Perceptions of the roles, impact, challenges and needs of community drug distributors in the control and elimination of neglected tropical diseases in difficult-to-access communities in Ghana.

INTRODUCTION: The success of mass drug administration (MDA) campaigns to control and eliminate neglected tropical diseases (NTDs) in Ghana depends, to a large extent, on the essential role community drug distributors (CDDs) play. This study aimed to investigate community's perceptions of CDDs' roles, impact of CDDs' work, challenges faced by CDDs, and views on resources required to enhance CDDs' work to sustain MDA campaigns. METHODS: A cross-sectional qualitative study employing the use of focus group discussions (FGDs) with community members and CDDs in selected NTD endemic communities together with individual interviews with district health officers (DHOs) was conducted. We interviewed 104 people aged 18 and over, purposively selected, through eight individual interviews, and 16 focus group discussions. RESULTS: Participants in the community FGDs noted that health education and the distribution of drugs were the main roles of CDDs. Participants also perceived that the work of CDDs had prevented the onset of NTDs, treated symptoms of NTDs, and generally reduced the incidence of infections. In the interviews with CDDs and DHOs, lack of cooperation/non-compliance by community members, demands by community members, lack of working resources and low financial motivation were mentioned as the main challenges to the work of CDDs. Moreover, the provision of logistics and financial motivation for CDDs were identified as factors that will enhance their work. CONCLUSIONS: Incorporating more attractive schemes will incentivise CDDs to improve output. Addressing the challenges highlighted is an important step for the work of CDDS to be effective in controlling NTDs in difficult-to-access communities in Ghana.

Coverage of preventive measures and surveillance for neglected tropical diseases in hard-to-reach communities in Ghana.

BACKGROUND: Neglected tropical diseases (NTDs) are a major public health burden which mainly affects poor populations living in tropical environments and hard-to-reach areas. The study sought to examine coverage of preventive efforts, and case surveillance for NTDs in hard-to-reach communities in Ghana. METHODS: The study investigated treatment efforts for lymphatic filariasis (LF), and onchocerciasis and schistosomiasis/soil transmitted helminths (SCH/STH) at household level, in difficult-to-access communities in Ghana. A total of 621 households were sampled from 6 communities in the Western, Oti and Greater Accra regions. RESULTS: Over 95% of the households surveyed were covered under mass drug administration (MDA) campaigns for lymphatic filariasis (LF) and onchocerciasis. More than 80% of households had received at least two visits by community drug distributors under the MDA campaigns in the last two years preceding the study. In addition, over 90% of households in the LF and onchocerciasis endemic communities had at least one member using anthelminthic medications under the MDA campaigns in the 12 months preceding the study. However, households where no member had taken anthelminthic medications in 12 months preceding the study were over 6 times likely to have someone in the household with LF. CONCLUSIONS: This study determined that SCH/STH, LF and onchocerciasis are of serious public health concern in some communities in Ghana. There is an urgent need for holistic practical disease control plan involving both financial and community support to ensure total control of NTDs in difficult-to-access communities is achieved.

Multidrug-Resistant Bacteria on the Mobile Phones and Computer Keyboards of Healthcare University Students in Ghana.

Globally, mobile phones and computers (laptops and desktops) are indispensable part of human lives for communication, entertainment, and educational purposes. However, there are concerns about the increasing risk of bacterial contamination and antibiotic resistant trends from the surfaces of these devices. This study aims to assess bacterial contamination of mobile phones and computer keyboards and their resistant profile at the University of Ghana, Korle-Bu Campus, Accra. This was a cross-sectional study conducted from March to June 2017 with 240 swabs collected from the surfaces of mobile phones and computer keyboards used by healthcare students. Swabs were cultured on MacConkey, blood, and mannitol salt agar. Bacteria identification was performed with a standard bacteriological method. A total of 91 bacterial isolates were obtained from the devices, and they were tested against 9 commonly used antibiotics by the Kirby-Bauer disc method. The study revealed mobile phones and computer keyboards had contamination levels of 83.3% and 43.3%. Bacteria isolated included Staphylococcus epidermidis (25.4%), Klebsiella spp. (12.9%), Staphylococcus aureus (9.2%), Escherichia coli (6.7%), Pseudomonas spp. (5.4%), Enterobacter cloacae (2.1%), and Enterobacter spp. (1.7%). Overall, 91 bacterial isolates were highly resistant to ampicillin (96.7%) and tetracycline (75.8%) and moderately resistant to chloramphenicol (49.5%) with lower resistance to cefotaxime (18.7%), ceftadizime (14.2%), ciprofloxacin (25.3%), and gentamycin (24.7%). Additionally, 45.1% of isolates were multidrug resistant. Findings from this study revealed mobile phones and computer keyboards of healthcare students in the university were contaminated with pathogenic bacteria. Hence, frequent hand hygiene and disinfection of mobile phones and computer keyboard surfaces is encouraged to minimize the spread of resistant bacteria pathogens.

