Shotgun Characterization of the Circulating IgM Antigenome of an Infectious Pathogen by Immunocapture-LC-MS/MS from Dried Serum Spots.

One of the main challenges in compiling the complete collection of protein antigens from pathogens for the selection of vaccine candidates or intervention targets is to acquire a broad enough representation of them to be recognized by the highly diversified immunoglobulin repertoire in human populations. Dried serum spot sampling (DSS) retains a large repertoire of circulating immunoglobulins from each individual that can be representative of a population, according to the sample size. In this work, shotgun proteomics of an infectious pathogen based on DSS sampling coupled with IgM immunoprecipitation, liquid chromatography-mass spectrometry (LC-MS/MS), and bioinformatic analyses was combined to characterize the circulating IgM antigenome. Serum samples from a malaria endemic region at different clinical statuses were studied to optimize IgM binding efficiency and antibody leaching by varying serum/immunomagnetic bead ratios and elution conditions. The method was validated using Plasmodium falciparum extracts identifying 110 of its IgM-reactive antigens while minimizing the presence of human proteins and antibodies. Furthermore, the IgM antigen recognition profile differentiated between malaria-infected and noninfected individuals at the time of sampling. We conclude that a shotgun proteomics approach offers advantages in providing a high-throughput, reliable, and clean way to identify IgM-recognized antigens from trace amounts of serum. The mass spectrometry raw data and metadata have been deposited with ProteomeXchange via MassIVE with the PXD identifier PXD043800.

Association between heavy metal uptake and growth and reproduction in the anecic earthworm, Alma nilotica (Grube 1855).

Elevated heavy metal concentrations in soils are a cause for concern as they are hazardous to soil organisms including earthworms which are considered as ecosystem engineers. Current ecotoxicity tests predominantly use temperate earthworm species, and thus there is the need to include a broader genera of native species to improve ecological risk assessment. Alma nilotica, is a tropical anecic earthworm species that survives well under laboratory conditions and has potential for use in ecotoxicology testing but lacks published toxicity data for important pollutants. Growth and reproduction bioassays were carried out with A. nilotica to determine the relationship between the concentrations of Cu, Zn, Pb and Cr in spiked soils and their bioaccumulation and toxic effects. Positive linear relationships were found between soil-metal and internal earthworm-metal concentrations. Cu did not inhibit growth up to 35 days of exposure but became toxic with longer exposure duration. Zn was not regulated by A. nilotica although it is an essential metal that is well regulated by Eisenia sp. commonly used in standard ecotoxicity tests, showing differences in metal regulation by earthworms of different ecological categories. Based on bioaccumulation factors (BAFs), growth inhibition and reproduction effects the metals were ranked in decreasing toxicity as Pb > Cr > Zn > Cu. The mean 20% Internal Effects Concentrations (IEC20s) for reproduction were 1.04, 2.9, 8.3 and 224.2 mg metal kg-1 earthworm for Pb, Cr, Zn and Cu respectively. These data can contribute to the improvement of metal risk assessment particularly in tropical contexts.

Effects of elevated temperatures on the development of immature stages of Anopheles gambiae (s.l.) mosquitoes.

OBJECTIVE: This study investigated the effects of temperature on the development of the immature stages of Anopheles gambiae (s.l.) mosquitoes. METHODS: Mosquito eggs were obtained from laboratory established colonies and reared under eight temperature regimes (25, 28, 30, 32, 34, 36, 38 and 40°C), and 80 ± 10% relative humidity. Larvae were checked daily for development to the next stage and for mortality. Pupation success, number of adults produced and sex ratio of the newly emerged adults were recorded. Larval survival was monitored every 24 h, and data were analysed using Kaplan-Meier survival analysis. Analysis of variance was used where data followed normal distribution, and a Kruskal-Wallis test where data were not normally distributed. Larval and pupal measurements were log-transformed and analysed using ordinary least square regression with robust standard errors. RESULTS: Increasing the temperature from 25 to 36°C decreased the development time by 10.57 days. Larval survival (X2 (6) = 5353.12, p < 0.001) and the number of adults produced (X2 (5) = 28.16, p < 0.001) decreased with increasing temperature. Increasing temperatures also resulted in significantly smaller larvae and pupae (p < 0.001). At higher temperatures, disproportionately more male than female mosquitoes were produced. CONCLUSIONS: Increased temperature affected different developmental stages in the life cycle of An. gambiae (s.l.) mosquitoes, from larval to adult emergence. This study contributes to the knowledge on the relationship between temperature and Anopheles mosquitoes and provides useful information for modelling vector population dynamics in the light of climate change.

