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

Background In Ghana, diagnostic laboratories rely on reference intervals (RIs) provided by manufacturers of laboratory analyzers which may not be appropriate. This study aimed to establish RIs for hematological parameters in adult Ghanaian population. Methods This cross‐sectional study recruited 501 apparently healthy adults from two major urban areas in Ghana based on the protocol by IFCC Committee for Reference Intervals and Decision Limits. Whole blood was tested for complete blood count (CBC) by Sysmex XN‐1000 analyzer, sera were tested for iron and ferritin by Beckman‐Coulter/AU480, for transferrin, vitamin‐B12, and folate was measured by Centaur‐XP/Siemen. Partitioning of reference values by sex and age was guided by “effect size” of between‐subgroup differences defined as standard deviation ratio (SDR) based on ANOVA. RIs were derived using parametric method with application of latent abnormal values exclusion method (LAVE), a multifaceted method of detecting subjects with abnormal results in related parameters. Results Using SDR ≥ 0.4 as a threshold, RIs were partitioned by sex for platelet, erythrocyte parameters except mean corpuscular constants, and iron markers. Application of LAVE had prominent effect on RIs for majority of erythrocyte and iron parameters. Global comparison of Ghanaian RIs revealed lower‐side shift of RIs for leukocyte and neutrophil counts, female hemoglobin and male platelet count, especially compared to non‐African countries. Conclusion The LAVE effect on many hematological RIs indicates the need for deliberate secondary exclusion for proper derivation of RIs. Obvious differences in Ghanaian RIs compared to other countries underscore the importance of country‐specific RIs for improved clinical decision‐making.

Giardia duodenalis is a common intestinal parasite in humans, a wide range of domesticated and wild animals. There are human and animal specific, as well as zoonotic pathogenic gen­otypes. It is not clear whether livestock in close proximity to humans could be infected with human specific genotypes, and vice versa. In this study, Giardia-positive faecal samples were collected from both humans (n = 4) (from Maamobi Polyclinic in the Ayawaso Sub- Metro) and calves (n = 8) (from Animal Research Institute Farms, Adentan Municipality), in Ghana. Nested PCR amplification using Giardia-specific, Glutamate dehydrogenase (GDH) genes and Tri­osephosphate isomerase (TPI) gene primers for human and animal faecal samples respectively was carried out. Results showed that 100% of the calves carried the TPI-B genotype, which is a common pathogenic genotype in humans. This report is based on the unusual results obtained as Giardia duodenalis genotype B is known to occur in humans but is being observed in calves for the first time. This suggests that calves in close proximity to humans could be reservoirs and sources of human Giardia infections.

Background Cryptosporidium is a ubiquitous enteric protozoan pathogen infecting humans, domestic animals, and wildlife worldwide. It is a waterborne pathogen with recognized zoonotic potential and a definite cause of diarrhea and nutritional disorders in institutional and community settings. One challenge facing the world’s supply of clean drinking water is contamination from feces and soil. It has been established that small quantities of oocysts, the infective stage, can cause human disease. Also, their resistance to chlorination and other water treatment procedures has been demonstrated. Kpong, a community in the Lower Manya Krobo Municipality of the Eastern Region of Ghana, is one of the primary sources of water supply to Accra, the capital city of Ghana. Being able to determine the effectiveness of water treatment processes and identifying sources of contamination of this pathogen in our water bodies is thus of public health importance. The study aimed to conduct molecular epidemiology of Cryptosporidium spp. in the Lower Manya Krobo Municipality. Methodology/Principal findings A total of 230 samples, 180 fecal samples from cattle and 50 water samples (tap water and well water) were collected from the following communities: Kpong, Akwernor, Ablotsi, Nuaso, and Atua, all in the Lower Manya Krobo Municipality. Samples were screened for Cryptosporidium by microscopy and PCR. The 18S rRNA gene was amplified by nested polymerase chain reaction (PCR), and the final product was sequenced. The prevalence of Cryptosporidium from the fecal samples was estimated as 10% (18/180) by microscopy, while all 50 water samples were negative. However, PCR gave the prevalence of Cryptosporidium as 47.8% (86/180) for fecal samples and 20% (10/50) for water samples. Based on the 18S rRNA gene, three sequenced samples showed high homology to C. parvum species. The phylogenetic analysis confirmed this as these sequences clustered with C. parvum sequences from other countries. Conclusion/Significance Cryptosporidium parvum was identified as the persistent species in the study communities. This outcome supports the evidence that domesticated animals serve as potential reservoirs of zoonotic transmission of cryptosporidiosis. The persistence of cryptosporidiosis in cattle indicates its presence in the human population. In addition, the presence of Cryptosporidium parvum in the wells makes it alarming and necessary to consider a holistic approach such as One Health Strategies to identify and control cases in humans.