The role of car tyres in the ecology of Aedes aegypti mosquitoes in Ghana.

Aedes aegypti is an important vector of arboviral diseases including dengue and yellow fever. Despite the wide distribution of this mosquito species, there are limited data on the ecology of Ae. aegypti in Ghana. In this study, we report on the oviposition preference and the larval life tables of Ae. aegypti mosquitoes in Accra, Ghana. The oviposition preference of the mosquitoes to three habitat types (car tyres, drums and bowls) was measured by setting up ovitraps. We recorded the presence and abundance of larvae every 3 days. Two-hour-old Ae. aegypti larvae were introduced and raised in three habitat types to undertake larval life tables. The number of surviving larvae at each developmental stage was recorded daily until they emerged as adults. Car tyres showed a higher abundance of Ae. aegypti larvae (52.3%) than drums (32.5%) and bowls (15.1%) (ANOVA, F(2,159) = 18.79, P < 0.001). The mean development time of Ae. aegypti larvae was significantly lower in car tyres (7 ± 1 days) compared to that of bowls (9 ± 0.0 days) and drums (12.6 ± 1.5 days) (P = 0.024). The differences in pupation rates and emergence rates were not significant across the habitat types; however, the highest pupation rate was observed in bowls (0.92 ± 0.17) and the emergence rate was highest in tyres (0.84 ± 0.10). The proportion of first-instar larvae that survived to emergence was significantly higher in car tyres (0.84 ± 0.10) compared to that of bowls (0.72 ± 0.20) and drums (0.62 ± 0.20) (P = 0.009). No mortalities were observed after 9 days in car tyres, 10 days in bowls and 15 days in drums. The results confirm that discarded car tyres were the preferred habitat choice for the oviposition of gravid female Ae. aegypti mosquitoes and provide the best habitat conditions for larval development and survival. These findings are necessary for understanding the ecology of Ae. aegypti to develop appropriate strategies for their control in Ghana.

The Role of Car Tyres in the Ecology of Aedes aegypti Mosquitoes in Ghana.

Background: The Aedes aegyptimosquito is an important vector of arboviral diseases including dengue and yellow fever. Despite the wide distribution of the Aedes aegypti mosquito, there is limited data on the ecology of Aedes aegypti mosquitoes in Ghana. In this study, we report on the oviposition preference and the larval life table of Aedes aegypti mosquitoes in Accra, Ghana. Methods: The oviposition preference of Aedesmosquitoes to three habitat types (tyres, drums and bowls) was measured by setting up ovitraps. Ovitraps were checked for the presence of Aedes larvae every 3 days. The presence and number of larvae were recorded for each habitat type. Two-hour-old Aedes aegypti larvae were introduced into and raised in these three habitat types to undertake larval life tables. The number of surviving larvae at each developmental stage was recorded daily until they emerge as adults. Results: Car tyres showed a high abundance of Aedeslarvae (52.33%) than drums (32.49%) and bowls (15.18%) (ANOVA, F _ 18.79, df _ 2, 159, P < 0.001). The mean development time of Ae. aegypti larvae was significantly lower in car tyres (7 ± 1 days) compared to that of bowls (9 ± 0.0 days) and drums (12.6 ± 1.5 days) (H (2) = 7.448, P = 0.024). The differences in pupation rates and emergence rates were not significant across the habitat types, however, the highest pupation rate was observed in bowls (0.92) and the emergence rate was highest in tyres (0.84). The proportion of first-instar larvae that survived to adults was significantly higher in tyres with a shorter survival time (0.84; 9 days) compared to that of bowls (0.72; 10 days) and drums (0.62 ± 0.2; 13 days) (H (2) = 2.822, P= 0.009). Conclusion: The results confirm that discarded car tyres were the preferred habitat choice for the oviposition of gravid female Aedes aegypti mosquitoes and provide the best habitat condition for larval development and survival. These findings are necessary for understanding the ecology of Aedes mosquitoes to develop appropriate strategies for their control in Ghana.