Derivation of sex and age-specific reference intervals for clinical chemistry analytes in healthy Ghanaian adults.

OBJECTVIES: This study is aimed at establishing reference intervals (RIs) of 40 chemistry and immunochemistry analytes for Ghanaian adults based on internationally harmonized protocol by IFCC Committee on Reference Intervals and Decision Limits (C-RIDL). METHODS: A total of 501 healthy volunteers aged ≥18 years were recruited from the northern and southern regions of Ghana. Blood samples were analyzed with Beckman-Coulter AU480 and Centaur-XP/Siemen auto-analyzers. Sources of variations of reference values (RVs) were evaluated by multiple regression analysis (MRA). The need for partitioning RVs by sex and age was guided by the SD ratio (SDR). The RI for each analyte was derived using parametric method with application of the latent abnormal values exclusion (LAVE) method. RESULTS: Using SDR≥0.4 as threshold, RVs were partitioned by sex for most enzymes, creatinine, uric acid (UA), bilirubin, immunoglobulin-M. MRA revealed age and body mass index (BMI) as major source of variations of many analytes. LAVE lowered the upper limits of RIs for alanine/aspartate aminotransferase, γ-glutamyl transaminase and lipids. Exclusion of individuals with BMI≥30 further lowered the RIs for lipids and CRP. After standardization based on value-assigned serum panel provided by C-RIDL, Ghanaian RIs were found higher for creatine kinase, amylase, and lower for albumin and urea compared to other collaborating countries. CONCLUSIONS: The LAVE effect on many clinical chemistry RIs supports the need for the secondary exclusion for reliable derivation of RIs. The differences in Ghanaian RIs compared to other countries underscore the importance of country specific-RIs for improved clinical decision making.

Preponderance of vaccine-preventable diseases hotspots in northern Ghana: a spatial and space-time clustering analysis from 2010 to 2014.

BACKGROUND: Vaccine-preventable diseases (VPDs) persist globally with a disproportionately high burden in Low and Middle-Income Countries (LMICs). Although this might be partly due to the failure to sustain vaccination coverage above 90% in some WHO regions, a more nuanced understanding of VPD transmission beyond vaccination coverage may unveil other important factors in VPD transmission and control. This study identified VPDs hotspots and explored their relationships with ecology, urbanicity and land-use variations (Artisanal and Small-scale Gold Mining (ASGM) activities) in Ghana. METHODS: District-level disease count data from 2010 to 2014 from the Ghana Health Service (GHS) and population data from the Ghana Population and Housing Census (PHC) were used to determine clustering patterns of six VPDs (Measles, Meningitis, Mumps, Otitis media, Pneumonia and Tetanus). Spatial and space-time cluster analyses were implemented in SaTScan using the discrete Poisson model. P-values were estimated using a combination of sequential Monte Carlo, standard Monte Carlo, and Gumbel approximations. RESULTS: The study found a preponderance for VPD hotspots in the northern parts of Ghana and northernmost ecological zones (Sudan Savannah and Guinea Savannah). Incidence of meningitis was higher in the Sudan Savannah ecological zone relative to: Tropical Rain Forest (p = 0.001); Semi Deciduous Forest (p < 0.0001); Transitional Zone (p < 0.0001); Coastal Savannah (p < 0.0001) and Guinea Savannah (p = 0.033). Except for mumps, which recorded a higher incidence in urban districts (p = 0.045), incidence of the other five VPDs did not differ across the urban-rural divide. Whereas spatial analysis suggested that some VPD hotspots (tetanus and otitis media) occur more frequently in mining districts in the southern part of the country, a Mann-Whitney U test revealed a higher incidence of meningitis in non-mining districts (p = 0.019). Pneumonia and meningitis recorded the highest (722.8 per 100,000) and least (0.8 per 100,000) incidence rates respectively during the study period. CONCLUSION: This study shows a preponderance of VPD hotspots in the northern parts of Ghana and in semi-arid ecoclimates. The relationship between ASGM activities and VPD transmission in Ghana remains blurred and requires further studies with better spatial resolution to clarify.