Background: Malaria is still endemic in sub-Saharan Africa, with a high disease burden. Misconceptions about malaria contribute to poor attitudes and practices, further increasing the burden in endemic countries. Studies have examined the knowledge, attitudes, and practices (KAP) of malaria among different populations. However, there seems to be no available literature reporting on the perspectives of day and night market traders. To the best of our knowledge, this is the first report on malaria KAP with a focus on day and night market traders. Methods: A descriptive cross-sectional study involving day and night market traders in 10 selected markets within the Greater Accra Region of Ghana was carried out. Data were collected from consenting respondents using a structured questionnaire. Results: Of the 760 respondents (33.3% (n = 253) night and 66.7% (n = 507) day traders) interviewed, there was no significant difference between the day and night market traders in terms of malaria KAP. Although the market traders had an overall moderate knowledge (54.0% of the day traders and 56.5% of the night traders), misconceptions about malaria (especially that it could be caused by exposure to the sun) still existed among the traders. Moreover, the majority of the traders who demonstrated high knowledge (43.98%, n = 250) did not always take laboratory tests to confirm their suspicion, indicating poor attitude. Furthermore, the market traders’ choice of drug for malaria treatment (p = 0.001) and preferred malaria treatment type (orthodox or herbal) (p = 0.005) were significantly associated with their knowledge level. Conclusions: Despite the observation that no significant difference in KAP exists between day and night market traders, appropriate health education programs and interventions still need to be directed at misconceptions, poor attitudes, and poor practices revealed by this study. This will ultimately help in the prevention and control of malaria in Ghana, and globally.

Background This study was designed to investigate whether household cockroaches harbor cephalosporin-resistant enterobacteria that share resistance determinants with human inhabitants. From February through July 2016, whole cockroach homogenates and human fecal samples from 100 households were cultured for cephalosporin-resistant enterobacteria (CRe). The CRe were examined for plasmid-mediated AmpC, ESBL, and carbapenemase genes; antibiotic susceptibility patterns; and conjugative transfer of antibiotic resistance mechanisms. Clonal associations between CRe were determined by multi-locus sequence typing (MLST). Results Twenty CRe were recovered from whole cockroach homogenates from 15 households. The prevalence of households with cockroaches that harbored CRe, AmpC- (based on phenotype, with no identifiable blaAmpC genes), ESBL-, and carbapenemase-producers were 15, 4, 5%(2 blaCTX-M-15/TEM-1; 1 blaCTX-M-15/TEM-4; 1 blaTEM-24; 1 blaSHV-4) and 3%(2 blaNDM-1 genes and 1 blaOXA-48 gene), respectively. Overall, 20 CRe were recovered from 61 fecal samples of inhabitants from all 15 households that had cockroach samples positive for CRe. Of these, 5CRe (1 per household) were positive for ESBLs (blaTEM-24, blaTEM-14, blaCTX-M-15/TEM-4, blaSHV-3, blaCTX-M-15/TEM-1) and none carried AmpCs or carbapenemases. From 4% of households, the pair of cockroach and human CRe shared the same sequence type (ST), clonal complex (CC), antibiogram, and conjugable bla gene sequence (house 34, E. coli ST9/CC20-blaTEM-4; house 37, E. coli ST44/CC10-blaCTX-15/TEM-4; house 41, E. coli ST443/CC205-blaCTX-15/TEM-1; house 49, K. pneumoniae ST231/CC131-blaSHV-13). Conclusion The findings provide evidence that household cockroaches may carry CTX-M-15-, OXA-48- and NDM-1-producers, and share clonal relationship and beta-lactam resistance determinants with humans.

