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Background: The association of the oral microbiome with SARS-CoV-2 infections and disease progression has been documented in European, Asian, and American populations but not in Africa., Methods: We conducted a study in Ghana to evaluate and compare the naso-oropharyngeal microbiome in SARS-CoV-2-infected and uninfected persons before (pre-vaccine) and after vaccine availability (post-vaccine) in the country. 16S rRNA V3-V4 variable region was sequenced and analysed from DNA extracted from naso-oropharyngeal swabs., Results: Considering only the infection status, infected and uninfected groups had no difference in their within-group diversity and was evident in the study population pre- and post-vaccine availability. The introduction of vaccines reduced the diversity of the naso-oropharyngeal microbiome particularly among SARS-CoV-2 positive persons and, vaccinated individuals (both infected and uninfected) had higher microbial diversity compared to their unvaccinated counterparts. SARS-CoV-2-positive and -negative individuals were largely compositionally similar varying by 4-7% but considering vaccination*infection statuses, the genetic distance increased to 12% (P = 0.003) and was mainly influenced by vaccination. Common among the pre- and post-vaccine samples, Atopobium and Finegoldia were abundant in infected and uninfected individuals, respectively. Bacteria belonging to major butyrate-producing phyla, Bacillota (particularly class Clostridia) and Bacteroidota showed increased abundance more strikingly in infected individuals before vaccines were available. They reduced significantly after vaccines were introduced into the country with Fusobacterium and Lachnoanaerobaculum being the only common bacteria between pre-vaccine infected persons and vaccinated individuals, suggesting that natural infection and vaccination correlate with high abundance of short-chain fatty acids., Conclusion: Our results show, in an African cohort, the abundance of bacteria taxa known for their protective pathophysiological processes, especially during infection, suggesting that this population is protected against severe COVID-19. The immune-related roles of the members of Bacillota and Bacteroidota that were found associated with infection and vaccination require further studies, and how these may be linked to ethnicity, diet and age. We also recommend expansion of microbiome-disease association studies across Africa to identify possible bacterial-mediated therapeutics for emerging infections., (© 2024. The Author(s).)

Schistosomiasis, an endemic neglected tropical disease in areas with poor sanitation, causes physical and mental defects in both children and adults. Various strategies, especially drug administration for morbidity control, have been implemented to combat the disease in Ghana and globally. Despite these efforts, schistosomiasis remains prevalent in Ghana, negatively impacting children's academic performance, growth, and overall quality of life. This study aimed to determine the prevalence of schistosomiasis in school children at Esuekyir, a peri-urban community in Ghana. A cross-sectional study using simple random sampling technique to select participants and collect stool and urine samples from 246 school children in Esuekyir was adopted. Microscopy of urine and stool samples was performed involving urine sedimentation and stool formol-ether sedimentation techniques to analyse for parasite eggs. Questionnaires were developed to help detect risk factors that expose these children to the disease. The prevalence of urogenital schistosomiasis in children at Esuekyir was 15.45% while that of intestinal schistosomiasis was 6.957.0%. There was one case of co-infection of urogenital and intestinal schistosomiasis from a 13 year old primary student. Children in primary school had higher risks of infection due to their activities around the water body. There was a significant association between class groups and urogenital schistosomiasis (p-value = 0.042). The presence of schistosomiasis in school children highlights the importance of targeted interventions and public health initiatives in addressing this specific disease condition especially in primary school children. Findings from the research revealed a higher prevalence of urogenital schistosomiasis in the study population as compared to intestinal schistosomiasis., (© 2024. The Author(s).)

Background: Human onchocerciasis remains a public health problem in Ghana. Mass drug administration (MDA) with ivermectin (IVM) has reduced disease morbidity and prevalence, but the transmission of onchocerciasis remains ongoing in several endemic foci. We investigated parasite transmission in some endemic communities in Ghana that had received > 18 rounds of annual MDA with IVM and determined the species composition of black fly (Simulium damnosum) vectors in these areas., Methods: Adult female black flies were collected using human landing catches and identified as either forest or savanna species using morpho-taxonomic keys. The adult flies underwent dissection to determine their parity and detect any O. volvulus larvae, followed by the calculation of entomological indices. Simulium damnosum s.l. larvae were collected and preserved in freshly prepared Carnoy's fixative and were later used for cytotaxonomic studies., Results: A total of 9,983 adult flies were caught: 6,569 and 3,414 in the rainy and dry seasons respectively. Black fly biting activities over the study period showed bimodal or trimodal patterns. The highest monthly biting rate (MBR) of 10,578.75 bites/person/month was recorded in July in Beposo, while the highest monthly transmission potential of 100.69 infective bites/person/month was recorded in Asubende in August. Morphological analysis of 2,032 flies showed that 99.8% (2,028) of the flies were savanna species, with only 4 (0.2%) adult flies being of the forest species. Cytogenetic studies on 114 black fly larvae revealed three cytospecies (Simulium damnosum s.s., S. sirbanum and S. sanctipauli) in the study area., Conclusions: The present studies confirmed an ongoing transmission of onchocerciasis in the study communities except Abua-1. It also provides further information on biting behaviors and onchocerciasis transmission indices in the study communities. Further, our data confirmed the savanna species (S. damnosum s.s. and S. sirbanum) of the S. damnosum s.l. to be the major vectors of onchocerciasis in the study areas, with only an occasional influx of forest cytotypes., (© 2024. The Author(s).)

Background: Cervical cancer remains a leading cause of cancer-related deaths among women in Ghana and other Sub-Sahara African (SSA) countries. Despite the importance of early diagnosis for timely treatment and death prevention, cervical cancer screening among women in developing countries remain very low. Nonetheless, there is a paucity of research examining the factors associated with screening uptake among women of reproductive age in Ghana. Thus, this study fills the scholarly void and contributes to the existing literature by examining the determinants of cervical cancer screening in Ghana., Methods: Utilizing data from the 2022 Ghana Demographic and Health Survey (GDHS) (N = 15,014 women), and by employing logistic regression models for a cross-sectional analysis, this study evaluated the factors associated with cervical cancer screening in Ghana., Results: Women with tertiary educational attainment (OR = 4.140; 95%CI: 2.960 5.789; p < 0.001), from the richer (OR = 1.968; p < 0.001) and richest households (OR = 2.492; p < 0.001), the married/living with partner (OR = 1.773; 95%CI:1.372 2.290; p < 0.001), the widowed/divorced/separated (OR = 1.888; 95%CI:1.320 2.701; p < 0.001), owners of valid health insurance card (OR = 1.356; 95%CI:1.086 1.693; p < 0.01), visitation to health facility in the past 12 months (OR = 1.312; 95%CI: 1.082 1.590; p < 0.001), those who watched television at least once in a week (OR = 1.395; 95%CI: 1.055 1.846; p < 0.001), as well as those who listened to radio at least once in a week (OR = 1.509; 95%CI: 1.228 1.853; p < 0.001), were all significantly more associated with cervical cancer screening in the study context. Also, ethnicity, religion, and the region of residence significantly predicted cervical cancer screening in the study context., Conclusion: Cervical cancer screening in Ghana can be improved by addressing socioeconomic and geographical disparities in the country's healthcare system. To ensure early detection, timely treatment or care and prevention of cervical cancer-related deaths in the country, there must be coordinated efforts by the government of Ghana to improve healthcare access and surveillance systems for cervical cancer cases, particularly, in geographically disadvantage areas., (© 2024. The Author(s).)

Background: Mycoplasma genitalium (MG), a sexually transmitted infection (STI), has emerged as a common cause of non-gonococcal urethritis and cervicitis worldwide, with documented resistance to commonly used antibiotics including doxycycline and azithromycin. Data in Ghana regarding the prevalence of MG is limited., Methods: This retrospective study investigated MG presence and macrolide resistance among patients who previously reported to selected clinics for STI symptoms between December 2012 and June 2020. Samples were screened for MG and mutations associated with azithromycin resistance were investigated using Nucleic Acid Amplification Testing (NAAT) including the Resistance Plus MG ® kit from SpeeDx and the LightMix ® kit for MG, combined with the Modular Mycoplasma Macrolide from TIB Molbiol., Results: A total of 1,015 samples were screened, out of which MG infection rate by TIB Molbiol and SpeeDx were 3.1% and 3.4%, respectively. The mutation responsible for macrolide resistance was detected in one MG positive sample by both assays. Both diagnostic tests revealed no significant association between MG infection and socio-demographic characteristics, clinical symptoms, gonorrhea, and chlamydia infection status. There was no significant difference in the mycoplasma percentage positivity rate detected using SpeeDx (3.4%) and TIB Molbiol (3.1%)., Conclusions: While not commonly tested as a cause of STI symptoms, MG is widespread in Ghana, exhibiting symptoms and prevalence comparable to those in other countries and linked to antimicrobial resistance. Future research using various molecular techniques is essential to monitor resistance trends and guide future antibiotic choices., (© 2024. The Author(s).)

Background: In many places in the world, workers in the meat processing industry report high incidence of injuries. Details of such injuries are not well known for Ghana or much of Africa., Methods: A cross-sectional survey involving 300 workers from three major meat processing facilities in the Kumasi metropolis of Ghana was carried out using a structured questionnaire from April to June 2023. The prevalence, types and outcome of injuries among workers were assessed. Test of association was established by Chi square analysis., Results: Over the prior 6 months, the prevalence of injury was 83.0%. Among the various injury types, lacerations had the highest prevalence (46.0%) followed by musculoskeletal pain (16.7%) bone fractures (14.0%), swelling (13.0%), burns and scalds (7.3%), and dislocations/sprains/strains (6.7%). More than half (58.9%) of injuries sustained were moderately severe (2-7 days of lost work) and nearly half (42.0%) required immediate medical attention. Gender, employment status, wages, availability and use of safety equipment were significantly associated with injuries among abattoir workers., Conclusions: The incidence of injuries among abattoir workers in Kumasi, Ghana demonstrates a large public health burden requiring attention and improved enforcement through occupational safety interventions., (© 2024. The Author(s).)