Association between global DNA methylation (LINE-1) and occupational particulate matter exposure among informal electronic-waste recyclers in Ghana.

This study examined the associations between PM (2.5 and 10) and global DNA methylation among 100 e-waste workers and 51 non-e-waste workers serving as controls. Long interspersed nucleotide repetitive elements-1 (LINE-1) was measured by pyrosequencing. Personal PM2.5 and PM10 were measured over a 4-hour work-shift using real-time particulate monitors incorporated into a backpack . Linear regression models were used to assess the association between PM and LINE-1 DNA methylation. The concentrations of PM2.5 and PM10 were significantly higher among the e-waste workers than the controls (77.32 vs 34.88, p < 0.001 and 210.21 vs 121.92, p < 0.001, respectively). PM2.5 exposure was associated with increased LINE-1 CpG2 DNA methylation (ß = 0.003; 95% CI; 0.001, 0.006; p = 0.022) but not with the average of all 4 CpG sites of LINE-1. In summary, high levels of PM2.5 exposure was associated with increased levels of global DNA methylation in a site-specific manner.

Lead (Pb) exposure assessment in dried blood spots using Total Reflection X-Ray Fluorescence (TXRF).

Lead (Pb) exposure is often determined through the analysis of whole blood though venipuncture poses ethical, economic, and logistical barriers. Dried Blood Spots (DBS) may help overcome such barriers though past studies measuring Pb in DBS have been challenged with quality control, small sample volumes, and other issues. Total Reflection X-Ray Fluorescence (TXRF) may help address some of these challenges but has yet to be used to measure Pb in DBS. As such, the aim of the current study was to develop, validate, and apply a method to analyze Pb in DBS samples using TXRF for use in human biomonitoring studies. First, we developed a novel method (tested a range of parameters), and then used blood reference materials to validate the method against performance criteria listed in ICH Q2A and Q2B and the European Bioanalysis Forum. Finally, we applied the method to two populations who exemplify divergent conditions (41 university members with relatively low Pb exposures sampled in a clinical environment; 40 electronic waste workers with relatively high Pb exposures sampled in a contaminated field setting). The limits of detection and quantification of the method were 0.28 and 0.69 µg/dL, respectively. The overall precision and accuracy of the method were 15% and 111%, respectively. The mean (±SD) DBS Pb levels by TXRF in the university members and e-waste workers were 0.78 (±0.46) and 3.78 (±3.01) µg/dL, respectively, and these were not different from Pb measures in venous whole blood using ICP-MS. Bland-Altman plot analyses indicated good agreement between DBS Pb measures by TXRF versus whole blood Pb measures by ICP-MS in both groups. By combining data from the two population groups, there was no significant constant bias (intercept of 0.02 µg/dL) or proportional bias (slope was -0.02) between the two measures, and the lower and upper LoA were -0.86 and 0.91 µg/dL, respectively, with a LoA range of 1.77 µg/dL. These results demonstrate that TXRF-based analysis of Pb content in DBS is a good alternative to the gold standard (i.e., ICP-MS analysis of whole blood), and helps overcome some of the challenges associated with current methods.

