effects and introducing measures to prevent their recurrence if possible are components of haemovigilance systems. Only few sub-Saharan African countries have haemovigilance systems, and there are very little data on adverse events of transfusion. Adverse events monitoring is an integral part of a haemovigilance system. Our study aimed to establish the incidence and types of adverse events of transfusions in Ghana and to identify interventions to improve effectiveness. MATERIALS AND METHODS: This prospective observational 1-year study enrolled 372 recipients of 432 transfusions in a Ghanaian teaching hospital. Vital signs were monitored at 15, 30 and 60 min intervals during the transfusion, then 8 h until 24 h post-transfusion. Three investigators independently classified any new signs and symptoms according to Serious Hazards of Transfusion definitions. RESULTS: The adverse events incidence was 21·3% (92/432), predominantly mild acute transfusion reactions (84%). A total of 20 transfusions (4·6%) were stopped before completion, 60% of them for mild febrile reactions, which could have been managed with transfusion in situ. CONCLUSION: This prospective study indicates a high incidence of adverse events of transfusion in Kumasi, Ghana. The significant numbers of discontinued transfusions suggest that guidelines on how to manage transfusion reactions would help preserve scarce blood stocks. Gradual implementation of a haemovigilance system, starting with monitoring adverse transfusion events, is a pragmatic approach in resource-limited settings.

Improving the screening of blood donors with syphilis rapid diagnostic test (RDT) and rapid plasma reagin (RPR) in low- and middle-income countries (LMIC).

BACKGROUND: Syphilis testing conventionally relies on a combination of non-treponemal and treponemal tests. The primary objective of this study was to describe the positive predictive value (PPV) of a screening algorithm in a combination of a treponemal rapid diagnostic test (RDT) and rapid plasma reagin (RPR) test at Komfo Anokye Teaching Hospital (KATH), Ghana. MATERIALS AND METHODS: From February 2014 to January 2015, 5 mL of venous blood samples were taken from 16 016 blood donors and tested with a treponemal RDT; 5 mL of venous blood was taken from 526 consenting initial syphilis sero-reactive blood donors. These RDT reactive samples were confirmed with an algorithm, applying the Vitros® /Abbott-Architect® algorithm as gold standard. RESULTS: A total of 478 of 526 RDT reactive donors were confirmed positive for syphilis, making a PPV of 90·9%. Of the 172 (32·7%) donors who were also RPR positive, 167 were confirmed, resulting in a PPV of 97·1%. The PPV of the combined RDT and RPR (suspected active syphilis) testing algorithm was highest among donors at an enhanced risk of syphilis, family/replacement donors (99·9%), and among voluntary donors above 25 years (98·6%). DISCUSSION: Screening of blood donors by combining syphilis RDT and RPR with relatively good PPV may provide a reasonable technology for LMIC that has a limited capacity for testing and can contribute to the improvement of blood safety with a minimal loss of donors.

A novel strategy for screening blood donors for syphilis at Komfo Anokye Teaching Hospital, Ghana.

OBJECTIVE: To implement and describe a novel syphilis screening strategy for blood donors. BACKGROUND: The seroprevalence of syphilis in blood donors is often high in low- and middle-income countries (LMIC) although the proportion of infectious donations is probably low. Syphilis screening may not happen at all; or the use of non-specific screening tests, which have high false positive rates, results in many donations being discarded unnecessarily. This can have a critical effect on already inadequate blood supplies. MATERIALS AND METHODS: Blood donors were screened at the time of donation with an anti-treponemal rapid diagnostic test (RDT) and blood collected irrespective of the result. Units screening negative for syphilis, human immunodeficiency virus (HIV) and hepatitis B and C were released to stock. RDT screen-positive units were re-tested with rapid plasma reagin (RPR) - units testing negative were released to stock and test-positive units discarded. RESULTS: Of the 2213 blood donors, 182 (8·2%; 182/2213) screened positive by RDT. In addition, 38 out of these 182 (20·9%) were RPR positive on post-donation testing. Over 2 months there was a 79% reduction in blood units discarded due to a positive syphilis screen. CONCLUSION: In other LMIC, this novel strategy can contribute to improving blood safety without jeopardising blood supply.