Introduction: In Sub-Saharan Africa alone, about 40-65% of Hepatitis B Virus infections among HCWs were a result of percutaneous occupational exposures to contaminated blood and body fluids of patients. Occupational exposure to blood and body fluids among healthcare workers is on the rise in Ghana. However, the relationship between self-reported exposures to blood and body fluids suspected to be contaminated with the hepatitis B virus and actual serological evidence of exposure remains unknown. The aim of the study however was to assess the self-reported exposure to HBV as against the serological evidence of lifetime exposure to HBV and associated factors among Ghanaian HCWs., Methods: The study was a cross-sectional analytical survey that involved 340 HCWs who were recruited using a simple random sampling procedure from six cadres of staff from five districts in Greater Accra. The participants were surveyed using a validated instrument and 5mls of venous blood was aseptically withdrawn for qualitative detection of Anti-HBc. SPSS version 23.0 was used to analyze the data to obtain proportions, odds ratios and their corresponding confidence intervals with the level of significance set at 0.05., Results: The response rate was 94% with Nurses and Doctors in the majority with a mean age of 35.6 ± 7.2. Self-reported exposure to HBV was 63% whereas lifetime exposure to HBV (Anti-HBc) prevalence was 8.2% (95% CI = 5.0-11.0%). Females were 60% less likely to be exposed to HBV (aOR = 0.4; 95% CI = 0.1-0.9) than their male counterparts. HCWs without training in the prevention of blood-borne infections had almost three times higher odds of being exposed to HBV in their lifetime (aOR = 2.6; 95% CI = 1.0-6.4)., Conclusions: The findings of this study suggest that self-reported exposure to HBV-contaminated biological materials was high with a corresponding high lifetime exposure to HBV. The female gender was protective of anti-HBc acquisition. Apart from direct interventions for preventing occupational exposures to HBV in the healthcare setting, periodic training of all categories of healthcare workers in infection prevention techniques could significantly reduce exposure to the Hepatitis B virus., (© 2024. The Author(s).)

Background: Reactive case detection (RCD) aims to reduce malaria transmission stemming from asymptomatic carriers. Symptomatic individuals diagnosed with malaria at a health centre are followed to their households, where members of the index case and neighbouring households are tested and treated for malaria. An RCD programme was tested in the Ashanti region of Ghana in order to study diagnostic accuracy in the hospital and household settings, assess the prevalence of subclinical infections and possible clustering in index case households, and identify operational challenges for future RCD programmes. Currently, transmission in this region is high, but reactive interventions might become an option once transmission is reduced., Methods: 264 febrile individuals were enrolled at the Mankranso Government Hospital and tested for malaria using rapid diagnostic tests (RDT). From the pool of RDT-positive febrile index cases, 14 successful RCD follow-ups were conducted, and 233 individuals were enrolled from the index case, neighbour, and control households. The sensitivity of diagnostic tools for clinical and subclinical cases was compared, including RDT, expert microscopy by World Health Organization-certified microscopists, field microscopy, and qPCR., Results: Poor diagnosis and low receptivity to RCD-style follow-ups were major limitations to a successful and effective RCD programme. Field microscopy detected only 49% of clinical infections compared to RDT. 54% of individuals did not agree to a follow-up, and 66% of attempted follow-ups failed. The system effectiveness of RCD, calculated as the product of correctly diagnosed index cases, successful follow-ups, and proportion of asymptomatic infections detected by RDT, was very low at 4.0%., Conclusions: Due to low system effectiveness and the endemic nature of the disease setting in which asymptomatic prevalence is high and infections are not clustered around index case households, RCD is currently not a feasible option for malaria control in this region. The operational challenges identified through this study may help inform future reactive intervention programme designs once transmission is reduced., (© 2024. The Author(s).)

Background: Intimate partner violence in pregnancy is a significant public health issue that has several detrimental effects. Pregnant women subjected to intimate partner violence (IPV) have a higher risk for adverse pregnancy outcomes., Objective: The aim of the study was to determine the prevalence, patterns and factors associated with intimate partner violence among pregnant women attending a primary care antenatal clinic., Methods: A quantitative cross-sectional study design was employed to study intimate partner violence among 269 pregnant women in Accra, Ghana between July and October 2021. Participants were selected by systematic sampling technique. The self-reported Composite Abuse Scale was used to assess and classify intimate partner violence. Socio-demographic, clinical (obstetric) and behavioural characteristics were obtained with a structured questionnaire. Associations were determined between independent and dependent variables using the chi-squared test, and logistic regression with adjusted odds ratio (AOR). The statistical significance level was set at a p-value ≤ 0.05., Results: The prevalence of IPV was 11.2%. The prevalence of emotional/psychological abuse, harassment/controlling behaviour, physical abuse, sexual abuse and severe combined abuse were 12.3%, 13.0%, 8.2%, 3.3% and 8.9% respectively. Pregnant women who were employed had reduced odds of experiencing IPV [AOR = 0.16 (95%CI: 0.05-0.47), p = 0.001], however, the past experience of violence [AOR = 4.9 (95%CI: 1.06-22.96), p = 0.042], alcohol use by women [AOR = 7.8 (95%CI: 1.63-37.42), p = 0.01], and partners' alcohol consumption [AOR = 10.0 (95%CI: 3.22-31.26), p<0.001] were associated with increased odds of IPV., Conclusions: There is a high prevalence of IPV among pregnant women in this study from a resource-limited setting. The factors found to be associated with IPV in pregnancy were the employment status of women, alcohol consumption by women or their partners and a previous history of violence. Healthcare providers in primary care need to recognize IPV as a medical condition that can occur in pregnancy and be ready to assist and manage the victims when it is detected., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Engmann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Malaria in pregnancy (MiP) is a condition that can be prevented by using intermittent preventive treatment using Sulfadoxine-pyrimethamine. However, despite all the effort to reduce the consequences of MiP for the woman, the unborn child, and the neonate, the knowledge of Intermittent Preventive Treatment of Malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) is low in most malaria-endemic countries, including Ghana. Thus, the need to examine knowledge, and attitude of service users of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine., Methods: The study was a cross-sectional survey of two selected districts in the Volta Region of Ghana. The study participants were randomly selected from communities within Nkwanta North and North Tongu District. In all a total of 438 mothers who have delivered in the past 24 months were selected for the study. The women were interviewed using a structured questionnaire and the bivariate and multivariable logistic regression results presented in tables., Results: The level of knowledge, and attitude were reported as 45.9% and 58.9% respectively. Knowledge of the service user is determined by the level of education of the women. The attitude of the service user is determined by making 4-7 visits during ANC, Gestational age at booking for ANC is 4-7 weeks, income level between 100 to 999, partner educational level above Middle/JHS/JSS, and age of a partner is above 40 years., Conclusion: The findings from the present studies highlighted important factor such as number of antenatal visits that affect both knowledge of services and attitude to use IPTp-SP. Therefore, a community-based health promotion programmes to help to increase knowledges and improved attitude on timely and regular antenatal attendance to promote the benefit of IPTp-SP should be encouraged., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Asem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Malaria in pregnancy (MiP) is a preventable condition leading to maternal and neonatal morbidity and mortality. Invariably, with all the knowledge about the serious consequences of MiP for the woman, the unborn child, and the neonate, the uptake of Intermittent Preventive Treatment of Malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) is low in most malaria-endemic countries, including Ghana. This study sought to examine the uptake and service user predictors of the implementation of IPTp-SP after the policy upgrade in 2014., Methods: This cross-sectional survey was carried out in two selected districts in the Volta Region. The study participants were randomly selected from communities within Nkwanta North and North Tongu District. A total of 438 mothers who have delivered in the past 24 months were selected for the study. The women were interviewed on their background, knowledge, and attitude toward the use of IPTp-SP using a structured questionnaire. Multiple logistic regression was done to determine the factors that influence the demand for IPTp-SP. The results were presented in the form of tables., Results: The mean number of antenatal care (ANC) attendance was 5 (SD:2.6) visits per client, with 262 (59.82%) of them getting the 3+ doses of IPTp-SP. Also, a significant 44 (10.1%) of the mothers did not receive any dose of IPTp-SP. Respondents who attended antenatal clinics 4-7 times had 7 (CI:3.9-12.3) times higher uptake of 3+ doses of IPTp-SP as compared to others who attended less than 4 visits. Similarly, women who had 8 or more visits had a 16.1 (CI: 5.9-43.6) times higher chance of getting more than 2 doses of IPTp-SP compared with others who had fewer than 4 attendances., Conclusion: The uptake of 3+ doses of IPTp-SP is still lower than the global target of 80%. Thus, the need for innovative interventions aimed at improving antenatal attendance and early booking for IPTp-SP are recommended., Competing Interests: The authors have declared that no competing interests exist, (Copyright: © 2024 Asem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Non-communicable diseases (NCDs) predispose households to exorbitant healthcare expenditures in health systems where there is no access to effective financial protection for healthcare. This study assessed the economic burden associated with the rising burden of type-2 diabetes (T2D) and hypertension comorbidity management, and its implications for healthcare seeking in urban Accra., Methods: A convergent parallel mixed-methods study design was used. Quantitative sociodemographic and cost data were collected through survey from a random community-based sample of 120 adults aged 25 years and older and living with comorbid T2D and hypertension in Ga Mashie, Accra, Ghana in November and December 2022. The monthly economic cost of T2D and hypertension comorbidity care was estimated using a descriptive cost-of-illness analysis technique from the perspective of patients. Thirteen focus group discussions (FGDs) were conducted among community members with and without comorbid T2D and hypertension. The FGDs were analysed using deductive and inductive thematic approaches. Findings from the survey and qualitative study were integrated in the discussion., Results: Out of a total of 120 respondents who self-reported comorbid T2D and hypertension, 23 (19.2%) provided complete healthcare cost data. The direct cost of managing T2D and hypertension comorbidity constituted almost 94% of the monthly economic cost of care, and the median direct cost of care was US$19.30 (IQR:10.55-118.88). Almost a quarter of the respondents pay for their healthcare through co-payment and insurance jointly, and 42.9% pay out-of-pocket (OOP). Patients with lower socioeconomic status incurred a higher direct cost burden compared to those in the higher socioeconomic bracket. The implications of the high economic burden resulting from self-funding of healthcare were found from the qualitative study to be: 1) poor access to quality healthcare; (2) poor medication adherence; (3) aggravated direct non-medical and indirect cost; and (4) psychosocial support to help cope with the cost burden., Conclusion: The economic burden associated with healthcare in instances of comorbid T2D and hypertension can significantly impact household budget and cause financial difficulty or impoverishment. Policies targeted at effectively managing NCDs should focus on strengthening a comprehensive and reliable National Health Insurance Scheme coverage for care of chronic conditions., (© 2024. The Author(s).)