Perceptions of the roles, impact, challenges and needs of community drug distributors in the control and elimination of neglected tropical diseases in difficult-to-access communities in Ghana.

The success of mass drug administration (MDA) campaigns to control and eliminate neglected tropical diseases (NTDs) in Ghana depends, to a large extent, on the essential role community drug distributors (CDDs) play. This study aimed to investigate community's perceptions of CDDs' roles, impact of CDDs' work, challenges faced by CDDs and views on resources required to enhance CDDs' work to sustain MDA campaigns. Methods : A cross-sectional qualitative study employing the use of focus group discussions (FGDs) with community members and CDDs in selected NTD endemic communities together with individual interviews with district health officers (DHOs)was conducted. We interviewed 104 people aged 18 and over, purposively selected, through eight individual interviews, and 16 focus group discussions. Results : Participants in the community FGDs noted that health education and distribution of drugs were the main roles of CDDs. Participants also perceived that the work of CDDs had prevented the onset of NTDs, treated symptoms of NTDs and generally reduced the incidence of infections. In the interviews with CDDs and DHOs, lack of cooperation/non-compliance by community members, demands by community members, lack of working resources and low financial motivation were mentioned as the main challenges to the work of CDDs. Moreover, provision of logistics and financial motivation for CDDs were identified as factors that will enhance their work. Conclusions : Incorporating more attractive schemes shall incentivise CDDs to improve output. Addressing the challenges highlighted is an important step for the work of CDDS to be effective in controlling NTDs in difficult-to-access communities in Ghana.

Insecticide resistance status of Aedes aegypti in southern and northern Ghana.

BACKGROUND: Outbreaks of Aedes-borne arboviral diseases are becoming rampant in Africa. In Ghana, there is no organized arboviral control programme with interventions restricted to mitigate outbreaks. Insecticide application is a crucial part of outbreak responses and future preventative control measures. Thus, knowledge of the resistance status and underlying mechanisms of Aedes populations is required to ensure optimal insecticide choices. The present study assessed the insecticide resistance status of Aedes aegypti populations from southern Ghana (Accra, Tema and Ada Foah) and northern Ghana (Navrongo) respectively. METHODS: Phenotypic resistance was determined with WHO susceptibility tests using Ae. aegypti collected as larvae and reared into adults. Knockdown resistance (kdr) mutations were detected using allele-specific PCR. Synergist assays were performed with piperonyl butoxide (PBO) to investigate the possible involvement of metabolic mechanisms in resistance phenotypes. RESULTS: Resistance to DDT was moderate to high across sites (11.3 to 75.8%) and, for the pyrethroids deltamethrin and permethrin, moderate resistance was detected (62.5 to 88.8%). The 1534C kdr and 1016I kdr alleles were common in all sites (0.65 to 1) and may be on a trajectory toward fixation. In addition, a third kdr mutant, V410L, was detected at lower frequencies (0.03 to 0.31). Pre-exposure to PBO significantly increased the susceptibility of Ae. aegypti to deltamethrin and permethrin (P < 0.001). This indicates that in addition to kdr mutants, metabolic enzymes (monooxygenases) may be involved in the resistance phenotypes observed in the Ae. aegypti populations in these sites. CONCLUSION: Insecticide resistance underpinned by multiple mechanisms in Ae. aegypti indicates the need for surveillance to assist in developing appropriate vector control strategies for arboviral disease control in Ghana.