The interplay between environmental exposures and COVID-19 risks in the health of children.

BACKGROUND: An unusual feature of SARS-Cov-2 infection and the COVID-19 pandemic is that children are less severely affected than adults. This is especially paradoxical given the epidemiological links between poor air quality and increased COVID-19 severity in adults and that children are generally more vulnerable than adults to the adverse consequences of air pollution. OBJECTIVES: To identify gaps in knowledge about the factors that protect children from severe SARS-Cov-2 infection even in the face of air pollution, and to develop a transdisciplinary research strategy to address these gaps. METHODS: An international group of researchers interested in children's environmental health was invited to identify knowledge gaps and to develop research questions to close these gaps. DISCUSSION: Key research questions identified include: what are the effects of SAR-Cov-2 infection during pregnancy on the developing fetus and child; what is the impact of age at infection and genetic susceptibility on disease severity; why do some children with COVID-19 infection develop toxic shock and Kawasaki-like symptoms; what are the impacts of toxic environmental exposures including poor air quality, chemical and metal exposures on innate immunity, especially in the respiratory epithelium; what is the possible role of a "dirty" environment in conveying protection - an example of the "hygiene hypothesis"; and what are the long term health effects of SARS-Cov-2 infection in early life. CONCLUSION: A concerted research effort by a multidisciplinary team of scientists is needed to understand the links between environmental exposures, especially air pollution and COVID-19. We call for specific research funding to encourage basic and clinical research to understand if/why exposure to environmental factors is associated with more severe disease, why children appear to be protected, and how innate immune responses may be involved. Lessons learned about SARS-Cov-2 infection in our children will help us to understand and reduce disease severity in adults, the opposite of the usual scenario.

Global DNA (LINE-1) methylation is associated with lead exposure and certain job tasks performed by electronic waste workers.

OBJECTIVE: This study assessed the associations between blood and urine levels of toxic metals; cadmium (Cd) and lead (Pb), and methylation levels of the LINE-1 gene among e-waste and control populations in Ghana. METHODS: The study enrolled 100 male e-waste workers and 51 all-male non-e-waste workers or controls. The concentrations of Cd and Pb were measured in blood and urine using inductively coupled plasma mass spectrometry, while LINE1 methylation levels were assessed by pyrosequencing of bisulfite-converted DNA extracted from whole blood. Single and multiple metals linear regression models were used to determine the associations between metals and LINE1 DNA methylation. RESULTS: Blood lead (BPb) and urine lead (UPb) showed higher median concentrations among the e-waste workers than the controls (76.82 µg/L vs 40.25 µg/L, p ≤ 0.001; and 6.89 µg/L vs 3.43 µg/L, p ≤ 0.001, respectively), whereas blood cadmium (BCd) concentration was lower in the e-waste workers compared to the controls (0.59 µg/L vs 0.81 µg/L, respectively, p = 0.003). There was no significant difference in LINE1 methylation between the e-waste and controls (85.16 ± 1.32% vs 85.17 ± 1.11%, p = 0.950). In our single metal linear regression models, BPb was significantly inversely associated with LINE1 methylation in the control group (ßBPb = - 0.027, 95% CI - 0.045, - 0.010, p = 0.003). In addition, a weak association between BPb and LINE1 was observed in the multiple metals analysis in the e-waste worker group (ßBPb = - 0.005, 95% CI - 0.011, 0.000, p = 0.058). CONCLUSION: Continuous Pb exposure may interfere with LINE1 methylation, leading to epigenetic alterations, thus serving as an early epigenetic marker for future adverse health outcomes.

Personal exposure to particulate matter and heart rate variability among informal electronic waste workers at Agbogbloshie: a longitudinal study.