Introduction: Cardiometabolic diseases are rapidly becoming primary causes of death in developing countries, including Ghana. However, risk factors for these diseases, including obesity phenotype, and availability of cost-effective diagnostic criteria are poorly documented in an African-ancestry populations in their native locations. The extent to which the environment, occupation, geography, stress, and sleep habits contribute to the development of Cardiometabolic disorders should be examined., Purpose: The overall goal of this study is to determine the prevalence of undiagnosed diabetes, prediabetes, and associated cardiovascular risks using a multi-sampled oral glucose tolerance test. The study will also investigate the phenotype and ocular characteristics of diabetes and prediabetes subgroups, as well as determine if lifestyle changes over a one-year period will impact the progression of diabetes and prediabetes., Methods and Analysis: The study employs a community-based quasi-experimental design, making use of pre- and post-intervention data, as well as a questionnaire survey of 1200 individuals residing in the Cape Coast metropolis to ascertain the prevalence and risk factors for undiagnosed diabetes and prediabetes. Physical activity, dietary habits, stress levels, sleep patterns, body image perception, and demographic characteristics will be assessed. Glucose dysregulation will be detected using oral glucose tolerance test, fasting plasma glucose, and glycated hemoglobin. Liver and kidney function will also be assessed. Diabetes and prediabetes will be classified using the American Diabetes Association criteria. Descriptive statistics, including percentages, will be used to determine the prevalence of undiagnosed diabetes and cardiovascular risks. Inferential statistics, including ANOVA, t-tests, chi-square tests, ROC curves, logistic regression, and linear mixed model regression will be used to analyze the phenotypic variations in the population, ocular characteristics, glycemic levels, sensitivity levels of diagnostic tests, etiological cause of diabetes in the population, and effects of lifestyle modifications, respectively. Additionally, t-tests will be used to assess changes in glucose regulation biomarkers after lifestyle modifications., Ethics and Dissemination: Ethics approval was granted by the Institutional Review Board of the University of Cape Coast, Ghana (UCCIRB/EXT/2022/27). The findings will be disseminated in community workshops, online learning platforms, academic conferences and submitted to peer-reviewed journals for publication., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hormenu, Salifu, Antiri, Paku, Arthur, Nyane, Ableh, Gablah, Banson, Amoah, Ishimwe and Mugeni.)

Objectives: The radiographic assessment of the head is a crucial part of headache care. A computed tomography (CT) scan enables a more detailed analysis of the condition and more focused care. This study examined head CT scans to determine what kinds of anomalies were present in patients with headaches as their primary complaint. Methods: We evaluated 4 years' worth of CT scan data from head exams conducted at two diagnostic facilities in Ghana's western and central regions. We examined data on 477 patients with a headache as their primary complaint between January 2017 and December 2020. We employed chi-square and Fisher's exact tests (where applicable) to compare head CT diagnoses between age groups, gender, headache subtypes, and brain lesion subgroups. Results: There were 53.5% ( n = 255) females and 46.5% ( n = 222) males in the study. The average age of patients was 38.67 ± 17.23 years, with an annual rate of abnormal CT diagnoses ranging from 35.9% in 2017 to 45.4% in 2022. Abnormal head CT diagnoses are strongly correlated with age groups and patient gender ( p = 0.011 and p = 0.009, respectively). Of the 202 patients, 15.3% and 24.3% were classified as intracranial lesions and extracranial lesions, respectively. Maxillary sinusitis affected nearly 60% of the patients, while tumors and hemorrhages affected 25.2% and 11.9%, respectively. Conclusions: A CT scan of the head is essential to detect abnormalities in nearly 50% of patients suffering from various degrees of headache. Sinusitis, brain tumors, and hemorrhage were common lesions detected. It is crucial to create local standard operating procedures to promote better utilization of this type of imaging service, particularly among patients who have been diagnosed with headaches., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Bashiru Babatunde Jimah et al.)

Background: Ticks are vectors of pathogens that affect the health of animals and humans. With the constant trade of livestock across borders, there is the risk of new tick species invasion accompanied by the spread of infectious tick-borne pathogens., Aim: This study sought to determine the diversity of tick species within abattoirs and a slaughter slab as well as identify the pathogens carried by these ticks., Methods: The ticks were collected from slaughtered cattle, identified and screened for pathogens using PCR and sequencing., Results: A total of 371 ticks were collected from slaughtered cattle across the three sampling sites: Kumasi abattoir (288, 77.63%), Akwatia Line slaughter slab (52, 14.02%) and Suame abattoir (31, 8.35%). The predominant species was Amblyomma variegatum (85.44%) with Rhipicephalus sanguineus (s.l.) (0.27%) as the least occurring species. Total nucleic acid from the tick pools was screened for pathogens based on the nucleoprotein gene region in the S segment of the Crimean-Congo haemorrhagic fever virus (CCHFV) genome, the 295-bp fragment of the transposase gene of the Coxiella burnetii IS1111a element, the 560 bp segment of the ssrRNA gene of Babesia and Theileria, the 345 bp fragment of the Ehrlichia genus 16SrRNA gene and the rOmpA gene (OmpA) of Rickettsia. From the 52 tick pools screened, 40 (76.92%) were found positive for pathogen DNA. The pathogens identified were Rickettsia africae (69.23%), Rickettsia aeschlimannii (7.69%), C. burnetii (5.77%), uncultured Ehrlichia sp. (5.77%), Candidatus Midichloria mitochondrii (3.85%) and CCHFV (3.85%). A significant association was observed among A. variegatum, Hyalomma rufipes, Hyalomma truncatum and occurring tick-borne pathogens R. africae, R. aeschlimannii and uncultured Ehrlichia sp. (p < 0.001)., Conclusion: The findings show the occurrence of zoonotic pathogens, suggesting an increased risk of infections among the abattoir workers. There is a need to adopt control measures within the abattoirs to prevent pathogen spread., (© 2024 The Author(s). Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Background: Severe Plasmodium falciparum malarial anemia is still the principal cause of death in children in underdeveloped countries. An imbalance between proinflammatory and anti-inflammatory cytokines is associated with malaria progression. This study evaluated circulating levels of selected inflammatory cytokines among malaria-infected children in Ghana., Methods: This case-control study was conducted at Tamale Teaching Hospital, Ghana. One hundred and twenty children with malaria and 60 controls, aged 12-144 months were selected from April to July, 2023 for the study. Malaria was diagnosed through microscopy, full blood count was measured using hematology analyzer, and cytokines were measured using enzyme-linked immunosorbent assay., Results: Malaria-infected children had higher tumor necrosis factor alpha (TNF-α) (p < .001), interferon-gamma (IFN-ɣ) (p < .001), interleukin (IL)-1β (p < .001), IL-6 (p < .001), granulocyte macrophage-colony stimulating factor (GM-CSF) (p < .001), and IL-10 (p < .001) levels than controls. Participants with high parasitemia had raised TNF-α (p < .001), IFN-ɣ (p < .001), IL-1β (p < .001), IL-6 (p < .001), GM-CSF (p < .001), and IL-10 (p < .001), but reduced IL-3 (p < .001) and TGF-β (p < .001) than those with low parasitemia. Severe malarial anemic children had elevated TNF-α (p < .001), IFN-ɣ (p < .001), IL-1β (p < .001), IL-6 (p < .001), GM-CSF (p < .001), and IL-10 (p < .001), but lower IL-3 (p < .001) and TGF-β (p < .001) than those with uncomplicated malaria., Conclusion: Parasite density was the principal predictor of the cytokine levels, as parasitemia positively associated with IL-10, GM-CSF, IL-6, IL-1β, IFN-ɣ, and TNF-α, but negatively associated with IL-3 and TGF-β. Malaria is associated with enhanced secretion of pro- and anti-inflammatory cytokines in Ghanaian children. Inflammatory cytokines may be involved in the development of severe malarial anemia in children. However, IL-3 and TGF-β may offer protection against severe malarial anemia., (© 2024 The Author(s). Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.)