The resting behavior of malaria vectors in different ecological zones of Ghana and its implications for vector control.

BACKGROUND: In sub-Saharan Africa there is widespread use of long-lasting insecticidal nets and indoor residual spraying to help control the densities of malaria vectors and decrease the incidence of malaria. This study was carried out to investigate the resting behavior, host preference and infection with Plasmodium falciparum of malaria vectors in Ghana in the context of the increasing insecticide resistance of malaria vectors in sub-Saharan Africa. METHODS: Indoor and outdoor resting anopheline mosquitoes were sampled during the dry and rainy seasons in five sites in three ecological zones [Sahel savannah (Kpalsogo, Pagaza, Libga); coastal savannah (Anyakpor); and forest (Konongo)]. Polymerase chain reaction-based molecular diagnostics were used to determine speciation, genotypes for knockdown resistance mutations (L1014S and L1014F) and the G119S ace1 mutation, specific host blood meal origins and sporozoite infection in the field-collected mosquitoes. RESULTS: Anopheles gambiae sensu lato (s.l.) predominated (89.95%, n = 1718), followed by Anopheles rufipes (8.48%, n = 162) and Anopheles funestus s.l. (1.57%, n = 30). Sibling species of the Anopheles gambiae s.l. revealed Anopheles coluzzii accounted for 63% (95% confidence interval = 57.10-68.91) and 27% (95% confidence interval = 21.66-32.55) was Anopheles gambiae s. s.. The mean resting density of An. gambiae s.l. was higher outdoors (79.63%; 1368/1718) than indoors (20.37%; 350/1718) (Wilcoxon rank sum test, Z = - 4.815, P < 0.0001). The kdr west L1014F and the ace1 mutation frequencies were higher in indoor resting An. coluzzii and An. gambiae in the Sahel savannah sites than in the forest and coastal savannah sites. Overall, the blood meal analyses revealed that a larger proportion of the malaria vectors preferred feeding on humans (70.2%) than on animals (29.8%) in all of the sites. Sporozoites were only detected in indoor resting An. coluzzii from the Sahel savannah (5.0%) and forest (2.5%) zones. CONCLUSIONS: This study reports high outdoor resting densities of An. gambiae and An. coluzzii with high kdr west mutation frequencies, and the presence of malaria vectors indoors despite the use of long-lasting insecticidal nets and indoor residual spraying. Continuous monitoring of changes in the resting behavior of mosquitoes and the implementation of complementary malaria control interventions that target outdoor resting Anopheles mosquitoes are necessary in Ghana.

Microbial Quality of Sliced Pawpaw (Carica papaya) and Watermelon (Citrullus lanatus) Sold on Some Streets of Accra Metropolis, Ghana.

In most African countries, street vending of fruits is prevalent and the likelihood of predisposing consumers to microbial contamination is very high. This study aimed to determine various bacteria and risk factors that are associated with fruits sold by street vendors in Accra. Sliced watermelons and pawpaws were randomly purchased from selected suburbs in Greater Accra Region of Ghana. One gram (1 g) of each watermelon and pawpaw was homogenized in 9 ml of sterile peptone water, and 0.1 ml from each serial dilutions of each fruit was spread on plate count agar, blood agar, and MacConkey agar plates for total aerobic counts and coliform counts. Agar plates were incubated at 33-37°C for 18-24 h. Bacterial identification was done by standard bacteriological methods. Additionally, questionnaires were administered to the vendors to gather data on food hygiene and knowledge on foodborne illness. The study revealed that although some of the fruit vendors were educated on food hygiene, most sold fruits were contaminated with mean total aerobic plate counts of 2.6 × 105-8.1 × 105 CFU g-1 and 3.7 × 104-7.1 × 104 CFU g-1 for watermelon and pawpaw. The mean coliform counts for pawpaw and watermelon ranged between 1.2 × 103-8.1 × 103 CFU g-1 and 1.6 × 104-3.1 × 104 CFU g-1, respectively. Overall, mean aerobic counts and mean coliform counts were not significantly different among vendors in selected locations (p > 0.05). However, predominant bacteria isolated included Enterobacter species (33.3%), Citrobacter sp. (20.0%), and Klebsiella sp. (15.9%). The study revealed that watermelon and pawpaw sold on the streets in Accra could be possible source of foodborne illness. Therefore, street food vendors must be educated on food hygiene protocols and measures to improve microbial quality of street vended fruits.