BACKGROUND: Informal electronic waste recycling activities are major contributors to ambient air pollution, yet studies assessing the effects or relationship between direct/continuous exposure of informal e-waste workers to particulate matter and cardiovascular function are rare. METHODS: Repeated measurements of fractions of PM2.5, PM10-2.5, and PM10 in personal air of informal e-waste workers, (n = 142) and a comparable group (n = 65) were taken over a period of 20 months (March 2017 to November, 2018). Concurrently, 5-min resting electrocardiogram was performed on each participant to assess resting heart rate variability indices. Linear mixed-effects models were used to assess the association between PM fractions and cardiac function. RESULTS: SDNN, RMSSD, LF, HF and LH/HF ratio were all associated with PM. Significant associations were observed for PM2.5 and Mean NN (p = 0.039), PM10 and SDNN (p = 0.035) and PM 10-2.5 and LH/HF (p = 0.039). A 10 µg/m3 increase in the concentrations of PM 2.5, PM10-2.5, and PM10 in personal air was associated with reduced HRV indices and increased resting HR. A 10 µg/m3 per interquartile (IQR) increase in PM10-2.5 and PM10, decreased SDNN by 11% [(95% CI: - 0.002- 0.000); (p = 0.187)] and 34% [(95% CI: - 0.002-0.001); (p = 0.035)] respectively. However, PM2.5 increased SDNN by 34% (95% CI: - 1.32-0.64); (p = 0.493). Also, 10 µg/m3 increase in PM2.5, PM10-2.5 and PM10 decreased RMSSD by 27% [(- 1.34-0.79); (p = 0.620)], 11% [(- 1.73, 0.95); (p = 0.846)] and 0.57% [(- 1.56-0.46); (p = 0.255%)]. CONCLUSION: Informal e-waste workers are at increased risk of developing cardiovascular disease from cardiac autonomic dysfunction as seen in reduced HRV and increased heart rate.

Opportunities and challenges in reducing personal inhalation exposure to air pollution among electronic waste recovery workers in Ghana.

BACKGROUND: Informal sector electronic waste (e-waste) recovery produces toxic emissions resulting from burning e-waste to recover valuable metals. OBJECTIVES: To identify high-risk worker groups by measuring relative levels of personal inhalation exposure to particulate matter (PM) of fine (≤2.5 µm) and coarse (2.5-10 µm) fractions (PM2.5 and PM2.5-10, respectively) across work activities among e-waste workers, and to assess how wind conditions modify levels of PM by activity and site location. METHODS: At the Agbogbloshie e-waste site, 170 partial-shift PM samples and time-activity data were collected from participants (N = 105) enrolled in the GeoHealth cohort study. Personal sampling included continuous measures of size-specific PM from the worker's breathing zone and time-activity derived from wearable cameras. Linear mixed models were used to estimate changes in personal PM2.5 and PM2.5-10 associated with activities and evaluate effect modification by wind conditions. RESULTS: Mean (±standard deviation) personal PM2.5 and PM2.5-10 concentrations were 80 (± 81) and 123 (± 139) µg m-3 , respectively. The adjusted mean PM2.5 concentration for burning e-waste was 88 µg m-3 , a 28% increase above concentrations during non-recovery activities (such as eating). Transportation-related and burning activities were associated with the highest PM2.5-10 concentrations. Frequent changes in wind direction were associated with higher PM2.5 concentrations when burning, and high wind speeds with higher PM2.5-10 concentrations when dismantling e-waste downwind of the burning zone.

A PRELIMINARY ASSESSMENT OF PHYSICAL WORK EXPOSURES AMONG ELECTRONIC WASTE WORKERS AT AGBOGBLOSHIE, ACCRA GHANA.