Background: Recent studies reveal that around 1.9 million stillbirths occur annually worldwide, with Sub-Saharan Africa having among the highest cases. Some Sub-Saharan African countries, including Ghana, failed to meet Millennium Development Goal 5 (MDG5) by 2015 and may struggle to meet Sustainable Development Goal 3 (SDG3) despite maternal healthcare interventions. Concerns arise about Ghana's ability to achieve the World Health Organization's neonatal mortality goal of 12 per 1000 live births by 2030. This study aims to identify key factors influencing childbirth outcomes and create a predictive method for high-risk pregnancies., Methods: We compared four machine learning classifiers (Extreme Gradient Boosting, Random Forest, Logistic Regression, and Artificial Neural Network) in predicting childbirth outcomes using data from a tertiary health facility in Ghana. To address class imbalance, we employed the Synthetic Minority Over-sampling Technique (SMOTE)., Results: Our findings show that fetal heartbeat, gestation age at birth are the most influential factors on birth outcome (stillbirth or live birth), while there is no significant association with maternal age, number of babies, and type of delivery method. Among the machine learning models considered, Random Forest emerged as the optimal model achieving an accuracy, F1-score, and AUC values of approximately 0.98, 0.99, and 0.90 respectively., Conclusion: Our study identifies key factors affecting childbirth outcomes and highlights the potential of machine learning for early high-risk pregnancy detection in clinical settings. These findings are crucial for Ghana and other Sub-Saharan African countries striving to meet maternal and neonatal healthcare goals. Further research and policy initiatives can use these results to improve healthcare in the region and work toward the World Health Organization's objectives by 2030., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: Mild cognitive impairment (MCI) is a unique indicator of underlying distress that may be strongly associated with suicide risk. Despite this, to date, no study has examined the association between MCI and suicidal ideation. Therefore, the present study aimed to examine the association between MCI and suicidal ideation among adults aged ≥65 years from 6 low- and middle-income countries (LMICs; China, Ghana, India, Mexico, Russia, and South Africa)., Methods: Cross-sectional, nationally representative data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Self-reported information on past 12-month suicidal ideation was collected. Multivariable logistic regression and meta-analysis were conducted to assess associations., Results: Data on 13,623 individuals aged ≥65 years were analyzed. The prevalence of suicidal ideation ranged from 0.5% in China to 6.0% in India, whereas the range of the prevalence of MCI was 9.7% (Ghana) to 26.4% (China). After adjustment for potential confounders, MCI was significantly associated with 1.66 (95% confidence interval [95% CI] = 1.12-2.46) times higher odds for suicidal ideation., Discussion: Mild cognitive impairment was significantly associated with higher odds for suicidal ideation among older adults in LMICs. Future longitudinal studies from LMICs are necessary to assess whether MCI is a risk factor for suicidal ideation., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: We sought to determine the achievement of key performance indicators (KPIs) of initial trauma care at non-tertiary hospitals in Ghana during on-hours (8AM-5PM weekdays) compared to off-hours (nights, weekends, and holidays). We also sought to assess the effectiveness of a standardized trauma intake form (TIF) with built-in decision support prompts to improve care and to assess whether this effectiveness varied between on-hours and off-hours., Methods: A stepped-wedge cluster randomized trial was performed with research assistants directly observing trauma care before and after introducing the TIF at emergency units of eight hospitals for 17.5 months. Differences in KPIs and mortality were assessed using multivariable logistic regression and generalized linear mixed regression., Results: Management of 4,077 patients was observed; 1,126 (28 %) during on-hours and 2,951(72 %) during off-hours. At baseline, four of 20 KPIs were performed significantly more often during off-hours. TIF improved care during both on- and off-hours. Seventeen KPIs improved during on-hours and 18 KPIs improved during off-hours. After TIF, six KPIs were performed more often during on-hours, but differences, though significant, were small (1-5 %). Examples of KPIs which were performed more often during on-hours after TIF included: airway assessment (99 % for on-hours vs. 98 % for off-hours), evaluation for intra-abdominal bleeding (91 % vs. 87 %), and spine immobilization for blunt trauma (90 % vs. 85 %) (all p < 0.05). At baseline, mortality among seriously injured patients (Injury Severity Score >9) was higher during on-hours (27 %) compared to off-hours (17 %, p = 0.047). TIF lowered mortality for seriously injured patients during both on-hours (27 % before TIF, 8 % after, p = 0.027) and during off-hours (17 % before, 7 % after, p = 0.004). After TIF, mortality among seriously injured patients was equal between on- and off-hours (8 % vs. 7 %, NS)., Conclusions: At baseline, KPIs of trauma care were slightly better during off-hours compared with on-hours, and mortality was lower among seriously injured patient during off-hours. A quality improvement initiative (the TIF) using built-in decision support prompts improved care strongly in both on- and off-hours and eliminated the mortality difference between on- and off-hours. Use of similar decision support prompts during initial trauma care should be promoted widely in other low- and middle-income countries., Competing Interests: Declaration of competing interest The authors of the manuscript titled “Differences in trauma care between on-hours and off-hours and responsiveness to a trauma intake form with decision support prompts in Ghana: A stepped-wedge cluster randomized trial” declare no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Food insecurity (FI) is a critical social determinant of poor psychosocial health. While data on the specific roles of sex and age in the FI-loneliness link among older adults are limited, the underlying mechanisms are largely unknown. This study examines the age-sex-specific associations of FI with loneliness among older adults in Ghana and quantifies the extent to which psychosomatic factors mediate the association., Methods: We analyzed cross-sectional data from the Aging, Health, Psychological, and Health-seeking Behavior Study in Ghana. The past 30-day FI was assessed using items on hunger and breakfast skipping frequency due to a lack of resources. We assessed loneliness severity with the University of California, Los Angeles 3-item Loneliness Scale. Multivariable OLS regressions and bootstrapping mediation analysis using the Hayes PROCESS macro plug-in were used to evaluate the associations., Results: We included 1,201 individuals aged ≥50 years (mean = 62.9 [SD = 11.9]; women = 63.3%). The prevalence of loneliness was 17.7%. The prevalence of moderate and severe FI was 44.0% and 8.5%, respectively. In the adjusted model, greater FI was significantly associated with loneliness severity (B = .22, SE = .029, p < .001). We found significant interactive effects of FI × age (B = -.17, SE = .023, p < .01) and FI × sex (B = -.28, SE = .036, p < .001) on loneliness. Thus, the FI-loneliness link was respectively more marked among women (B = .25, SE = .035, p < .001) and ≥65 age groups (B = .34, SE = .041, p < .001) than men (B = .16, SE = .051, p < .01) and those aged 50-64 (B = .22; SE = .040, p < .001). Finally, comorbid depression/anxiety (41.07%), hopelessness (48.6%), worthlessness (42.1%), functional limitations (8.2%), and pain severity (6.4%) mediated the FI-loneliness association., Conclusions: Age- and sex-specific associations between FI and loneliness exist among older Ghanaians. Addressing FI in concert with psychosomatic problems in older adults may contribute meaningfully to reducing loneliness in later life., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

This study simultaneously modelled the injury severity of motorcycle riders and their pillion passengers and determine the associated risk factors. The analysis is based on motorcycle crashes data in Ashanti region of Ghana spanning from 2017 to 2019. The study implemented bivariate ordered probit model to identify the possible risk factors under the premise that the injury severity of pillion passenger is endogenously related to that of the rider in the event of crash. The model provides more efficient estimates by considered the common unobserved factors shared between rider and pillion passenger. The result shows a significant positive relationship between the two injury severities with a correlation coefficient of 0.63. Thus, the unobservable factors that increase the probability of the rider to sustain more severe injury in the event of crash also increase that of their corresponding pillion passenger. The rider and their pillion passenger injury severities have different propensity to some of the risk factors including passengers' gender, day of week, road width and light condition. In addition, the study found that time of day, weather condition, collision type, and number of vehicles involved in the crash jointly influence the injury severity of both rider and pillion passenger significantly.

Objectives: Limited data exist on the association between physical activity (PA) and depression in older adults from low- and middle-income countries (LMICs). In this study, we examine the association between meeting the World Health Organization (WHO) PA guidelines and depression in adults aged ≥50 years in Ghana and investigate the psychosomatic factors explaining this association., Methods: Cross-sectional data from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana (2016-18) were analyzed. Depression was assessed with the Center for Epidemiological Studies Depression Scale (CES-D-10). PA was assessed using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Multivariable logistic regression and Hayes PROCESS macro with bootstrapping mediation analyses were performed to evaluate the hypothesized associations., Results: The study included 1201 individuals (mean [SD] age 66.1 [11.9] years; 63.3% women). The prevalence of meeting PA guidelines and depression was 36.7% and 29.5%, respectively. Meeting the WHO-recommended PA guidelines was associated with a 16% lower rate of developing depression even after adjusting for potential confounders (OR = 0.84, p <0.001). This association was much stronger among men and those aged 50-64 years. Loneliness, social isolation, sleep problems, functional limitations, and pain characteristics largely mediated the association of PA with depression., Conclusions: PA was negatively associated with depression among older adults in Ghana, and psychosocial and physical factors partially explained the association. The promotion of PA in old age may aid in the prevention of depression, especially in men and those aged 50-64 years. Longitudinal data may confirm our findings., Competing Interests: DISCLOSURES The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Aim: In Ghana, we know little about the epidemiology of suicide ideation, plan and attempts among junior high school (JHS) students in Ghana including the years preceding high school. This study explores the onset, characteristics, and recent patterns of 12-month suicide behavior among Ghanaian junior high school (JHS) students., Materials and Methods: Paper-based surveys were administered to a sample (n = 800) of junior high school students in the Greater Accra region of Ghana. Self-reported measures on suicide ideation, plan and attempt as well as several psychological and psychosocial factors related to mental health, substance use, poverty, sexual behavior, interpersonal relationships, and family structure were employed. Bi-variate, multivariate and logistic regression analyses were performed using Statistical Package for the Social Sciences (SPSS version 25)., Results: This study found that 1 out of 5 adolescents have experienced suicide ideation in the last 12 months. Girls had significantly higher 12-month (χ 2  = 3.5, p < 0.05) suicide ideation rates than boys. More importantly, the study found stress significantly increasing the odds of suicide behaviors in the last 12 months (β = 1.14; CI = 1.05-1.24, p < 0.05) and parental support significantly reducing the odds of suicide behaviors in the last 12 months (β = 0.86; CI = 0.81-0.91, p < 0.05). Additionally, we found significant associations between sexual intercourse, dating, hunger, substance use, suicide stigma and suicide behaviors., Conclusion: This finding highlights a potential emerging suicide crisis among preteens which warrants attention. Additional studies are needed to observe these increasing trends and identify risk, protective and precipitating factors to help prevent suicide among these children., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Prcis: In the largest clinic-based study to date, our review of 588 patients presenting with glaucoma in Northern Ghana revealed 36% of these had primary angle closure glaucoma (PACG)., Objective: Glaucoma is the second leading cause of blindness worldwide. In Africa, glaucoma is an established public health problem, and PACG is not commonly discussed. Recognizing it is important because of its negative impact on visual morbidity, and also because its treatment is different from primary open angle glaucoma. In response to the observation of many PACG cases at the Northern Community Eye Hospital in Tamale, Ghana, we investigated the proportion of those attending with a first diagnosis of glaucoma who had PACG., Patients and Methods: Using the electronic records, we identified 976 patients who attended with a first diagnosis of glaucoma between January 2021 and October 2022. Of these, 588 met the inclusion criterion of a clear glaucoma subtype diagnosis., Results: Of these 316 (53.7%) had primary open angle glaucoma, 210 (35.7%) PACG, and 62 (10.5%) secondary glaucoma. Thus, over a third of presenting glaucomas had PACG., Conclusion: This study highlights that PACG is present in about a third of patients presenting to our clinic in North Ghana. Our study demonstrates the importance of a clear diagnostic pathway including gonioscopy in the assessment of glaucoma patients and the consideration of wider training on angle closure glaucoma diagnosis and management., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Child labor remains a concern in sub-Saharan Africa. Yet, evidence-based preventive efforts are limited. We analyzed longitudinal data from Ghanaian adolescent girls in a pilot randomized clinical trial testing the preliminary impact of a combination intervention on family cohesion as a protective factor against child labor and school dropout. While there was no statistical difference between the control and intervention groups at 9 months, the results show that family cohesion scores improved significantly from baseline to 9 months for the ANZANSI intervention group. Qualitative results indicated improved family cohesion in the intervention group. Hence, future studies should further examine this promising social work intervention., (© 2024 Society for Research on Adolescence.)

