Langbong Bimi

Epidemiology of Hookworm Infection in Kintampo North Municipality, Ghana: Patterns of Malaria Coinfection, Anemia, and Albendazole Treatment Failure

A cross-sectional pilot study of hookworm infection was carried out among 292 subjects from 62 households in Kintampo North, Ghana. The overall prevalence of hookworm infection was 45%, peaking in those 11-20 years old (58.5%). In children, risk factors for hookworm infection included coinfection with malaria and increased serum immunoglobulin G reactivity to hookworm secretory antigens. Risk factors for infection in adults included poor nutritional status, not using a latrine, not wearing shoes, and occupation (farming). Although albendazole therapy was associated with an overall egg reduction rate of 82%, 37 subjects (39%) remained infected. Among those who failed therapy, treatment was not associated with a significant reduction in egg excretion, and nearly one-third had higher counts on repeat examination. These data confirm a high prevalence of low-intensity hookworm infection in central Ghana and its association with poor nutritional status. The high rate of albendazole failure raises concern about emerging resistance.

Insecticide resistance profiles for malaria vectors in the Kassena-Nankana District of Ghana

BackgroundMalaria is a major public health problem in Ghana. The current strategy of the National Malaria Control Programme is based on effective case management and the use of insecticide treated bed nets among vulnerable groups such as children under-five years of age and pregnant women. Resistance to pyrethroids by Anopheles gambiae s.l. and Anopheles funestus has been reported in several African countries including neighbouring Burkina Faso.MethodsIndoor resting Anopheles mosquitoes were collected. Blood-fed and gravid females were allowed to oviposit, eggs hatched and larvae reared to 1–3 days old adults and tested against permethrin 0.75%, deltamethrin 0.05%, cyfluthrin 0.15%, lambdacyhalothrin 0.1% and DDT 4%, based on WHO methodology. PCR analyses were carried out on a sub-sample of 192 of the An. gambiae for sibling species complex determination. Resistance to pyrethroids and DDT was determined by genotyping the knock-down resistance kdr gene mutations in the study area.ResultsA total of 9,749 1–3 days-old F1 female Anopheles mosquitoes were exposed to the insecticides. Among the pyrethroids, permethrin, 0.75% had the least knockdown effect, whilst cyfluthrin 0.15%, had the highest knock-down effect. Overall, no difference in susceptibility between An. gambiae 93.3% (95% CI: 92.5–94.1) and An. funestus 94.5% (95% CI: 93.7–95.3) was observed when exposed to the pyrethroids. Similarly, there was no difference in susceptibility between the two vector species (An. gambiae = 79.1% (95% CI: 76.6–81.8) and An. funestus = 83.5% (95% CI: 80.2–86.4) when exposed to DDT. Overall susceptibility to the insecticides was between 80% and 98%, suggesting that there is some level of resistance, except for cyfluthrin 0.15%. The kdr PCR assay however, did not reveal any kdr mutations. The analysis also revealed only the molecular M (Mopti) form.ConclusionThe findings in this study show that An. gambiae and An. funestus, the main malaria vector mosquitoes in the Kassena-Nankana district are susceptible to the insecticides being used in the treatment of bed nets in the malaria control programme. There is however, the need for continuous monitoring of the pyrethroids as the efficacy is not very high.

Simultaneous administration of praziquantel, ivermectin and albendazole, in a community in rural northern Ghana endemic for schistosomiasis, onchocerciasis and lymphatic filariasis

Objectives  To compare (i) side effects associated with the simultaneous adminstration of praziquantel, albendazole and ivermectin with side affects associated with albendazole and ivermectin only and (ii) coverage by volunteers distributing three or two drugs.