Occupational exposure associated with unstructured, informal e-waste recycling has received very limited attention. This study aimed to quantify the occupational physical exposures among informal e-waste workers at the largest e-waste site in Africa. A cross-sectional field survey of 163 male e-waste workers was conducted using a self-report occupational physical activity questionnaire, along with direct work observations, and pedometer estimates of walking activity for a subset of workers (n = 42). Results indicated significant differences in self-reported 7-day work exposures among the three main e-waste job categories, namely, collectors (n = 70), dismantlers (n = 73) and burners (n = 20). Prolonged walking, sitting and standing on five or more days in the workweek was frequently reported by collectors (87%), dismantlers (82%) and burners (60%), respectively. Nearly 90% of collectors and burners and 60% of dismantlers reported lifting and carrying on five or more days in the workweek. The exposure combinations identified suggest a risk for musculoskeletal disorders (MSDs). Findings call attention to the need for research examining potential associations between physical exposures and MSDs affecting e-waste workers in Agbogbloshie. The high exposure variability both between and within workers has implications for future exposure assessments conducted in unregulated, informal work settings.

Micronutrient-rich dietary intake is associated with a reduction in the effects of particulate matter on blood pressure among electronic waste recyclers at Agbogbloshie, Ghana.

BACKGROUND: Informal recycling of electronic waste (e-waste) releases particulate matter (PM) into the ambient air. Human exposure to PM has been reported to induce adverse effects on cardiovascular health. However, the impact of PM on the cardiovascular health of e-waste recyclers in Ghana has not been studied. Although intake of micronutrient-rich diet is known to modify these PM-induced adverse health effects, no data are available on the relationship between micronutrient status of e-waste recyclers and the reported high-level exposure to PM. We therefore investigated whether the intake of micronutrient-rich diets ameliorates the adverse effects of ambient exposure to PM2.5 on blood pressure (BP). METHODS: This study was conducted among e-waste and non-e-waste recyclers from March 2017 to October 2018. Dietary micronutrient (Fe, Ca, Mg, Se, Zn, and Cu) intake was assessed using a 2-day 24-h recall. Breathing zone PM2.5 was measured with a real-time monitor. Cardiovascular indices such as systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were measured using a sphygmomanometer. Ordinary least-squares regression models were used to estimate the joint effects of ambient exposure to PM2.5 and dietary micronutrient intake on cardiovascular health outcomes. RESULTS: Fe was consumed in adequate quantities, while Ca, Se, Zn, Mg, and Cu were inadequately consumed among e-waste and non-e-waste recyclers. Dietary Ca, and Fe intake was associated with reduced SBP and PP of e-waste recyclers. Although PM2.5 levels were higher in e-waste recyclers, exposures in the control group also exceeded the WHO 24-h guideline value (25 µg/m3). Exposure to 1 µg/m3 of PM2.5 was associated with an increased heart rate (HR) among e-waste recyclers. Dietary Fe intake was associated with a reduction in systolic blood pressure levels of e-waste recyclers after PM exposure. CONCLUSIONS: Consistent adequate dietary Fe intake was associated with reduced effects of PM2.5 on SBP of e-waste recyclers overtime. Nonetheless, given that all other micronutrients are necessary in ameliorating the adverse effects of PM on cardiovascular health, nutrition-related policy dialogues are required. Such initiatives would help educate informal e-waste recyclers and the general population on specific nutrients of concern and their impact on the exposure to ambient air pollutants.

Socioeconomic Status and Temporal Urban Environmental Change in Accra: a Comparative Analysis of Area-based Socioeconomic and Urban Environmental Quality Conditions Between Two Time Points.

The influence of area-based socioeconomic (SE) conditions on environmental quality conditions has recently been reported showing the precise spatial relationship between area-based SE conditions and neighborhood environmental quality in an urban area in a low-income setting. Nonetheless, there is still a lack of understanding of the nature of the relationship on a temporal scale. This study aimed to investigate the dynamic temporal relationship between area-based SE conditions and urban environmental quality conditions over a decadal period in Accra, Ghana. The results showed that there were differences in environmental quality across the SE quintiles in space (with regard to per capita waste generation (p < 0.012), waste collection/clearing (p < 0.01), and waste deposition (p < 0.001) and that the urban environmental quality conditions had changed dramatically over the decade for most of the environmental variables (p < 0.001). Despite the enormous urban development initiatives, some of the environmental quality indicators (e.g., proportion of households without flush toilet/Water Closet, connection to central sewer p < 0.001) appeared to have worsened in the high class quintile, suggesting that a high proportion of households were without acceptable sanitation facilities. The study concludes that urban development in low-income countries will need to follow strictly international best practice by observing standardized building codes and guidelines, if progress should be made in meeting the Millennium Development Goals targets.