Tracers of health system equity, neglected tropical diseases (NTDs) disproportionately affect marginalized populations. NTDs that manifest on the skin - "skin NTDs" - are associated with scarring, disfigurement, physical disability, social exclusion, psychological distress, and economic hardship. To support development and evaluation of appropriate intervention strategies, we aimed to improve understanding of the role of economic factors in shaping and constituting the burden that skin NTDs place on households. We collected data in 2021 in two predominantly rural districts: Atwima Mponua in Ghana (where Buruli ulcer, yaws, and leprosy are endemic) and Kalu in Ethiopia (where cutaneous leishmaniasis and leprosy are endemic). We conducted interviews (n = 50) and focus group discussions (n = 14) that explored economic themes with affected individuals, caregivers, and community members and analysed the data thematically using a pre-defined framework. We found remarkable commonalities across countries and diseases. We developed a conceptual framework which illustrates skin NTDs' negative economic impact, including financial costs of care-seeking and reductions in work and schooling; categorises coping strategies by their degree of risk-pooling; and clarifies the mechanisms through which skin NTDs disproportionately affect the poorest. Despite health insurance schemes in both countries, wide-ranging, often harmful coping strategies were reported. Traditional healers were often described as more accessible, affordable and offering more flexible payment terms than formal health services, except for Ethiopia's well-established leprosy programme. Our findings are important in informing strategies to mitigate the skin NTD burden and identifying key drivers of household costs to measure in future evaluations. To reduce skin NTDs' impact on households' physical, mental, and economic wellbeing, intervention strategies should address economic constraints to prompt and effective care-seeking. While financial support and incentives for referrals and promotion of insurance enrolment may mitigate some constraints, structural interventions that decentralise care may offer more equitable and sustainable access to skin NTD care., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Analysing data on adverse drug reactions (ADRs) in health facilities is an essential step to help develop effective strategies to reduce their incidence. The objective was to analyse spontaneous ADR reports sent to the Ghanaian Food and Drugs Authority (FDA) by two reporting health facilities over 5 years. Methods: Data from duplicate spontaneous ADR reports sent to the FDA (Ghana) from 2014 to 2018 were extracted. The relationship between independent variables such as age, sex, and source of drugs and ADR outcomes was assessed with either chi-square or a Cramer's V test for association where appropriate. Results: Type A reactions (65.2%) were the most prevalent of the ADRs, followed by Type B (34.1%), with the majority (80%) of patients affected recovering fully. The majority of Type A reactions (54.1%) occurred in the clinic, while the majority of Type B reactions (43.5%) occurred in the hospital. The skin and central nervous system (CNS) were the most affected (70.8%) organs. A higher incidence of CNS and skin-related ADRs was recorded in patients older than 30 (RR = 1.28 (1.07-1.53)). Also, females were more likely to experience a CNS-related ADR. The seriousness of the ADR was found to be significantly associated with the (1) type of prescriber, (2) whether the drug was prescribed, or (3) whether the drug regimen prescribed was appropriate. Even though, in 86% of cases, the offending drug was withdrawn within the first 5 days, it exceeded 20 days in about 6% of cases. The record of allergy status in a patient's folder and the source of the drug were significantly associated with the chance that the offending drug was withdrawn. However, recording ADRs did not influence whether the offending drug was stopped. Conclusion: Most of the ADRs experienced by patients could be avoided if the current systems are improved to prevent the rechallenge of offending drugs. Efforts to improve and update patient medication records and steps to ensure continuity of care are essential in preventing these adverse drug events., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Courage Edem Ketor et al.)

Background: The human hand has constant contact with the environment, hence requires regular hand hygiene. Hand hygiene has gained recognition because of the COVID-19 pandemic and is a largely effective, affordable preventive measure against infectious diseases. This study used both national and sub-national analyses to evaluate the effect of COVID-19 handwashing guidelines on instances of diarrhea in Ghana., Methods: Data on diarrhea cases spanning February 2018 and March 2022 were retrieved from the District Health Information Management System (DHIMS 2) using a data extraction guide. The data were summarized using descriptive statistics. The difference in diarrhea cases between the pre-COVID-19 and COVID-19 periods was measured using a two-sample t-test across Ghana's 16 administrative areas. Causal Impact package in R statistical software was employed to determine the impact of the introduction of COVID-19 hand hygiene protocols on diarrheal disease., Results: A total of 5,645,533 diarrheal cases reported between February 2018 and March 2022 through the routine MIS (DHIMS2) were examined. Fifty-three percent of the cases occurred before the introduction of the hand hygiene protocol. Descriptive statistics indicated a statistically significant decrease in average diarrheal cases during the hand hygiene implementation era (13,463 cases reduction, p<0.001). Sub-national analyses revealed significant reductions in various regions: Greater Accra, Ashanti, Ahafo, Central, Eastern, Northern, Upper East, Upper West, and Volta (p<0.05). Causal impact analysis confirmed 11.0% nationwide reduction in diarrheal cases attributed to the COVID-19 hand hygiene protocols (p<0.001)., Conclusion: This study underscores the effectiveness of COVID-19 hand hygiene protocols in reducing diarrheal morbidity in Ghana, with varying regional impacts. These findings advocate for the sustenance of investments and commitments made at the COVID hand hygiene protocols, particularly in this era where the pandemic appears controlled., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Adu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The purpose of this study was to examine the effect of psychological well-being on job performance among nurses and midwives in rural and urban hospitals in Ghana amidst COVID-19. The study adopted a purely quantitative approach, using the explanatory research design. Data were collected from 262 nurses and midwives in two selected hospitals in the Central Region of Ghana. The Structural Equation Modelling was used to analyze the data collected. The results revealed that the levels of psychological well-being and job performance were high in both hospitals amidst the pandemic. Further, it was observed that although psychological well- being had significant influence on job performance among the nurses and midwives in both rural and urban communities, the effect was more significant in the urban settlements. Given these findings, the study recommended that in order to effectively improve the job performance of nurses and midwives, management must adopt policies such as, flexible work arrangements, leave policy, and counselling services to support their psychological well-being., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2024 Opoku, Owusu. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To describe the profile of Streptococcus pneumoniae , identify research gaps, and provide in-depth insights into various aspects related to the pathogen. Methods: Google Scholar, PubMed, and ScienceDirect were searched for all studies on the pneumococcus in Ghana that reported on specimen collected, population and sample size, carriage prevalence, incidence of pneumococcal diseases, age of the study population, types of test performed, serotypes identified, antimicrobial susceptibilities, or molecular analysis on the pneumococci for data extraction. Results: Overall, a total of 7954 results were obtained from the three-database search, and of this, 24 articles were selected after screening. A total of 924 isolates were accounted for by serotyping/serogrouping. The prevalence of pneumococcal carriage in Ghana ranges from 11.0% to 51.4% in the population depending on the age (≤ 24-80 years), sickle cell disease (SCD), human immunodeficiency virus (HIV) status, or health of the study population, and penicillin (Pen)-nonsusceptible isolates ranged from 17% to 63%. The prevalence of pneumococci found as the etiologic agent of diseases among Ghanaians ranges from 3.4% for otitis media to 77.7% for meningitis. Overall, the 13-valent pneumococcal conjugate vaccine (PCV) (PCV-13) carriage serotypes accounted for 28.4% of the reported pneumococcal isolates. PCV-13 invasive serotypes accounted for 22.4% of the reported isolates. The non-PCV-13 carriage serotypes accounted for most (43.9%) of the reported isolates. In the pre-PCV-13 era, the nontypeable (NT) (5.5%) and other nonvaccine types (NVTs) (6.4%) were reported as being predominant. The non-PCV-13 serotypes accounted for 4.4% of the reported isolates in invasive pneumococcal disease (IPD) cases. Multidrug resistance (MDR) ranged from 7.8% to 100%. Conclusion: Predicting the invasiveness of pneumococci using molecular typing is the way to go in the future as this will provide answers to the extent to which capsular switching is contributing to the pneumococcal disease burden in Ghana almost a decade after introducing PCV-13. Continuous monitoring of antibiotic resistance patterns at both phenotypic and genotypic levels, along with serotyping and molecular typing, should be a standard practice in the surveillance of pneumococcal disease burden in Ghana., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Reuben E. Arhin et al.)

Ghana and other parts of West Africa have experienced lower COVID-19 mortality rates than other regions. This phenomenon has been hypothesized to be associated with previous exposure to infections such as malaria. This study investigated the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the influence of previous malaria exposure. Blood samples were collected from individuals with asymptomatic or symptomatic COVID-19 (n = 217). A variety of assays were used to characterize the SARS-CoV-2-specific immune response, and malaria exposure was quantified using Plasmodium falciparum ELISA. The study found evidence of attenuated immune responses to COVID-19 among asymptomatic individuals, with elevated proportions of non-classical monocytes and greater memory B cell activation. Symptomatic patients displayed higher P. falciparum-specific T cell recall immune responses, whereas asymptomatic individuals demonstrated elevated P. falciparum antibody levels. Summarily, this study suggests that P. falciparum exposure-associated immune modulation may contribute to reduced severity of SARS-CoV-2 infection among people living in malaria-endemic regions., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Globally, the population is rapidly ageing, stemming from a recent decline in mortality, and an increase in life expectancy. About 727 million people globally were aged ≥65 in 2020, and 1 in 6 people will be ≥65 years by 2050. About 7% of Ghana's population was over 60 years in 2010, and projected to be 12% by 2050. However, the aged are confronted with degenerative conditions that translate into difficulty with mobility. The study was conducted to investigate the difficulty with mobility among the aged in Ghana., Methods: The study utilised a cross-sectional dataset of the 2014/2015 (wave 2) Study on Global Ageing and Adult Health and included 1,856 participants aged ≥50 years. The survey command was applied to adjust for sampling biases and the design of the study. At 5% alpha level, a chi-square test of independence was conducted to determine the association between dependent and independent variables. At 95% confidence interval and 5% alpha level, three-level multilevel logistic regression models were performed. The fixed-effects were presented in odds ratio and the random effects were presented using the Intra-Class Correlation. All analysis were performed using STATA statistical software version 16.0., Results: Out of the 1,856 participants, 40.3% had difficulty with mobility. Additionally, age (80 and above) [AOR = 3.05, 95%CI = 1.78-5.22], self-reported poor/bad health status [AOR = 2.39, 95%CI = 1.35-4.23], having severe/extreme difficulty performing household activities [AOR = 25.12, 95%CI = 11.49-44.91], experienced severe/extreme bodily pains [AOR = 4.56, 95%CI = 2.16-9.64], severe/extreme sleep problems [AOR = 4.15, 95%CI = 1.68-10.29], and participants with difficulty with sight/vision [AOR = 1.56, 95%CI = 1.16-2.10] had higher odds of difficulty with mobility., Conclusion: The aged in Ghana had relatively higher prevalence (40.3%) of difficulty with mobility which is influenced by demographics, health status, and degeneration associated with ageing. This highlights the need to provide social support and strengthen social capital for the aged in Ghana, especially those with difficulty with vision, experiencing bodily pains and had poor health status. Additionally, the Government and stakeholders should provide assistive devices for the aged and geriatric care including recreational fields and care homes to address the health and physical needs of the aged in Ghana., Competing Interests: The authors have declared that no competing interests exist, (Copyright: © 2024 Boakye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Echocardiography can be used to screen, confirm, and assist in the management of some cardiovascular diseases in people living with human immunodeficiency virus (HIV) (PLWH). Thus, complications from subclinical cardiovascular conditions or more apparent conditions, such as massive pericardial effusion with tamponade, can be promptly identified and managed to minimize cardiovascular morbidity and mortality associated with HIV infection. Since the introduction of antiretroviral therapy (ART) in Ghana approximately two decades ago, studies on the prevalence and patterns of echocardiographic abnormalities among PLWH on ART have been limited. This study was designed to assess the prevalence and patterns of echocardiographic abnormalities among PLWH on ART., Methods: This was a cross-sectional study. PLWH on ART (cases) attending the HIV clinic at Komfo Anokye Teaching Hospital (KATH) and HIV-negative blood donors (controls) were consecutively recruited and enrolled in this study. The interviews were performed via a standardized questionnaire. After a clinical examination was performed, all patients underwent two-dimensional (2D) and Doppler transthoracic echocardiograms. The prevalence and patterns of echocardiographic abnormalities were characterized., Results: There were 117 patients in each arm of the study. There were more females than males among both the cases (92 (78.6%) and controls (80 (68.4%)); however, the sex distribution was similar between the two groups (p = 0.075). For clinical characteristics such as age, weight, height and blood pressure, there were no statistically significant differences between the cases and controls. Echocardiographic abnormalities were more frequently observed and demonstrated a statistically significant difference between cases and controls, with an overall prevalence of 35.0% among cases and 19.7% among controls (p = 0.008). The echocardiographic abnormalities that demonstrated significant differences between the cases and controls were left ventricular (LV) diastolic dysfunction (28.2% versus 8.6%; p = 0.000) and LV hypertrophy (7% versus 0.9%; p = 0.017)., Conclusion: Nearly 1 in 3 PLWH on ART had an echocardiographic abnormality in this Ghanaian study. Echocardiograms are recommended as helpful screening modalities for diagnosing cardiac abnormalities among PLWH on ART., (© 2024. The Author(s).)