Appropriateness of blood product transfusion in the Obstetrics and Gynaecology (O&G) department of a tertiary hospital in West Africa.

BACKGROUND: Misuse of blood by clinicians was suggested to explain blood shortage in sub-Saharan Africa although based on little evidence. This study evaluated whether routine halving (restricted) of blood requests was justified. STUDY DESIGN AND METHODS: On alternated days for 3 months in 2011-2012, restricted or full blood product supply [whole blood (WB), red cell concentrate (RCC)] was provided to the Obstetrics & Gynaecology department (O&G). Patient age, haemoglobin (Hb) level pre- and post-transfusion, clinical condition, blood products request and supply, transfused and returned, clinical outcome were collated. RESULTS: Five hundred and nineteen patients (249 restricted and 270 full supply) received 1001 blood products (94.6% WB, 6.4% RCC). Clinical conditions were severe peri-partum bleeding (72.4%) requiring emergency transfusion (82%) whilst 27.6% of total transfusion was for anaemia, 18% being moderate (8-10 g dL(-1) ). Pre-transfusion Hb level was <6 g dL(-1) in 36.7%, 6-8 g dL(-1) 29.1% and ≥ 8 g dL(-1) in 33.2% of cases. Fifty-five percent of the transfused blood was stored ≤ 1 week. Restricted supply triggered additional request (40%) compared to 10% in full supply mode. Whether with restricted or full supply, blood requests, supply and units transfused/patient were similar (restricted 2.3 and 2.1 unit patient(-1) and full 2.9 and 2.3 unit patient(-1) , respectively). Fatal clinical outcome was 3.1% evenly distributed between supply modes and transfusion reactions 0.8%. CONCLUSIONS: O&G clinicians order blood according to clinical need and transfuse 85% of the products supplied. Product supply did not significantly affect use although appropriateness of transfusion was difficult to assess.

Hepatitis E virus infection in Ghanaian blood donors - the importance of immunoassay selection and confirmation.

BACKGROUND AND OBJECTIVES: Hepatitis E virus (HEV) infection is emerging as a potential new threat to blood safety after several cases of transfusion-transmission were reported from non-epidemic countries. On the basis of seroprevalence data, HEV is endemic in Ghana where poor sanitary conditions and regular flooding are prevalent. However, no data are available for HEV prevalence in blood donors. MATERIALS AND METHODS: Plasma samples from 239 Ghanaian blood donors were tested for anti-HEV IgG and IgM by ELISA (two and three assays, respectively) and Western blot (recomLine) and for HEV-RNA by RT-qPCR. RESULTS: All donors were RNA negative. Results from the different serological assays were discrepant: reactivity in two of the three IgM assays was correlated with elevated IgM levels, but the discrepancies between IgG assays were unrelated to the donors' IgG levels and more likely related to assay sensitivity. Fourteen samples (5·9%) were anti-HEV IgM reactive and 11 samples (4·6%) anti-HEV IgG reactive in at least two serological assays from different manufacturers. CONCLUSIONS: (a) In the absence of accepted confirmatory assays, it is crucial to confirm anti-HEV reactive samples with an alternative assay, especially when the population tested carries high levels of immunoglobulin M. (b) Although asymptomatic HEV infections are common in Ghanaian blood donors, currently, it does not seem to be a major risk to blood safety.

Fostering repeat donations in Ghana.