Environmental health risks and benefits of the use of mosquito coils as malaria prevention and control strategy.

BACKGROUND: Malaria is an infectious disease that causes many deaths in sub-Saharan Africa. In resource-poor malaria endemic communities, mosquito coils are commonly applied in households to repel the vector mosquito that transmits malaria parasites. In applying these coils, users have mainly been interested in the environmental health benefits potentially derived from repelling the mosquito, while oblivious of the environmental health risks that may be associated with exposure to emissions from the use of mosquito coil. This study evaluated the effectiveness of the mosquito coil, ascertained and/or estimated the toxic emissions that may emanate from the coil, and determined its overall appropriateness by conducting a risk-benefit analysis of the use of this strategy in malaria prevention at household levels. METHODS: The repellent ability of mosquito coils was tested by conducting a mosquito knockdown/mortality test in experimental chambers synonymous of local room spaces and conditions. The gaseous and particulate emissions from the mosquito coil were also analysed. Additional scenarios were generated with the Monte Carlo technique and a risk-benefit analysis was conducted applying @Risk software. RESULTS: Mosquito mortality arising from the application of various mosquito coils averagely ranged between 24 and 64%, which might not provide adequate repellency effect. Emissions from the mosquito coil were also found to contain CO, VOCs, SO2, NO2, PM2.5 and PM10. The Hazard Index of the respective pollutants characterized over a lifetime exposure scenario was low (< 1 for each pollutant), which suggests that the concentrations of the specific chemicals and particulate matter emitted from the mosquito coil may not constitute adverse environmental health risk. CONCLUSION: Although the risk of morbidity from the use of the mosquito coil was low, the coil yielded limited protection as a mosquito avoidance method. It may, therefore, have a reduced benefit in controlling malaria and should be applied sparingly in a highly regulated manner only when traditionally proven effective vector control strategies are not available or too expensive for resource-poor malaria endemic regions.

A mobile phone based tool to identify symptoms of common childhood diseases in Ghana: development and evaluation of the integrated clinical algorithm in a cross-sectional study.

BACKGROUND: The aim of this study was the development and evaluation of an algorithm-based diagnosis-tool, applicable on mobile phones, to support guardians in providing appropriate care to sick children. METHODS: The algorithm was developed on the basis of the Integrated Management of Childhood Illness (IMCI) guidelines and evaluated at a hospital in Ghana. Two hundred and thirty-seven guardians applied the tool to assess their child's symptoms. Data recorded by the tool and health records completed by a physician were compared in terms of symptom detection, disease assessment and treatment recommendation. To compare both assessments, Kappa statistics and predictive values were calculated. RESULTS: The tool detected the symptoms of cough, fever, diarrhoea and vomiting with good agreement to the physicians' findings (kappa = 0.64; 0.59; 0.57 and 0.42 respectively). The disease assessment barely coincided with the physicians' findings. The tool's treatment recommendation correlated with the physicians' assessments in 93 out of 237 cases (39.2% agreement, kappa = 0.11), but underestimated a child's condition in only seven cases (3.0%). CONCLUSIONS: The algorithm-based tool achieved reliable symptom detection and treatment recommendations were administered conformably to the physicians' assessment. Testing in domestic environment is envisaged.

Scarification in sub-Saharan Africa: social skin, remedy and medical import.