The Northern part of Ghana lies within the African meningitis belt and has historically been experiencing seasonal meningitis outbreaks. Despite the continuous meningitis outbreak in the region, the risk factors contributing to the occurrence of these outbreaks have not been clearly identified. This study, therefore, sought to describe the clinical characteristics and possible risk factors associated with meningitis outbreaks in the Upper West Region (UWR). A 1:2 matched case-control study was conducted in May-December 2021 to retrospectively investigate possible risk factors for meningitis outbreak in the UWR of Ghana between January and December 2020. Cases were persons with laboratory confirmed meningitis, and controls were persons of similar age and sex without meningitis living in the same house or neighborhood with a confirmed case. Both primary and secondary data including clinical, socio-demographic and laboratory information were collected and entered on standard questionnaires. Data was analyzed using descriptive statistics and conditional logistic regression. Meningitis cases were mostly due to Streptococcus pneumoniae (67/98; 68.37%), followed by Neisseria meningitides serogroup X (27/98; 27.55%). Fever occurred in 94.03% (63/67) of Streptococcus pneumoniae cases and 100% in both Neisseria meningitidis serogroup X (27/27) and Neisseria meningitidis serogroup W groups (3/3). CSF white cell count was significantly associated with the causative agents of meningitis. Conditional logistic regression analysis showed that, passive exposure to tobacco [AOR = 3.65, 95%CI = 1.03-12.96], bedrooms with 3 or more people [AOR = 4.70, 95%CI = 1.48-14.89] and persons with sore throat infection [AOR = 8.97, 95%CI = 2.73-29.43] were independent risk factors for meningitis infection. Headache, fever and neck pain continue to be the most common symptoms reported by meningitis patients. Education and other preventive interventions targeting exposure to tobacco smoke and crowded rooms would be helpful in reducing meningitis outbreaks in the Upper West Region of Ghana., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kabanunye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: People who inject drugs (PWID) and people who use drugs (PWUD) are an important population group that remain under-served in Ghana. Though PWID and PWUD are among the key populations most-at-risk to acquire sexually transmitted or blood-borne diseases, they are among those with the least access to human immunodeficiency (HIV), hepatitis B (HBV) and hepatitis C (HCV) viruses' prevention, care and treatment services in Ghana due to lack of data on them. We provide a rapid assessment of the PWUD and PWID situation in Ghana., Methods: This rapid cross-sectional design undertook consultative meetings between the study team and relevant stakeholders, including Civil Society Organizations (CSO) working with PWUD/PWID. The assessment considered a representative sample of PWID and PWUD. It was conducted in four (4) selected regions of Ghana (Greater Accra, Ashanti, Western, and Northern). Overall, 323 participants were interviewed using respondent-driven sampling (RDS) approach. Information obtained from participants were demographics, HIV risk behaviors, human immunodeficiency (HIV) and sexually transmitted infections (STI)-related knowledge HIV/HCV/HBV screening, attitude, and practices among others. Analyses were conducted using Stata version 17 and RDSAT version 7.1.46 software., Findings: Drug use was found to be more prevalent among the youth with a median age of 37 years. Majority of the respondents were males (86%). About 28% of the female respondents identified themselves as sex workers, while about 74% have been involved in transactional sex. The median age at which respondents started using and injecting drugs was 20 and 22 years respectively. Majority (68%) of the respondents consume drugs through smoking, with 20% through snorting, inhaling or swallowing and 12% through injection. The drug mostly used among the respondents was heroin (52%). The most commonly injected drug was cocaine (55%). About 64.7% of respondents reported mixing two or more drugs. HIV prevalence among respondents was 2.5%, 12.3% among women and 17.7% among women engaged in sex work, highlighting the overlap vulnerability. The prevalence of hepatitis C was 6.0%, and Hepatitis B was 4.5%. Access to care is limited, with 63% of the respondents never been tested for HIV., Conclusion: These rapid assessment findings reveal the challenging conditions for people who use and inject drugs coupled with a relatively high prevalence of HIV and Hepatitis C compared to the general population. However, it also reveals that Ghana has a window of opportunity to prevent an exponential spread of HIV and Hepatitis in this population. Therefore, there is the need to implement prevention and treatment programs for HIV and hepatitis among people who use and inject drugs including essential strategies for an enabling environment in Ghana., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Guure et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Intervention efforts against falciparum malaria in high-transmission regions remain challenging, with rapid resurgence typically following their relaxation. Such resilience co-occurs with incomplete immunity and a large transmission reservoir from high asymptomatic prevalence. Incomplete immunity relates to the large antigenic variation of the parasite, with the major surface antigen of the blood stage of infection encoded by the multigene and recombinant family known as var. With a stochastic agent-based model, we investigate the existence of a sharp transition in resurgence ability with intervention intensity and identify molecular indicators informative of its proximity. Their application to survey data with deep sampling of var sequences from individual isolates in northern Ghana suggests that the transmission system was brought close to transition by intervention with indoor residual spraying. These results indicate that sustaining and intensifying intervention would have pushed malaria dynamics to a slow-rebound regime with an increased probability of local parasite extinction., (© 2024. The Author(s).)

Background: Plasmodium falciparum infection is associated with the human ABO blood group. However, there is a paucity of data on the role that ABO and Rhesus blood groups play in malaria clinical presentations. Therefore, the objective of this study was to assess the association of human ABO blood groups and the Rhesus blood (Rh) types with the severity of malaria., Methods: This cross-sectional study was carried out at the Suhum Government Hospital in the Eastern region of Ghana. Conveniently, study participants with malaria, diagnosed by microscopy, were selected into the study. Subsequently, their ABO and Rh blood groups were determined (Accucare ABO/Rh monoclonal antibodies, Chennai, India). Malaria severity was assessed using the criteria for assessing severe malarial anaemia published by the World Health Organization. According to the criteria, severe malarial anaemia was classified as having haemoglobin (Hb) < 5 g/dL for children < 12 years and in patients ≥ 12 years, Hb level < 7 g/dL, with parasitaemia > 10,000/µL in both cases. Severe malarial anaemia was also classified as having plasma bilirubin > 50 µmol/L with parasitaemia ≥ 100,000/µL, for all ages. Chi square statistical analysis was used to test the association between the blood groups and the clinical or laboratory findings, while multivariate analysis was performed to identify which blood groups were more vulnerable to develop severe malarial anaemia., Results: Of the total number of the study participants (n = 328), most of the patients had blood group O Rh positive (35.7%) while few of them had blood group AB Rh negative (2.1%). The types of Rhesus did not associate with malaria. However, compared to blood group O, the odds of developing severe malarial anaemia, in children < 12 years and in patients ≥ 12 years, were 16 times and 17.8 times higher among patients with blood group A, respectively. Furthermore, the odds of having bilirubin level > 50 µmol/L with parasitaemia ≥ 100,000 /µL was 10 times higher among patients with blood groups A and 2.6 times higher in patients with blood group B, compared to blood group O. Finally, in patients with blood group A majority (71.6%) of them developed high temperature (> 37.5 °C) while 43.3% of them vomited and had diarrhoea. However, pallor (group B = 46.2% vs group A = 37.3%), fever (group B = 84.6% vs group A = 79.1%) and nausea (group B = 46.2% vs group A = 25.4%) were more frequent in patients with blood group B than A., Conclusions: This study found that people with blood groups A and B were severely affected by malaria, with group A being the most vulnerable. It is recommended that blood group assessment be performed for all patients with malaria. Patients found to have blood group A or B must be promptly and efficiently managed to avoid the development of severe malaria anaemia., (© 2024. The Author(s).)