Bacterial drug-resistance patterns and genetic diversity of bacteria-associated bacteriuria in diabetic patients in Ghana.

Objectives: Our study aimed to determine the etiology of urinary tract infections (UTIs), resistance profiles of isolated bacteria, and virulence factors of Escherichia coli associated with bacteriuria in diabetic patients in Ghana. Methods: Midstream urine samples from 982 diabetic patients were tested for uropathogens at the National Diabetes Management and Research Centre in Ghana, using standard bacteriological methods, with antibiogram testing of the isolates using the Kirby-Bauer disk diffusion, as per CLSI guidelines. Polymerase chain reaction (PCR) was used to investigate the phylogenetic groupings and virulence factor (VF) genes of isolated E. coli. Results: The overall prevalence of UTIs was 9.2%, and the main uropathogens were Klebsiella spp. (55.6%) and Escherichia coli (31.3%). Age, duration of diabetes, and a previous history of UTIs were risk factors associated with UTI (p-value < 0.05). High levels of antibacterial resistance to cefuroxime (84%), ampicillin (80%), and gentamicin (70.7%) were observed. The distribution of VFs in each phylogenetic group revealed that sfa-iutA-KpsTMII-KpsTMIII genes were associated with group B2, and iutA-ibe were associated with group D. Conclusions: The isolated uropathogens were highly resistant, and the E. coli isolates possessed varying VFs. Continuous monitoring of bacteria associated with UTI in diabetics is highly recommended.

Characterization of Campylobacter associated gastric enteritis among patients with Human Immunodeficiency Virus (HIV) in a hospital in Accra, Ghana.

BACKGROUND: Campylobacter infections in HIV positive patients often present with substantial mortality and morbidity when compared to HIV negative patients. AIM: This study assessed the prevalence of Campylobacter, antibiotic resistance phenotypes and genetic factors, and risk of Campylobacter infection associated with living in close proximity to domestic animals in HIV patients with gastric enteritis at Korle-Bu Teaching Hospital, Accra, Ghana. METHODS: Resistance to different antibiotics was assessed with Kirby-Bauer disk diffusion method. In addition, all the Campylobacter isolates were tested for ampicillin (blaOXA-61), erythromycin (aph-3-1), tetracycline tet(O), streptomycin (aadE), and the energy-dependent multi-drug efflux pump (cmeB) resistance genes using multiplex polymerase chain reaction. RESULTS: Out of a total of 140 (97 females and 43 males) tested patients, 71 (50.7%) patients were positive for Campylobacter coli. Female patients aged within 31-40 years (31.6%) and 41-50 years (31.6%) had high frequency of Campylobacter infection. Most of the infected patients lived in close proximity to chickens (53.5%), however, some patients (14.1%) lived in close proximity to goats. Phenotypic resistance evaluation revealed widespread resistance to ampicillin (100%), tetracycline (100%), ciprofloxacin (71.8%), erythromycin (69%), and gentamicin (49.3%). However, limited no of isolates contained blaOXA-61 (1.41%), cmeB (7.0%) and tet(O (7.0%) resistance genes. CONCLUSION: HIV patients with gastric enteritis were infected with resistant Campylobacter coli. Further studies are required to examine correlation of infected patients with C. coli and risk of living in close proximity to poultry birds. There is the need for routine investigation of Campylobacter in patients with gastroenteritis in order to assist in the development of strategies for combating diseases involving resistant zoonotic bacteria strains.

Correction to: Escherichia coli bacteriuria in pregnant women in Ghana: antibiotic resistance patterns and virulence factors.

Following publication of the original article [1], the authors reported that one of the authors' names was spelled incorrectly. In this Correction the incorrect and correct author name are shown. The original publication of this article has been corrected.