Background. Schistosomiasis is the second major human parasitic disease next to malaria, in terms of socioeconomic and public health consequences, especially in sub-Saharan Africa.Schistosoma haematobium(S. haematobium) is a trematode and one of the species ofSchistosomathat cause urogenital schistosomiasis (urinary schistosomiasis). Although the knowledge of this disease has improved over the years, there are still endemic areas, with most of the reported cases in Africa, including Ghana. Not much has been done in Ghana to investigate cytological abnormalities in individuals within endemic communities, although there are epidemiologic evidences linkingS. haematobiuminfection with carcinoma of the bladder.Aim. The aim of this study was to identify microscopic and cytological abnormalities in the urine deposits ofS. haematobium-infected children.Methodology. Three hundred and sixty-seven (367) urine samples were collected from school children in Zenu and Weija communities. All the samples were examined microscopically for the presence ofS. haematobiumeggs, after which the infected samples and controls were processed for cytological investigation.Results.S. haematobiumova were present in 66 (18.0%) out of the 367 urine samples. Inflammatory cells (82%, 54/66), hyperkeratosis (47%, 31/66), and squamous cell metaplasia (24%, 16/66) were the main observations made during the cytological examination of theS. haematobium-infected urine samples.Conclusion. Cytological abnormalities inS. haematobium-infected children may play an important role in the severity of the disease, leading to the possible development of bladder cancer in later years, if early attention is not given. Therefore, routine cytological screening for urogenital schistosomiasis patients (especially children) at hospitals inS. haematobium-endemic locations is recommended.

We developed and validated a new analytical method for the simultaneous quantification of artemether and lumefantrine in fixed-dose tablets and powders for reconstitution into pediatric suspensions (PSs). The method showed linearity (r2 > 0.9947), precision (coefficient of variation < 2%), accuracy (deviation of mean from actual concentrations < 4%), and specificity (peak purities > 99%). The validated method was used to analyze 24 batches of fixed-dose tablets and PSs of artemether and lumefantrine. Of the samples, 23 were obtained using convenience sampling of commonly available brands within Accra in Ghana and one was obtained from Aarhus University Hospital. In all, 83.3% (confidence interval: 80–120%) passed for both artemether and lumefantrine contents, 16.7% failed by the U.S. Pharmacopoeia standards, 8.3% failed for one content, and 8.3% failed for both contents. All four products (16.7%) that failed were PSs, and two (8.3%) showed higher levels of artemether than prescribed (222% and 756%). We developed and validated a new analytical method for the simultaneous quantification of artemether and lumefantrine in fixed-dose tablets and powders for reconstitution into pediatric suspensions (PSs). The method showed linearity (r(2) > 0.9947), precision (coefficient of variation < 2%), accuracy (deviation of mean from actual concentrations < 4%), and specificity (peak purities > 99%). The validated method was used to analyze 24 batches of fixed-dose tablets and PSs of artemether and lumefantrine. Of the samples, 23 were obtained using convenience sampling of commonly available brands within Accra in Ghana and one was obtained from Aarhus University Hospital. In all, 83.3% (confidence interval: 80-120%) passed for both artemether and lumefantrine contents, 16.7% failed by the U.S. Pharmacopoeia standards, 8.3% failed for one content, and 8.3% failed for both contents. All four products (16.7%) that failed were PSs, and two (8.3%) showed higher levels of artemether than prescribed (222% and 756%).