INTRODUCTION: Most African countries are challenged in recruiting and retaining voluntary blood donors by cost and other complexities and in establishing and implementing national blood policies. The availability of replacement donors who are a cheaper source of blood has not enhanced repeat voluntary donor initiatives. METHODS: An overview of activities for recruiting and retaining voluntary blood donors was carried out. Donor records from mobile sessions were reviewed from 2002 to 2008. RESULTS AND DISCUSSION: A total of 71,701 blood donations; 45,515 (63.5%) being voluntary donations with 11,680 (25%) repeat donations were collected during the study period. Donations from schools and colleges contributed a steady 60% of total voluntary whilst radio station blood drives increased contribution from 10 to 27%. Though Muslim population is less than 20%, blood collection was above the 30-donation cost-effectiveness threshold with a repeat donation trend reaching 60%. In contrast Christian worshippers provided <25 unit/session and 30% repeat donations. Repeat donation trends amongst school donors and radio blood drives were 20% and 70% respectively. CONCLUSION: Repeat donations rates have been variable amongst different blood donor groups in Kumasi, Ghana. The impact of community leaders in propagating altruism cannot be overemphasized. Programs aiming at motivating replacement donors to be repeat donors should be developed and assessed.

The blood donor in sub-Saharan Africa: a review.

The high prevalence of numerous endemic and epidemic diseases such as malaria, HIV infection and viral hepatitis in some areas of sub-Saharan Africa (SSA) affects the health status of blood donors. Considering the difficulties in ensuring sufficient and safe blood supply, analysing epidemiological factors that impact blood donors in this community may further bring light on issues of supply and safety, and help in planning for its rational use. This review does not aim to propose new strategies but describes the main characteristics of blood donors in SSA as collected from different reports. Data were mainly obtained from the reports of the World Health Organization and national blood transfusion programmes and also from relevant literature and conference reports. Several characteristics are common in blood donors, such as the predominance of young adult males, the high frequency of Transmission-transmitted Infections (TTIs) and some erythrocytic phenotypes. The data indicate variations in the level of improvement of blood collection and blood safety from one area to another, particularly in the field of donor motivation or screening strategies for TTIs. These data could be useful to supplement previous reports and to provide updates for governments and international organizations' programs involved in the improvement of blood safety in Africa.

Atovaquone-proguanil for treating uncomplicated malaria.

BACKGROUND: Many conventional treatments for uncomplicated malaria are failing because malaria parasites develop resistance to them. One way to combat this resistance is to treat people with a combination of drugs, such as atovaquone-proguanil. OBJECTIVES: To compare atovaquone-proguanil with other antimalarial drugs (alone or in combination) for treating children and adults with uncomplicated Plasmodium falciparum malaria. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (June 2005), CENTRAL (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005), LILACS (1982 to June 2005), reference lists, and conference abstracts. We also contacted relevant pharmaceutical manufacturers and researchers. SELECTION CRITERIA: Randomized controlled trials comparing atovaquone-proguanil with other antimalarial drugs for treating children and adults confirmed to have uncomplicated P. falciparum malaria. DATA COLLECTION AND ANALYSIS: Three authors independently assessed trial eligibility and methodological quality, and extracted data for an intention-to-treat analysis (where possible). We used relative risk (RR) and 95% confidence intervals (CI) for dichotomous data. We contacted trial authors for additional information where needed. MAIN RESULTS: Ten trials, with a total of 2345 participants, met the inclusion criteria. The trials were conducted in four geographical regions and were often small, but they included comparisons across eight drugs. Nine trials were funded by a pharmaceutical company, only three carried out an intention-to-treat analysis, and allocation concealment was unclear in seven. Atovaquone-proguanil had fewer treatment failures by day 28 than chloroquine (RR 0.04, 95% CI 0.00 to 0.57; 27 participants, 1 trial), amodiaquine (RR 0.22, 95% CI 0.13 to 0.36; 342 participants, 2 trials), and mefloquine (RR 0.04, 95% CI 0.00 to 0.73; 158 participants, 1 trial). There were insufficient data to draw a conclusion for this outcome from comparisons with sulfadoxine-pyrimethamine (172 participants, 2 trials), halofantrine (205 participants, 1 trial), artesunate plus mefloquine (1063 participants, 1 trial), quinine plus tetracycline (154 participants, 1 trial), and dihydroartemisinin-piperaquine-trimethoprim-primaquine (161 participants, 1 trial). Adverse events were mainly common symptoms of malaria and did not differ in frequency between groups. AUTHORS' CONCLUSIONS: Data are limited but appear to suggest that atovaquone-proguanil is more effective than chloroquine, amodiaquine, and mefloquine. There are insufficient data for comparisons against sulfadoxine-pyrimethamine, halofantrine, artesunate plus mefloquine, quinine plus tetracycline, and dihydroartemisinin-piperaquine-trimethoprim-primaquine in treating malaria. There are not enough data to assess safety, but a number of adverse events were identified with all drugs. Large trials comparing atovaquone-proguanil with other new combination therapies are needed.