Hepatitis B virus (HBV) infection poses a considerable public health challenge in limited-resource settings especially in the sub-Saharan African region. Even though HBV infection is incurable, timely treatment is effective in preventing disease progression to liver cirrhosis or hepatocellular carcinoma. However, not all infected patients require treatment. The aim of the study was to determine the clinical, immunological, and virological profiles of treatment naïve patients with HBV infection, seen at the outpatient clinic of the Cape Coast Teaching Hospital. Additionally, the study sought to determine the antiviral treatment eligibility rate based on the 2015 guidelines of the World Health Organization (WHO) compared with the new 2024 guidelines. A hospital-based cross-sectional study involving total sampling of 220 treatment naïve HBV surface antigen positive clients was carried out. A structured questionnaire was used to collect data that were analyzed with STATA version 16. The median age at diagnosis was 34 years (IQR 26.0-41.5) with a male to female ratio of 1:1.5. A total of 138 participants (62.7%) were diagnosed with HBV infection following voluntary testing. There was a median delay of 8.5 months (IQR 3.0-22.5) between initial diagnosis and patients' presentation for medical care. In all, 24 patients (10.9%) had abnormal clinical examination findings, 172 patients (78.2%) had HBV DNA levels ≤ 2000 IU/ml whereas 8 (3.6%) were seropositive for the HBV envelope antigen. A few patients had concomitant human immunodeficiency virus (2.7%) and hepatitis C virus (1.4%) infections. Treatment eligibility rate based on the WHO 2015 guidelines was 6.4% (n = 14), however, with the updated 2024 guidelines, treatment eligibility was 42.3% (n = 93). Increasing the screening rate among the general population, early linkage to clinical care of screen positives and vaccination of screen negatives will help reduce HBV-related clinical conditions in resource-limited settings., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Daniels et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background/purpose: Sepsis is a leading cause of morbidity, mortality and healthcare utilisation for children worldwide, particularly in resource-limited regions. In Kumasi, Ghana, organ system failure and mortality in children who present to the emergency department (ED) with symptoms of sepsis are often due to late presentation and lack of recognition and implementation of time-critical evidence-based interventions. The purpose of this study was to assess the barriers and facilitators for families in seeking healthcare for their septic children; and to understand the barriers and facilitators for ED providers in Kumasi to recognise and implement sepsis bundle interventions., Design: Single-centre qualitative interviews of 39 caregivers and 35 ED providers in a teaching hospital in Kumasi, Ghana., Results: Thematic analysis of data from caregivers about barriers included: fear of hospital, finances, transportation, delay from referring hospital, cultural/spiritual differences, limited autonomy and concerns with privacy and confidentiality. Negative impacts on family life included financial strain and neglect of other children. ED providers reported barriers included: lack of training, poor work environment and accessibility of equipment. Facilitators from caregivers and providers included some support from the National Health Insurance. Caregivers reported having positive experiences with frontline clinicians, which encouraged them to return to seek health services., Implications: Qualitative structured interviews identified facilitator and critical barrier themes about seeking healthcare, and sepsis identification/management in the paediatric population arriving for care in our centre in Kumasi, Ghana. This study highlights significant deficiencies in healthcare systems that make sepsis management challenging in these settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Occupational stress is increasing globally and affecting all workplaces and countries' health professionals. Despite its significant impact on healthcare delivery, limited studies have actually compared the prevalence, causes, effects, and coping strategies of stress among nurses working in hospitals with variation in capacity and function in Ghana. We, therefore, examined and compared the prevalence, causes, effects and coping strategies of occupational stress among nurses working in a secondary care and tertiary hospital in Ghana., Methods: We conducted a health facility-based cross-sectional study among 248 nurses from two hospitals (Volta Regional Hospital [VRH] and Ho Teaching Hospital [HTH]). The Perceived Stress Scale (PSS) and Weiman Occupational Stress Scale (WOSS) were used to measure the nurses' stress levels and causes of occupational stress respectively. A self-reported checklist was used to measure both the effects of stress and strategies. Descriptive analyses and t-tests were performed, and statistical significance was measured at the 0.05 level., Results: The majority of nurses 77.8% experienced a moderate level of perceived stress. The total individual mean scores of the nurses from the two hospitals (VRH = 3.02 and HTH = 3.09) were 34% and 37% respectively higher than the established WOSS individual average of 2.25. Nursing difficult patients (t=-1.1196, p = 0.037), Unfriendly relationships with superiors, colleagues, and subordinates (t=-2.3333, p = 0.020), working with incompetent staff (t=-1.3129, p = 0.037) were the statistically significant stressors among nurses in the HTH. Whereas, long work hours (t = 2.0841, p = 0.038) and needle-stick injuries (t = 2.6669, p = 0.008) were the statistically significant stressors among nurses from the VRH. Headache (VRH = 73.8% and HTH = 97.9%), Fatigue (VRH = 68.9% and HTH = 83.5%), Frustration VRH = 50.5% and HTH = 68.3%) and Lack of Concentration (VRH = 81.6% and HTH = 80.0%) were most common effects of occupational stress reported., Conclusion: The majority of nurses reported moderate levels of stress, with the two institutions' stressors differing. Key causes of stress were needle stick injuries, long hours, dealing with challenging patients and strained interpersonal relationships. Common side effects were headaches, exhaustion, irritability, and trouble focusing. To accelerate progress towards achieving the sustainable development goal (SDG) 3.4 of promoting mental health and well-being by 2030, the 2012 Mental Health Act of Ghana and the Occupational Health and Safety Regulations, should fully and effectively be implemented in health facilities across the country., (© 2024. The Author(s).)

Introduction: Globally, 7 million people with HIV (PWH) aged over 50 years exist. 5 million of them live in sub-Saharan Africa, the epicenter of the HIV epidemic. In Ghana, every 1 in 6 PWH is aged over 50 years. However, access to geriatric health care is grossly limited in Ghana and the sub-Saharan Africa region. This has resulted in a lack of focus on geriatric syndromes, a multi-factorial clinical condition common in older PWH, that do not fit discrete disease categories. Consequently, this gap threatens the life expectancy for aging PWH, necessitating the need to promptly fill it. The KNUST Aging and HIV Outcomes (KAHO) study will help identify priorities and opportunities for developing an effective integrated model of HIV and geriatric healthcare in Ghana., Methods and Analysis: The KAHO study will recruit 151 PWH aged 50 years and older at the Infectious Disease Unit (IDU) of the University Hospital, Kwame Nkrumah University of Science and Technology (KNUST). The study will be conducted over a 2-year period and participants will be seen at months 0, 6 and 12. Participants at each visit will be taken through assessments and questionnaires on geriatric health, cognition, social vulnerability, HIV-related conditions and they will provide biospecimens for laboratory testing. We will also conduct semi-structured qualitative interviews of PWH, healthcare providers, policy makers and study research assistants. Quantitative data will be analyzed using one sample proportion test and linear regression models appropriately. The Levesque's framework will be used as a guide to analyze qualitative data., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Werekuu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Breast cancer poses a significant health challenge in Sub-Saharan Africa, particularly in Ghana, where late-stage diagnoses and limited healthcare access contribute to elevated mortality rates. This study focuses on the crucial role of pathology and laboratory medical (PALM) services in the timely diagnosis of breast cancer within Ghana., Methods: A cross-sectional survey of hospitals was completed from November 2020 to October 2021, with 94.8% of identified in-country hospitals participating. Pathology service-related parameters assessed included whether pathology was available for the diagnosis of breast cancer on-site or via external referral, the number of pathology personnel, additional breast cancer diagnostic capabilities including estrogen and progesterone and/or HER2 testing, and the time from biopsy to patients receiving their results. Geospatial mapping was used to identify areas of limited access., Results: Of the 328 participating hospitals, 136 (41%) reported breast cancer pathology services, with only 6 having on-site capabilities. Pathology personnel, comprising 15 consultants and 15 specialists, were concentrated in major referral centers, particularly in Greater Accra and Kumasi. An assessment of referral patterns suggested that 75% of the population reside within an hour of breast cancer pathology services. Among the 136 hospitals with access to breast cancer pathology, only a limited number reported that results included ER/PR (38%) and HER2 testing (33%)., Conclusion: Ghana has been able to ensure significant pathology service availability through robust referral pathways with centralized labs. Despite this, difficulties persist with the majority of pathology results not including hormone receptor testing which is important in providing tumor specific treatment., Competing Interests: AFR is currently an employee of Hologic. The majority of this study was completed while AFR was engaged as a full-time faculty member at the Johns Hopkins Bloomberg School of Public Health; only the revision phase occurred during AFR’s employment at Hologic. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare., (Copyright: © 2024 Price et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Pneumococcal meningitis outbreaks occur sporadically in the African meningitis belt. Outbreak control guidelines and interventions are well established for meningococcal but not pneumococcal meningitis. Mathematical modelling is a useful tool for assessing the potential impact of different pneumococcal control strategies. This work aimed to estimate the impact of reactive vaccination with pneumococcal conjugate vaccine (PCV) had it been implemented in past African meningitis belt outbreaks and assess their efficiency relative to existing routine infant immunisation with PCV., Methods & Results: Using recent pneumococcal meningitis outbreaks in Burkina Faso, Chad, and Ghana as case studies, we investigated the potential impact of reactive vaccination. We calculated the number needed to vaccinate to avert one case (NNV) in each outbreak setting and over all outbreaks and compared this to the NNV for existing routine infant vaccination. We extended previous analyses of reactive vaccination by considering longer-term protection in vaccinees over five years, incorporating a proxy for indirect effects. We found that implementing reactive vaccination in previous pneumococcal meningitis outbreaks could have averted up to 10-20 % of outbreak cases, with the biggest potential impact in Brong Ahafo, Ghana (2015-2016) and Goundi, Chad (2009). The NNV, and hence the value of reactive vaccination, varied greatly. 'Large' (80 + cumulative modelled cases per 100,000 population) and/or 'prolonged' (exceeding a response threshold of 10 suspected cases per 100,000 per week for four weeks or more) outbreaks had NNV estimates under 10,000. For routine infant vaccination with PCV, the estimated NNV ranged from 3,100-5,600 in Burkina Faso and 1,500-2,600 in Ghana., Implications: This analysis provides evidence to inform the design of pneumococcal meningitis outbreak response guidelines. Countries should consider reactive vaccination in each outbreak event, together with maintaining routine infant vaccination as the primary intervention to reduce pneumococcal disease burden and outbreak risk., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Ghana adopted the Integrated Disease Surveillance and Response (IDSR) system, which is an integration of the various programs in the surveillance system and can contain disease outbreaks and pandemics. Implementation of the IDSR is influenced by several factors which can affect its functionality and ability to contain disease outbreaks. This study assessed the factors influencing the IDSR system in selected districts in the Eastern Region of Ghana., Method: A cross-sectional study was conducted between February-March, 2022 in Fanteakwa North, Abuakwa South and New Juaben South districts in the Eastern Region of Ghana among health care workers who are involved in IDRS activities. Both primary and secondary data were collected and analyzed using descriptive statistics and regression analysis at 0.05 significant level with 95% confidence interval., Results: Three hundred and forty-seven (347) health care workers participated in the study with 56.2% (195/347) indicating that rumor registers were available at the health facilities. Most of the respondents (64.8%, 225/347) had means of transport for disease surveillance activities while majority (61.9%, 215/347) had case-based forms for case investigation. About half (51.9%, 180/347) of the participants revealed that they did not receive any feedback from the next higher level in the past year. Availability of transport for IDSR activities was almost 3.4 times more likely to contribute positively to IDSR system compared to facilities without transport (AOR = 3.36; 95% CI = 1.44-7.83; p = 0.005). Respondents who have the capacity to apply case definition are 2 times more likely to contribute to an effective IDSR system compared to health workers who cannot apply case definition (AOR = 1.94; 95% CI = 1.17-3.21; p = 0.013). Respondents who did not receive feedback from the next higher level were 52% less likely to have an effective IDSR system compared to respondents who received feedback from the next higher level (AOR = 0.48; 95% CI = 0.23-1.00; p = 0.05)., Conclusion: Effective operation of IDSR is affected by the application of case definition and means of transport at health facilities. In addition, the capacity of health care workers to provide feedback can influence the smooth operation of the IDSR in the studied area in Ghana., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Twene et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Small for gestational age (SGA) and large for gestational age (LGA) births are topical issues due to their devastating effects on the life course and are also accountable for neonatal mortalities and long-term morbidities., Objective: We tested the hypothesis that abnormal haemoglobin levels in each trimester of pregnancy will increase the risk of SGA and LGA deliveries in Northern Ghana., Design: A retrospective cohort study was conducted from April to July 2020., Settings and Participants: 422 postpartum mothers who had delivered in the last 6-8 weeks before their interview dates were recruited through a systematic random sampling technique from five primary and public health facilities in Northern Ghana., Primary Measures: Using the INTERGROWTH-21st standard, SGA and LGA births were obtained. Haemoglobin levels from antenatal records were analysed to determine their effect on SGA and LGA births by employing multinomial logistic regression after adjusting for sociodemographic and obstetric factors at a significance level of α=0.05., Results: Prevalence of anaemia in the first, second and third trimesters of pregnancy was 63.5%, 71.3% and 45.3%, respectively, and that of polycythaemia in the corresponding trimesters of pregnancy was 5.9%, 3.6% and 1.7%. About 8.8% and 9.2% of the women delivered SGA and LGA babies, respectively. After adjusting for confounders, anaemic mothers in the third trimester of pregnancy had an increased risk of having SGA births (adjusted OR, aOR 5.56; 95% CI 1.65 to 48.1; p<0.001). Mothers with polycythaemia in the first, second and third trimesters of pregnancy were 93% (aOR 0.07; 95% CI 0.01 to 0.46; p=0.040), 85% (aOR 0.15; 95% CI 0.08 to 0.64; p<0.001) and 88% (aOR 0.12; 95% CI 0.07 to 0.15; p=0.001) protected from having SGA births, respectively. Interestingly, anaemia and polycythaemia across all trimesters of pregnancy were not statistically significant with LGA births., Conclusion: Anaemia during pregnancy increased from the first to the second trimester and subsequently decreased in the third trimester while polycythaemia consistently decreased from the first to the third trimester. LGA babies were more predominant compared with SGA babies. While anaemia in the third trimester of pregnancy increased the risk of SGA births, polycythaemia across the trimesters offered significant protection. Healthcare providers and stakeholders should target pressing interventions for anaemia reduction throughout pregnancy, especially during the third trimester to achieve healthy birth outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Infectious disease surveillance is difficult in many low- and middle-income countries. Information market (IM)-based participatory surveillance is a crowdsourcing method that encourages individuals to actively report health symptoms and observed trends by trading web-based virtual "stocks" with payoffs tied to a future event., Objective: This study aims to assess the feasibility and acceptability of a tailored IM surveillance system to monitor population-level COVID-19 outcomes in Accra, Ghana., Methods: We designed and evaluated a prediction markets IM system from October to December 2021 using a mixed methods study approach. Health care workers and community volunteers aged ≥18 years living in Accra participated in the pilot trading. Participants received 10,000 virtual credits to trade on 12 questions on COVID-19-related outcomes. Payoffs were tied to the cost estimation of new and cumulative cases in the region (Greater Accra) and nationwide (Ghana) at specified future time points. Questions included the number of new COVID-19 cases, the number of people likely to get the COVID-19 vaccination, and the total number of COVID-19 cases in Ghana by the end of the year. Phone credits were awarded based on the tally of virtual credits left and the participant's percentile ranking. Data collected included age, occupation, and trading frequency. In-depth interviews explored the reasons and factors associated with participants' user journey experience, barriers to system use, and willingness to use IM systems in the future. Trading frequency was assessed using trend analysis, and ordinary least squares regression analysis was conducted to determine the factors associated with trading at least once., Results: Of the 105 eligible participants invited, 21 (84%) traded at least once on the platform. Questions estimating the national-level number of COVID-19 cases received 13 to 19 trades, and obtaining COVID-19-related information mainly from television and radio was associated with less likelihood of trading (marginal effect: -0.184). Individuals aged <30 years traded 7.5 times more and earned GH ¢134.1 (US $11.7) more in rewards than those aged >30 years (marginal effect: 0.0135). Implementing the IM surveillance was feasible; all 21 participants who traded found using IM for COVID-19 surveillance acceptable. Active trading by friends with communal discussion and a strong onboarding process facilitated participation. The lack of bidirectional communication on social media and technical difficulties were key barriers., Conclusions: Using an IM system for disease surveillance is feasible and acceptable in Ghana. This approach shows promise as a cost-effective source of information on disease trends in low- and middle-income countries where surveillance is underdeveloped, but further studies are needed to optimize its use., (©Gifty Marley, Phyllis Dako-Gyeke, Prajwol Nepal, Rohini Rajgopal, Evelyn Koko, Elizabeth Chen, Kwabena Nuamah, Kingsley Osei, Hubertus Hofkirchner, Michael Marks, Joseph D Tucker, Rosalind Eggo, William Ampofo, Sean Sylvia. Originally published in JMIR Infodemiology (https://infodemiology.jmir.org), 12.08.2024.)