Background There is little data on Trichomonas vaginalis infection in Ghana. This study evaluated the prevalence of trichomoniasis using different diagnostic methods and determined the risk factors for infection in patients. Methods A structured questionnaire was administered. Vaginal swabs, urethral swabs and urine specimens were obtained from consenting patients; and the samples processed following standard protocols. The presence of T. vaginalis was determined using wet mount microscopy and polymerase chain reaction (PCR) as gold standard. We also assessed the diagnostic performance the JD’s Trichomonas V® rapid antigen test to inform clinical practice. Results The PCR assay detected T. vaginalis positivity in 64 of 150 patients (42.6, 95%CI:35.0, 50.6) including all positive samples of wet mount microscopy and JD’s Trichomonas V® test. Wet mount microscopy showed low sensitivity (31.6%), high specificity (100%), moderate positive predictive value (75.0%), moderate positive likelihood ratio (3.0), and weak agreement (Cohen’s kappa, 0.283) with PCR assay. The JD’s Trichomonas V® test displayed lower sensitivity (25.0%), specificity (83.3%), and weaker measure of agreement (Cohen’s kappa, 0.233) with PCR. In multivariate analysis, the strongest independent predictor for T. vaginalis was female gender [adjusted odds ratio (AOR), 24.89; 95% confidence interval (CI): 10.58, 51.21; P-value

AimHousehold insect pests, including cockroaches, have gained consideration as potential vectors for multidrug resistant pathogens of public health concern. This study was designed to investigate whether household cockroaches share beta-lactam resistance determinants with human inhabitants.MethodsFrom February through July 2016, 400 cockroaches were systematically collected from 100 households. Whole insect homogenates and faecal samples from inhabitants of all included households were cultured for cephalosporin-resistant enterobacteria (CRe). The CRe were examined for AmpC, ESBL, and carbapenemase genes; antibiotic susceptibility patterns; and conjugative transfer of antibiotic resistance mechanisms. Clonal relationships between isolates were determined by multi-locus sequence typing (MLST).ResultsTwenty CRe were recovered from whole cockroach homogenates of 15 households. Five harbored ESBL genes (2 blaCTX-M-15/TEM-1; 1 blaCTX-M-15/TEM-4; 1 blaTEM-24; 1 blaSHV-4), and 3 carried carbapenemase genes (2 blaNDM-1 genes and 1 blaOXA-48 gene) all of which were transferrable by conjugation to E. coli J53 recipients. There was high clonal diversity with low inter-species similarity regardless of the beta-lactamase gene sequence. From 6 households, the pair of cockroach and human CRe shared the same antibiogram, ST and/or conjugable blaESBL gene sequence (house 34, E. coli ST9-blaTEM-4; house 37, E. coli ST44-blaCTX-15/TEM-4; house 41, E. coli ST443-blaCTX-15/TEM-1; house 49, K. pneumoniae ST231-blaSHV-13).ConclusionThe findings highlight household cockroaches as reservoirs of CTX-M-15, OXA-48 and NDM-1 genes that share beta-lactam resistance determinants with humans.

An active case detection approach with PCR diagnosis was used in the Ho District of the Volta Region, Ghana that identified individuals with active cutaneous leishmaniasis. Three isolates were successfully cultured and DNA sequences from these were analysed (ribosomal RNA internal transcribed spacer 1; ribosomal protein L23a intergenic spacer; RNA polymerase II large subunit), showing them to be Leishmania, identical to each other but different from all other known Leishmania spp. Phylogenetic analysis showed the parasites to be new members of the Leishmania enriettii complex, which is emerging as a possible new subgenus of Leishmania parasites containing human pathogens.