Sociology and behaviour of West African blood donors: the impact of religion on human immunodeficiency virus infection.

BACKGROUND AND OBJECTIVES: Ghana is one of the countries of sub-Saharan Africa where the human immunodeficiency virus (HIV) prevalence in blood donors ranges between 1 and 4%. Considering the social importance of religion and the very high level of religious practice observed in Ghana, the hypothesis that these factors may play a role in containing HIV was tested. MATERIALS AND METHODS: Consenting HIV-infected candidate blood donors, and two age- and gender-matched seronegative control donors, were asked to complete a questionnaire regarding their religious and sexual behaviour. Multivariable conditional logistic regression was used. RESULTS: Irrespective of their HIV status or religion, 95% of the respondents believed that extra-marital sex was a sin, and 79% of those tempted to have an extra-marital affair considered that their religious beliefs helped them to abstain. In the multivariable models, having a formal role in church activities was associated with reduced odds of HIV [odds ratio (OR) = 0.41; 95% confidence interval (CI): 0.21-0.80]. Worshipping at the same location for more than 20 years was associated with a reduced risk (OR = 0.30; 95% CI: 0.08-1.10). In addition to other factors limiting HIV spread, such as male circumcision, relatively high level of education and an absence of armed conflicts in Ghana, the use of condoms conferred a reduced risk. CONCLUSIONS: An active role in religion, and reporting a lengthy duration of worship at the same place was beneficial. Collecting blood at places of worship with a strict behavioural code and from donors practicing in the community of their birth might improve blood safety.

Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease.

BACKGROUND: People with sickle cell disease are particularly susceptible to infection. Infants and very young children are especially vulnerable, and the Cooperative Study of Sickle Cell Disease observed an incidence rate of 10 per 100 patient years of pneumococcal septicaemia in children under the age of three. Vaccines, including customary pneumococcal vaccines, may be of limited use in this age group. Therefore, prophylactic penicillin regimes may be advisable for this population. OBJECTIVES: To assess the effects of prophylactic antibiotic regimes for preventing pneumococcal infection in children with sickle cell disease. SEARCH STRATEGY: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group specialist trials register which comprises references identified from comprehensive electronic database searches, hand searching relevant journals and hand searching abstract books of conference proceedings. Date of the most recent search: December 2001. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing prophylactic antibiotics to prevent pneumococcal infection in children with sickle cell disease with placebo, no treatment or a comparator drug. DATA COLLECTION AND ANALYSIS: Both reviewers independently extracted data and assessed trial quality. MAIN RESULTS: Five trials were identified by the initial search, of which three trials met the inclusion criteria. All of the included trials showed a reduced risk of infection in children with sickle cell disease (SS or Sb0Thal) receiving prophylactic penicillin. For initiation of treatment the odds ratio was 0.37 (95% CI 0.16, 0.86), and for withdrawal OR= 0.49 (95% CI 0.09, 2.71). Adverse drug effects were rare and minor. Rates of pneumococcal infection were found to be relatively low in children over the age of five. REVIEWER'S CONCLUSIONS: Prophylactic penicillin significantly reduces risk of pneumococcal infection in children with homozygous sickle cell disease, and is associated with minimal adverse reactions. Further research may help to determine the ideal age to safely withdraw penicillin.