Background: There is no replacement for blood, and patients requiring transfusion depend on human donors, most of whom are family donors. Family donors may deny engagement in high-risk activities, which threaten the safety of donated blood. This study determined frequency of self-reported high-risk behaviors among replacement donors., Methods: This retrospective study recruited 1317 donor records from 2017-2020, at Mankranso Hospital, Ghana. Data from archived donor questionnaires were extracted and analyzed with SPSS and GraphPad. Frequencies, associations, and quartiles were presented., Results: The donors were predominantly males (84.4%), 17-26 years old (43.7%), informal workers (71.8%), rural inhabitants (56.5%), first-time (65.0%), and screened in the rainy season (56.3%). Donation frequency was significantly associated with age, sex, occupation, and residence. Repeat donors were significantly older (p≤0.001). More males than females were deferred (p = 0.008), drug addicts (p = 0.001), had body modifications (p = 0.025), multiple sexual partners (p = 0.045), and STIs (p≤0.001), whereas, more females were recently treated (p = 0.044). Weight loss (p = 0.005) and pregnancy (p = 0.026) were frequent among 17-26-year group, whereas, tuberculosis was frequent among 37-60-year group (p = 0.009). More first-time donors were unwell (p = 0.005), deferred (p≤0.001), pregnant (p = 0.002), drug addicts, had impending rigorous activity (p = 0.037), body modifications (p = 0.001), multiple sexual partners (p = 0.030), and STIs (p = 0.008). STIs were frequent in the dry season (p = 0.010). First-time donors had reduced hemoglobin (p = 0.0032), weight (p = 0.0003), and diastolic pressure (p = 0.0241)., Conclusion: Donation frequency was associated with age, sex, occupation, and residence, with first-time donors younger than repeat donors. Deferral from donation, drug addiction, body modification, multiple sexual partners, and STIs were frequent among males, whereas, more females received treatment. Tuberculosis was frequently reported among older adults, whereas, weight loss and pregnancy were frequent among younger individuals. More first-time donors reported being unwell, deferred, drug addiction, body modifications, multiple sexual partners, STIs, and pregnant. Hemoglobin, weight, and diastolic BP were reduced among first-time donors., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Osei-Boakye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

African swine fever virus (ASFV) is the causative agent of African swine fever (ASF), a highly infectious and lethal disease of domesticated swine. Outbreaks of ASF have been mostly restricted to the continent of Africa. The outbreaks that have occurred outside of Africa were controlled by extensive depopulation of the domesticated pig population. However, in 2007, an outbreak occurred in the country of Georgia, where ASFV infected wild pigs and quickly spread across eastern Europe. Since the reintroduction of ASF into Europe, variants of the current pandemic strain, ASFV Georgia 2007/01 (ASFV-G), which is classified as Genotype 2 based on p72 sequencing, have been reported in countries within western Europe, Asia, and the island of Hispaniola. Additionally, isolates collected in 2020 confirmed the presence of variants of ASFV-G in Nigeria. Recently, we reported similar variants of ASFV-G collected from domestic pigs suspected of dying of ASF in Ghana in 2022. Here, we retroactively report, based on full-length sequencing, that similar variants were present in Ghana in 2021. The SNP analysis revealed derivatives of ASFV with distinct genetic markers. Furthermore, we identified three full-length ASFV genomes as Genotype 1, indicating that there were two genotypes circulating in proximity during the 2021 ASF outbreaks in Ghana.

Background: Adolescent pregnancies continue to be a global issue that affects more high-income, middle-income, and then low-income countries, with the latter experiencing the majority of cases. Aim: The current study looked into the prevalence and variables predicting adolescent childbearing in Ghana. Methodology: Data from the Ghana Multiple Indicator Cluster Survey (MICS) 2017-2018 was used to conduct an analytical cross-sectional study. The results were examined with SPSS Version 20 (IBM Corp., 2011, and NY). Pearson's chi-square and binary logistics analyses were done for associations. A p value of 0.05 was used to determine the analysis's statistical significance. Results: The total number of adolescents isolated from the 2017 Ghana MICS dataset for this study analysis was 2974. The mean age of the study participants was 16.9 ± 1.4 years with a modal age of 15 years. The prevalence of adolescent childbearing according to this study analysis was 12.3%. The predictive factors for adolescent childbearing were increasing age, decreasing educational level, Volta regional originality, ethnic originality of the study participants, and low economic status. Conclusion: The prevalence of adolescent childbearing in this study was significant and needs the attention of all. Programs to improve adolescent reproductive health must take into account multiple levels of elements, such as the individual, family, community, institutions, national, and international challenges that have an impact on such programs., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Abdul Rauf Alhassan et al.)

Background: Snakebite is a global environmental and occupational hazard and a significant public health threat. In rural areas, snakebite cases often go unreported and undocumented due to the lack of access to well-structured healthcare facilities/infrastructure. In some cases, the need for antisnake venom (ASV) far outstrips supply, negatively affecting treatment outcomes. This study, therefore, assessed the epidemiological characteristics of snakebite cases, their management, and how antivenoms are utilised at the selected hospital in the Jasikan District Hospital. Methods: A 6-year retrospective study using secondary data from antivenom return forms (pharmacy records), clinical records (patient folders), the District Health Information Management System-2 (DHIMS-2) database, and consulting room registers was carried out in selected hospitals in the Jasikan District, Oti, Ghana. Results: The predominant symptom of snakebite was localised pain (71.4%). The snakebite commonly occurred at home (19%) and on farms (18%). Of the 98 snakebite cases, ASV was administered to 73 (74.5%) cases. Supportive treatment applied included prophylactic antitetanus immunoglobulin (ATS) (80.6%), prophylactic antibiotics (63%), corticosteroids (80.6%), and analgesics (63%). 95% ( n = 94) of complete recoveries were recorded; three were discharged against medical advice, and one was mortality. The supply and use of antivenom were erratic throughout the months of high incidence, partly due to inconsistent availability at the Regional Medical Stores. The average ASV vials and hospital stay duration were 1.23 ± 0.86 vials and 2.67 ± 1.97 days, respectively. Although the peak of snakebites occurs in April, May, and June, the demand for antivenom in April and May exceeded supply. Conclusion: The outcome of most snakebite case management was appropriate, irrespective of inadequate ASV supply in certain months. The erratic antivenom supply should be aligned with seasonal and facility-use patterns to enhance regional snakebite management., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Courage Edem Ketor et al.)