Associations between Red Cell Polymorphisms and Plasmodium falciparum Infection in the Middle Belt of Ghana

Background Red blood cell (RBC) polymorphisms are common in malaria endemic regions and are known to protect against severe forms of the disease. Therefore, it is important to screen for these polymorphisms in drugs or vaccines efficacy trials. This study was undertaken to evaluate associations between clinical malaria and RBC polymorphisms to assess biological interactions that may be necessary for consideration when designing clinical trials. Method In a cross-sectional study of 341 febrile children less than five years of age, associations between clinical malaria and common RBC polymorphisms including the sickle cell gene and G6PD deficiency was evaluated between November 2008 and June 2009 in the middle belt of Ghana, Kintampo. G6PD deficiency was determined by quantitative methods whiles haemoglobin variants were determined by haemoglobin titan gel electrophoresis. Blood smears were stained with Giemsa and parasite densities were determined microscopically. Results The prevalence of clinical malarial among the enrolled children was 31.9%. The frequency of G6PD deficiency was 19.0% and that for the haemoglobin variants were 74.7%, 14.7%, 9.1%, 0.9% respectively for HbAA, HbAC, HbAS and HbSS. In Multivariate regression analysis, children with the HbAS genotype had 79% lower risk of malaria infection compared to those with the HbAA genotypes (OR = 0.21, 95% CI: 0.06–0.73, p = 0.01). HbAC genotype was not significantly associated with malaria infection relative to the HbAA genotype (OR = 0.70, 95% CI: 0.35–1.42, p = 0.33). G6PD deficient subgroup had a marginally increased risk of malaria infection compared to the G6PD normal subgroup (OR = 1.76, 95% CI: 0.98–3.16, p = 0.06). Conclusion These results confirm previous findings showing a protective effect of sickle cell trait on clinical malaria infection. However, G6PD deficiency was associated with a marginal increase in susceptibility to clinical malaria compared to children without G6PD deficiency.

Water Contact Activities and Prevalence of Schistosomiasis Infection among School-age Children in Communities along an Irrigation Scheme in Rural Northern Ghana

Of the various trematodes that infect humans, schistosomes remain among the most prevalent, and the various forms of schistosomiasis still pose significant public health problems. The prevalence of schistosomiasis infection among in-school and not-in-school children resident in communities along the Tono irrigation canals in northern Ghana was determined. Stool and urine samples from random representative samples were parasitologically examined using the Kato-Katz and 10 ml urine filtration methods respectively. A total of 920 children (mean age: 11.0 yrs; range: 6-15 yrs; STD Dev: 4.6 yrs), 573 (62.3%) males and 347 (37.7%) females with 473 in-school and 447 not-in-school participated in the study. The prevalence of Schistosoma haematobium infection was 33.2% (305/920) whilst that of S. mansoni was 19.8% (95% CI: 17.3-22.5; 182/920). The overall prevalence of infection (S. haematobium plus S. mansoni) was 47.7% (439/920). Many more males (51.7%; 95% CI: 47.5-55.8) than females (41.2%; 95% CI: 36.0-46.6) were infected. Forty-six (5.0%, 46/920) children were infected with both S. haematobium and S. mansoni. There was no difference in the prevalence of infection (S. haematobium plus S. mansoni) among children in-school (48.4%; 95% CI: 43.8-53.0) and those not-in-school (46.5%; 95% CI: 41.8-51.3). There was a statistically significant difference in prevalence of infection among communities (P=0.0002); with the lowest level of infection in residents of Korania (29.9%; CI: 20.0- 41.4) and the highest among those resident in Kajelo (64.9%; CI: 51.1-77.1), with significant differences in levels of water contact activities (χ2 =6.69; P=0.04). The highest intensity of S. mansoni infection (115.6 epg) was in Bonia where the highest prevalence of blood stained stools was collected (5.5%). Overall, 2.8% (26/920; 95% CI: 1.9-4.2) of stool samples were blood stained, whilst 10% (92/920; 95% CI: 8.2-12.2) of children had haematuria. S. haematobium ova were detected in 98.9% (91/92) of blood stained urine samples. Children infected by S. mansoni were more likely to have blood stained stool (χ2 =32.7; P<0.0001). The prevalence of schistosomiasis infection in the irrigation project site is high, adding praziquantel to albendazole and ivermectin for distribution during the annual mass drug administration for filariasis and onchocerciasis control will be an effective way of reaching all at risk groups in the Kassena-Nankana district for the control of schistosomiasis.