Studies on the relationship between complement receptor 1 (CR1) polymorphisms in exon 29 encoding the Knops blood group antigens (Swain-Langley (Sl) and McCoy (McC)) and outcome of clinical malaria have produced inconsistent results.Blood samples from Ghanaian children (n = 150) aged 1-12 years with complicated and uncomplicated malaria were genotyped for the Sl and McC blood group alleles by polymerase chain reaction and restriction fragment length polymorphism. Effect of Sl and McC genotypes on the clinical outcome of malaria was evaluated using logistic regression.McCa/b genotype was significantly associated with more than two-fold increased susceptibility for severe malaria (OR = 2.31; 95% CI: 1.03-5.20, P = 0.043). However, McCb/b was associated with an 88% reduced risk of severe malaria (OR = 0.12; 95% CI: 0.02-0.64, P = 0.013). In contrast, there was no significant association between severe malaria and Sl1/1, Sl1/2, Sl2/and McCa/a genotypes. There was a trend towards decreased susceptibility to both cerebral malaria (CM) (OR = 0.13; 95% CI: 0.02-1.15, P = 0.07) and severe malarial anaemia (SA) (OR = 0.14; 95% CI: 0.02-1.19, P = 0.07) for McCb/b genotype when compared with the McCa/a genotype. There were no significant associations between Sl1/2 or Sl2/2 genotype and CM or SA when compared with Sl1/1 genotype.McCa/b was associated with increased susceptibility to severe malaria and McCb/b associated with reduced risk of severe malaria. Further studies with large sample size in other malaria endemic regions in Africa are warranted to confirm these findings.

Water is essential for life and in most parts of the world including Ghana it is used for various activities such as drinking, bathing and recreational purposes. The objective of this study was to assess the bacteriological quality of swimming pools’ water in the Accra Metropolis. Five swimming pools were selected randomly and a research team visited the pools to collect water samples and at the same time administer short questionnaires about the characteristics of the pools. The average number of swimmers, swimming bathing loads, average age group of pool users, methods of disinfection, type of chlorine used, recycling, and treatment of the water before and after use were investigated. During the visit, water samples were collected for total coliform, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus counts using the Membrane Filtration (MF) method and cultured on chromogenic media. Most (60%) of the selected swimming pools had a bathing load≤20 per day. The operators of the pools disinfect their pools’ water with chorine but majority (60%) of the pool operators chlorinated their pools manually with powdered chlorine. The 20 water samples investigated show that 48% of swimming pools water was contaminated with S. aureus, 30.4% with Ps. aeruginosa, 20.9% with total coli form and 0.7% with E. coli. The E. coli count found in this study was very low indicating that the selected swimming pools were not feacally polluted at the time of sampling. It is recommended that future studies should use large sample sizes.

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

Background: Diarrhoeal diseases are common among children in developing countries, and are caused by several aetiological agents including Cryptosporidium sp. Several species of this parasite exist which may belong to either anthroponotic or zoonotic forms. With recent application of molecular tools, species involved in human transmission in any locality and sources of infection can now be determined. Aim: We screened children with acute diarrhoea at a paediatric hospital in Accra, Ghana for enteric parasites to determine frequency of cryptosporidial diarrhoea. Cryptosporidium isolates were then characterized by molecular methods to determine the genetic species in transmission. Methodology: A total of 365 diarrhoeic children of age ≤ 5 years were used in this cross-sectional study. Stool samples were collected and tested for enteric parasites by microscopy and ELISA. Cryptosporidium isolates were subsequently genotyped by PCR-RFLP and confirmed by sequencing of the 18S rRNA gene. Demographic and clinical data were obtained by a structured questionnaire and data analysed for possible association with cryptosporidial diarrhoea. Results: Enteric parasites detected were Cryptosporidium sp. (22.2%), G. lamblia (5.8%) and E. histolytica (0.8%). Neither gender nor breastfeeding habits, presence of domestic animals, source of children’s food, seasons (dry or rainy) appeared to be associated with infection of Cryptosporidium sp. However, age of children, source of drinking water, and education level of mother seems to have association with infection of the parasite. Genotyping results show that C. parvum is the only species involved in transmission. Conclusion: Cryptosporidium parvum is the commonest enteric parasite causing diarrhoea among children with acute diarrhoea. Children ≤ 3 years and those who drank sachet water were most affected. A carefully planned health education among illiterate mothers and improved sanitary conditions could reduce rate of infections. Further sub-genotyping of C. parvum is needed to determine whether source of infection is zoonotic or anthroponotic.