The role of family size, employment and education of parents in the prevalence of intestinal parasitic infections in school children in Accra.

INTRODUCTION: Intestinal parasitic infections (IPIs) in school children are a public health problem in most developing countries. METHODS AND PRINCIPAL FINDINGS: A cross sectional survey was conducted from May to July 2016 with school children living in overcrowded urban slums in Accra, Ghana. A simple random sample of 300 children aged 2-9 years was collected. The study used structured pre-tested questionnaire and stool tests to obtain information on epidemiological, sanitation habits, employment and education status of parents and children. Data were analysed using appropriate descriptive, univariate and multivariable logistic tools of analyses. The mean age of participants was 6.9 years and 49% were males and 51.3% were females. Giardia lamblia was found in males (10.95%) and females (7.79%). Very low prevalences for Schistosoma mansoni, Ascaris lumbricoides, Taenia species, and Entamoeba coli were detected. Whilst children from mothers (62.2%) and fathers (55.6%) with no education were often infected, a few children from fathers (22.2%) and mothers (6.7%) with no jobs were infected. Most of the infected children's (93.7%) parents did not have any knowledge of IPIs. The educational and employment status of the mothers [p = 1.0 and p = 0.422] was not significant, however, the family size was a predisposing factor (p = 0.031) for parasitic infections. CONCLUSIONS: Intestinal parasites were prevalent in children from overcrowded families and with no knowledge of IPIs. Educative programmes on IPIs, improving hygiene, and application of supportive programmes to elevate socioeconomic conditions may help reduce the burden of intestinal parasite carriage in children.

Escherichia coli bacteriuria in pregnant women in Ghana: antibiotic resistance patterns and virulence factors.

OBJECTIVES: The relevance of Escherichia coli associated bacteriuria infection in pregnant women is poorly understood, despite these strains sharing a similar virulence profile with other pathogenic E. coli causing severe obstetric and neonatal infections. We characterized and determined the antimicrobial susceptibility, resistance genes and virulence profiles of 82 E. coli isolates associated with asymptomatic bacteriuria in some pregnant in Ghana from February to August 2016 using Kirby-Bauer disc diffusion and polymerase chain reaction. RESULTS: High levels of antimicrobial resistance were observed to ampicillin (79.3%), tetracycline (70.7%) and cotrimoxazole (59.8%), except for cefuroxime (32.9%). Resistance genes analyses revealed 58.5% were positive for BlaTEM and 7.3% for aph(3)-Ia(aphA2). Virulence factors (VFs) was more widespread in pregnant women in the 2nd and 3rd trimesters than 1st trimester. VFs relating to adhesion (papC and iha), Protectins (traT), aerobactin acquisition (iutA) and iron acquisition systems (fyuA and irp2) were more prevalent in the resistant E. coli isolates. This study provides evidence for a link in bacteriuria and transmission of extra-intestinal E. coli in pregnant women to cause multi-resistant obstetric or neonatal infections. Considering the involvement of extra-intestinal E. coli in infections, results are helpful to develop strategies to prevent maternal and/ neonatal infections.

Intestinal parasitic infections and risk factors: a cross-sectional survey of some school children in a suburb in Accra, Ghana.

OBJECTIVE: This study aimed to determine the prevalence and establish some risk factors associated with the acquisition of gastrointestinal parasitic infections in school children in Accra, Ghana. RESULTS: The overall prevalence of intestinal parasitic infection was 15%. Giardia lamblia (10%) and Schistosoma mansoni (1.7%) were the common parasites found. Out of the 15% students postive for intestinal parasites, 13.6% had single parasites and 1.3% had double parasitic infections. Children between the ages of 4-5 and 6-7 years (20% each) had the most parasitic infections. The prevalence of intestinal parasitic infection was not significantly related to gender (p = 0.1451), and source of drinking water (p = 0.8832). However, a statistically significant association between children infected with parasites and close proximity to domestic animals or pets was observed (p = 0.0284). Continuous education on personal hygiene, environmental sanitation and deworming of domestic animals or pets are required to reduce the prevalence of intestinal parasites in school children in Accra.