Childhood Activities and Schistosomiasis Infection in the Kassena-Nankana District of Northern Ghana

Schistosomiasis is a common cause of morbidity especially among rural children in less developed countries. The extent and distribution of schistosomiasis infection among school-age children was assessed and the association between some childhood activities and prevalence of infection was determined in northern Ghana. A cross-sectional study was conducted during which stool and urine samples were collected from children 6-15 years. Samples were analysed using the Kato-Katz technique and the 10 ml urine filtration methods respectively. Data on water contact activities were also collected. The level of infection was compared in relation to location and water contact activities. A total of 1,764 children participated in the study. Prevalence of Schistosoma haematobium infection was 18.9%. The highest level of infection (33.1%) was found among children resident in the southern part of the district, the lowest among those in the eastern (3.6%) and northern (3.8%) parts. S. mansoni infection was 10.9%. The highest level of S. mansoni infection (54.2%) was found among children resident in the central part of the district. The overall prevalence of infection (S. haematobium+S. mansoni) was moderate (27.1%). More males (32.5%) than females (20.2%) were infected (χ2=32.8, P<0.0001). Children aged 9-12 years had the highest prevalence of infection (31.8%; 95% CI: 28.4- 35.5) with the lowest among those aged 6-8 years (23.9%; 95% CI: 20.2-28.0). Swimming in the canals (χ2=404.4, P<0.0001) and working on tomato farms (χ2=37.7, P<0.0001) were risk factors for infection. Herding cattle appeared to have protected the children from infection (χ2=34.8, P=0.0001). Schistosomiasis is prevalent throughout the district with children resident in the central and southern parts of the district being more at risk of infection. There is the need to put in place an integrated and effective schistosomiasis control programme.

Diversity in breeding sites and distribution of Anopheles mosquitoes in selected urban areas of southern Ghana

BackgroundAnopheles vectors of malaria are supposedly less common in urban areas as a result of pollution, but there is increasing evidence of their adaptation to organically polluted water bodies. This study characterized the breeding habitats of Anopheles mosquitoes in the two major urban areas in southern Ghana; Accra (AMA) and Sekondi-Takoradi (STMA) Metropolitan Areas, during dry and wet seasons.MethodsAnopheles mosquito larvae were sampled using standard dipping methods to determine larval densities. The origin, nature and stability of 21 randomly selected sites were observed and recorded. Mosquito larvae were reared to adults and Anopheles species identified by both morphological and molecular means.ResultsSixty-six percent of Anopheles habitats were permanent and 34% temporal, and 74.5% man-made while 25.5% were natural. Puddles and urban farm sites accounted for over 51% of all Anopheles mosquitoes sampled. The mean larval densities among the habitat types was highest of 13.7/dip for puddles and lowest of 2.3/dip for stream/river, and the variation between densities were significant (P = 0.002). The mean larval densities were significantly higher in the wet season than in the dry season for the two study areas combined (P = 0.0191) and AMA (P = 0.0228). Over 99% of the 5,802 morphologically identified Anopheles species were An. gambiae (s.l.) of which more than 99% of the studied 898 were An. coluzzii (62%) and An. gambiae (s.s.) (34%). Urban farms, puddles, swamps and ditches/ dugouts accounted for approximately 70% of all An. coluzzii identified. Conversely, drains, construction sites, streams/rivers and “others” contributed 80% of all An. gambiae (s.s.) sampled. The wet season had significantly higher proportion of Anopheles larvae compared to the dry season (Z = 8.3683, P < 0.0001). Also, the proportion of Anopheles mosquitoes produced by permanent breeding sites was 61.3% and that of temporary sites was 38.7%.ConclusionTaken together, the data suggest that man-made and/ or permanent habitats were the main contributors to Anopheles larval populations in the cities and that regulation of the anthropogenic processes that lead to development of breeding places and proper environmental management can drastically reduce mosquito breeding sites in urban areas of Ghana.

Congenital toxoplasmosis and pregnancy malaria detection post-partum: Effective diagnosis and its implication for efficient management of congenital infection.