Parasitic infections particularly neglected tropical diseases affect millions of individuals in sub-Saharan Africa. It is associated with poverty and limited resources, which is a key characteristic of orphanages. Unfortunately, there is very scarce baseline data about the prevalence of parasitic infections within orphanages and other institutions with limited resources and special needs in Ghana. We conducted a cross-sectional survey among 101 inhabitants of one of the major orphanages in Ghana. We collected demographic and anthropological data to assess living conditions as well as nutritional status and how these relate to parasitic infections. Parasitic infections were detected from stool samples collected and analyzed by standard parasitological techniques. The prevalence of parasitic infections was 15.8%. Parasites isolated were Ascaris lumbricoides (5%), Trichuris trichiura (1%), hookworm (1%), Clonorchis sinensis (2%), Fasciola hepatica (2%), Hymenolepis nana (2%), Schistosoma mansoni (3%), Taenia spp. (1%), Strongyloides stercoralis (2%), and Giardia duodenalis (1%). There was a significant association between malnutrition and parasitic infections. The prevalence of intestinal parasites among inmates is high. With the exception of S. stercoralis, which infects via skin penetration, all others have some association with water either drunk or for play. The need for proper evaluation of water supply and its safety is strongly encouraged.

Background Trichomonas vaginalis (TV) infection is the most prevalent non-viral sexually transmitted pathogen worldwide. Among pregnant women, the infection may cause adverse birth outcomes such as premature rupture of membranes and premature labour. In view of the paucity of information relating to TV among Ghanaian pregnant women, this study investigated its prevalence and associated co-infections among pregnant women. Methods High vaginal swabs were obtained from 99 pregnant women using sterile cotton swab sticks. Wet preparation, Grams staining, culturing, coagulase and sensitivity testing were carried out to determine the presence of TV and associated microorganisms. Results The prevalence of TV among the pregnant women was found to be 20.2% (n = 20). Concurring with Trichomoniasis, 75% (n = 15) of participants had other infections such as Candida with prevalence of 53% (n = 8), Proteus infection - 20% (n = 3), Streptococcus infection - 13% (n = 2) and other GNRs and Gonococci having 7% each (n = 1). Moreover, there was 86.9% (n = 86) prevalence of Staphylococcus spp. among study participants. There was statistically significant correlation between TV and Gonococci infection at a correlation co-efficient of 0.107 (P

Malaria is hyper-endemic in Ghana. Haematological alterations in the disease pathology may offer complimentary criteria to improve clinical and microscopy diagnosis. Our primary outcome was to evaluate haematological parameters in children with Plasmodium falciparum infections and report their predictive risk and diagnostic performance for malaria infections in Ghana. Haematological data, including thin and thick blood films were examined for children less than 12 years of age in a multicenter-based active case finding approach. Haematological changes were common in P. falciparum infected children and more pronounced in severe malaria cases. More so, a unit increase in parasiteamia increased the odds for severe malaria infection by 93 % [OR, 95 % CI: 1.93 (1.28–2.91); P value = 0.02]. In multivariate regression, low haemoglobin was a significant haematological change in predicting P. falciparum infections [OR, 95 % CI: 3.20 (1.26–7.09); P value = 0.001]. Low haemoglobin levels 7,500 µL. In malaria endemic settings, low haemoglobin concentration (