Various forms of body modification may be observed in sub-Saharan Africa. Hypotheses and theories of scarification and tribal marking in sub-Saharan Africa are described, plus the procedure of scarification, examples from several African countries, assumed effects in prevention and treatment of diseases, and the medical risks resulting from unsterile manipulation.

Solid medical waste: a cross sectional study of household disposal practices and reported harm in Southern Ghana.

BACKGROUND: Solid medical waste (SMW) in households is perceived to pose minimal risks to the public compared to SMW generated from healthcare facilities. While waste from healthcare facilities is subject to recommended safety measures to minimize risks to human health and the environment, similar waste in households is often untreated and co-mingled with household waste which ends up in landfills and open dumps in many African countries. In Ghana, the management of this potentially hazardous waste stream at household and community level has not been widely reported. The objective of this study was to investigate household disposal practices and harm resulting from SMW generated in households and the community. METHODS: A cross-sectional questionnaire survey of 600 households was undertaken in Ga South Municipal Assembly in Accra, Ghana from mid-April to June, 2014. Factors investigated included socio-demographic characteristics, medication related practices, the belief that one is at risk of diseases associated with SMW, SMW disposal practices and reported harm associated with SMW at home and in the community. RESULTS: Eighty percent and 89% of respondents discarded unwanted medicines and sharps in household refuse bins respectively. A corresponding 23% and 35% of respondents discarded these items without a container. Harm from SMW in the household and in the community was reported by 5% and 3% of respondents respectively. Persons who believed they were at risk of diseases associated with SMW were nearly three times more likely to report harm in the household (OR 2.75, 95%CI 1.15-6.54). CONCLUSION: The belief that one can be harmed by diseases associated with SMW influenced reporting rates in the study area. Disposal practices suggest the presence of unwanted medicines and sharps in the household waste stream conferring on it hazardous properties. Given the low rates of harm reported, elimination of preventable harm might justify community intervention.

A Way Forward for Healthcare in Madagascar?

A healthcare utilization survey was conducted as a component of the Typhoid Fever Surveillance in Africa Program (TSAP). The findings of this survey in Madagascar contrasted with those in other sites of the program; namely, only 30% of the population sought healthcare at the government-provided healthcare facilities for fever. These findings promoted us to determine the drivers and barriers in accessing and utilizing healthcare in Madagascar. Here we review the results of the TSAP healthcare utilization initiative and place them in the context of the current organization of the Madagascan healthcare system. Our work highlights the demands of the population for access to appropriate healthcare and the need for novel solutions that can quickly provide an affordable and sustainable basic healthcare infrastructure until a government-funded scheme is in place.

Minimising invasiveness in diagnostics: developing a rapid urine-based monoclonal antibody dipstick test for malaria.

OBJECTIVE: To generate monoclonal antibodies (MAbs) for developing a rapid malaria diagnostic urine-based assay (RUBDA), using Plasmodium-infected human urinary antigens. METHODS: Plasmodium-infected human urinary (PAgHU) and cultured parasite (CPfAg) antigens were used to generate mouse MAbs. The reactivity and accuracy of the MAbs produced were then evaluated using microplate ELISA, SDS-PAGE, Western blotting assay, microscopy and immunochromatographic tests. RESULTS: Ninety-six MAb clones were generated, of which 68.8% reacted to both PAgHU and CPfAg, 31.3% reacted to PAgHU only, and none reacted to CPfAg only. One promising MAb (UCP4W7) reacted in WBA, to both PAgHU and CPfAg, but not to Plasmodium-negative human urine and blood, Schistosoma haematobium and S. mansoni antigens nor measles and poliomyelitis vaccines. CONCLUSION: MAb UCP4W7 seems promising for diagnosing Plasmodium infection. Urine is a reliable biomarker source for developing non-invasive malaria diagnostic tests. SDS-PAGE and MAb-based WBA appear explorable in assays for detecting different levels of Plasmodium parasitaemia.