Congenital toxoplasmosis (CT) and pregnancy malaria (PM) have been individually reported to cause severe negative outcomes in pregnancies but the diagnostic method is still debatable. This study sought to estimate the prevalence of PM and CT single and co-infections in pregnant women by using various specimens including plasma and placental tissues. Genomic DNA extracted from the placenta, cord blood or blood of mothers was tested by PCR. Conventional method of immunodiagnosis was done for CT. We tested 79 pregnant women aged 18-42 years (mean: 28±1.06). Prevalence of Plasmodium falciparum infection determined by PCR on mothers peripheral blood specimen was 6.3% whiles 57.3% was recorded for placental tissues (p<0.01). PCR testing for placental tissues showed 29.2% positive for Toxoplasma gondii, whiles 76.0% of mothers had serum IgG against T. gondii. It should be noted that 6.3% of the placental tissues showed PCR positive for SAG 3, a marker of active infection in T. gondii. Although there were no enhanced foetal disorders at birth in our study, there is a possibility of active transmission of T. gondii from mothers to foetuses even in immune mothers. Our study suggests that foetuses were exposed to P. falciparum and T. gondii in utero, and placenta is a better specimen for PCR in detecting such episodes. In cases of PCR-positive samples, clinical follow-up after birth may be important.

Prevalence and Risk Factors of Taeniasis in theBunkpurugu-Yunyoo District of Northern Ghana

Although Taenia solium infestation and cysticercosis have been documented as the main causes of acquired epilepsy and their recognition as important public health hazards has risen over the past 10 years, there is lack of information on the disease burden due to Tape worm infestation and its associated risk factors in the rural communities of northern Ghana. This study was conducted to evaluate the prevalence of Taeniasis and document its associated risk factors. The study describes the results of a cross-sectional survey involving 494 participants, selected by a village- based random sampling method from a population of 99,729 in 4 villages. Stool samples from selected people were examined by the Kato-Katz method for worm eggs/ova. Eggs were detected in 65 people (13.15%) of the Kato smears. Four factors were observed to be associated with Taeniasis infestation on multivariate analysis. A history of a family member ever contracting the disease and pork consumption were the main implicated factors for infestation (P-value = 0.003 & 0.001 respectively). Among the pork consumers, those who opted for measly pork and people who took pork light soups prepared in the markets were observed to have higher probabilities of getting infected. Also, Taenia cysts were observed in 18.8% (22/117) of pigs slaughtered for consumption in the area. These carcasses were either consumed or smoked and transported to towns in the southern sector for sale. Whilst pig rearing was mostly done by the women in the area to supplement household incomes, the husbandry practices (food and feeding habits) were observed to be unsatisfactory. Health education on the need for sanitary and hygienic practices and mass anthelminthic drug administration in the area are recommended.

An Evaluation of Treatment Outcomes in a Cohort of Clients on the DOTS Strategy, 2012–2016

We present, for the first time, an evaluation of treatment outcomes in a cohort at a TB referral centre in the Central Region of Ghana. Of the 213 clients placed on DOTS, 59.2% (126/213) were sputum smear-positive. An overall cure rate of 90.2% (51.6% cured + 37.6% completed) and a death rate of 8.5% (18/213) were estimated. Of the number of clients who died, 5.7% (12/213) were males (χ 2 = 2.891, p = 0.699; LR = 3.004, p = 0.699). Deaths were only recorded among clients who were > 19 years old (χ 2 = 40.319, p = 0.099; LR = 41.244, p = 0.083). Also, 0.9% (2/213) was lost to follow-up, while 1.4% (3/213) had treatment failure. In total, 13.6% (7.0%, 15/213 males, and 6.6%, 14/213 females) of clients who were placed on DOTS were HIV seropositive. Ages of 40–49 years had the highest number, 13/213 (6.1%), infected with HIV, though the difference among the remaining age groups was not statistically significant (χ 2 = 9.621, p = 0.142). Furthermore, 7.0% (15/213) had TB/HIV coinfection. Out of them, 9 were cured and 5 died at home, while 1 had treatment failure. Tuberculosis/HIV infection prevention advocacy and interventions that address sociodemographic determinants of unfavourable treatment outcomes are urgently required to augment national efforts towards control.