We investigated the occurrence of urinary schistosomiasis and estimated predictors for risk of infection among children in the Bunuso community of Ashanti Region of Ghana, West Africa. The cross-sectional survey was conducted between June and December 2009. Information was obtained on socio-demographic characteristics, schistosomiasis symptoms and other risk factors through interviews and questionnaires. Urine samples were analysed for Schistosoma haematobium ova using centrifugation and sedimentation, filtration and microscopy. Bivariate estimations and multiple logistic regression modelling with odds ratios (OR) were used to assess risk factors for S. haematobium infections. Inspections at River Nanakwaw revealed snail vectors, Bulinus truncatus. Overall, 95 out of 100 (95 % confidence interval [CI] 88.8–97.6) children tested positive for S. haematobium infection. The mean ova density (eggs/10 ml of urine) of infections was 58.12 (95 % CI 31.3–71.6) and varied significantly between age-group distributions (P value = 0.001; Post Hoc, P > 0.05 for ≤8 vs 15–17 years, and 9–11 vs 12–14 years), sources of house-hold water (P value = 0.019; Post Hoc, P

Cockroaches are common in the environment of many hospitals in Ghana; however, little is known about their public health risks. To evaluate potential risks, we investigated the external and internal microbial flora of 61 cockroaches from a tertiary hospital in Ghana and evaluated the antibiotic resistance profiles of the common bacterial species. Standard methods were used in all the microbiological investigations and antibiotic susceptibility testing. A rotavirus carriage rate of 19.7% was observed among the cockroaches. Four types of intestinal parasites were carried externally by the cockroaches, and the most prevalent was Hookworm (4.9%). Eight nosocomial bacteria were isolated from the cockroaches, and the most prevalent was Klebsiella pneumoniae, which occurred internally in 29.5% of the cockroaches and 26.2% externally. Multiple drug resistance among common bacteria isolated from the cockroaches ranged from 13.8% ( Escherichia coli) to 41.1% ( Klebsiella pneumoniae). Cockroaches constitute an important reservoir for pathogenic microorganisms, and may be important vectors of multiple resistant nosocomial pathogens in the studied hospital.

Consumers perceive packaged drinking water, usually distributed as bottled or in polyethylene packages (sachets), as healthier and safer alternatives to tap water. The objective of this study was to determine the microbiological quality of different types of packaged drinking water available in Accra, Ghana. Sixty samples of sachet water and ten of (PET) bottled water were randomly purchased from various locations in Accra. Bacteriological and parasitological analyses of the packaged (sachet and bottled) and tap water (as control) were done according to standard procedures. Fifty-two out of 60 sachet water samples (86.7%) had HPC levels well above the internationally recommended limits. For the bottled water, nine out of the ten (90%) were within the recommended limits for HPC. Two out of the five (40%) tap water samples (control samples) had HPC above the recommended limits of 500 cfu/mL. While none of the bottled water samples showed the presence of protozoa, two out of the five tap water and 31 out of the 60 sachet water samples had a wide range of protozoa including rotifers. The findings clearly indicate that while PET bottled water sold in Accra may be generally safe, the same cannot be said for the sachet water; since the study found its microbiological quality not significantly different from tap water.

Schistosomiasis is a parasitic disease of the tropics which is estimated to affect up to 300 million people worldwide. While it is being successfully controlled in many countries, it remains a major public health problem, especially in developing countries including Ghana. Extensive work on schistosomiasis has been undertaken along theVoltaRiverbasin, leaving very little data and information on this infection in the urban and peri-urban areas inGhana. This study was aimed at determining the urinary schistosomiasis burden among children of school going age within Zenu, a suburb of the capital city. Urine samples were taken from 274 school children within the Zenu community and examined with urine chemistry dipsticks for detection and confirmation of haematuria, followed by microscopy for detection of Schistosoma haematobium ova. Prevalence of urinary schistosomiasis was 30.7% (95% CI: 25.2-36.2). 44 (52%) of the positive samples were collected from males whiles 40 (48%) were collected from females, but prevalence of the infection was not significantly associated with gender (χ2 = 0.041, DF = 1, P-Value = 0.839). Among the S. haematobium positive children, haematuria was detected by the dipstick in 88.1% (74/84, 95% CI: 81.2- 95.0), but it was not detected in 11.9% (10/84, 95% CI: 5.0-18.8). Meanwhile, the dipstick detected haematuria in 7.3% (20/274, 95% CI: 4.3-7.3) of the total population but microscopy could not detect the presence of Schistosoma ova in those children. An association was found between Schistosoma infection and haematuria detected by dipstick (χ2 = 84.715, DF = 1, P-Value

Background: Acute promyelocytic leukaemia (APL) represents 5-15% of all adult leukaemias. One of the approaches to treat APL is differentiation therapy which works by inducing differentiation of leukaemic promonocytes into mature non-replicative cell types that eventually undergo apoptosis. Plasma Membrane-derived Vesicles, (PMVs) are a heterogeneous group of small, membrane-coated vesicles with phospholipid rich particles, membrane receptors as well as other proteins inherent in their parental cells. There is evidence that PMVs are involved in differentiation in the hematopoietic environment in the bone marrow which suggests a possible involvement in leukaemia myeloid development, and possibly monocytic haematopoiesis. This work aimed to show principally whether PMVs can initiate differentiation/stop proliferation in HL-60 cells (promonocytes) and cause their differentiation into macrophages. This way, PMVs can be considered for differentiation therapy. Methods: PMVs were induced from cells using differential centrifugation. We also employed flow cytometry, ELISA, fluorescent microscopy analysis, SDS-PAGE, western blotting, growth inhibition & differentiation assays, nitroblue tetrazolium assay and cell cycle analysis to conduct our experiments. Results: HL-60 cells treated with PMVs showed a dose-dependent increase in adherence and increased expression of CD11b and CD14 as a sign of differentiation. Morphological changes were induced in HL-60 as well as phosphorylation of the TGF-?/Smad signaling pathway upon treatment with PMVs. Again, TGF-?1-bearing PMVs reduced the proliferation of HL-60 cells and caused them to exit the cell cycle at G0/G1. It was also shown that PMVs from HL60 or THP-1 cells but not from MCF-7 cells significantly reduce the growth rate of HL-60 cells and the reduction in proliferation was dependent on TGF-?1 delivered by the PMVs. Conclusion: This work showed that PMVs (isolated from HL-60 and THP-1 cells) carry TGF-β1 on their membrane surface. These TGF-β1-bearing PMVs can modulate the growth rate of HL-60 promonocytes without inducing apoptosis, the cells exiting the cell cycle at G0/G1. In addition, dramatic changes in the morphology of PMV-treated cells were observed as they became increasingly irregular in shape with membrane extensions resembling pseudopodia. It might therefore be prudent to look at PMV-releasing agents, as potential alternative drugs in differentiation therapy against APL. Background: Acute promyelocytic leukaemia (APL) represents 5-15% of all adult leukaemias. One of the approaches to treat APL is differentiation therapy which works by inducing differentiation of leukaemic promonocytes into mature non-replicative cell types that eventually undergo apoptosis. Plasma Membrane-derived Vesicles, (PMVs) are a heterogeneous group of small, membrane-coated vesicles with phospholipid rich particles, membrane receptors as well as other proteins inherent in their parental cells. There is evidence that PMVs are involved in differentiation in the hematopoietic environment in the bone marrow which suggests a possible involvement in leukaemia myeloid development, and possibly monocytic haematopoiesis. This work aimed to show principally whether PMVs can initiate differentiation/stop proliferation in HL-60 cells (promonocytes) and cause their differentiation into macrophages. This way, PMVs can be considered for differentiation therapy. Methods: PMVs were induced from cells using differential centrifugation. We also employed flow cytometry, ELISA, fluorescent microscopy analysis, SDS-PAGE, western blotting, growth inhibition & differentiation assays, nitroblue tetrazolium assay and cell cycle analysis to conduct our experiments. Results: HL-60 cells treated with PMVs showed a dose-dependent increase in adherence and increased expression of CD11b and CD14 as a sign of differentiation. Morphological changes were induced in HL-60 as well as phosphorylation of the TGF-?/Smad signaling pathway upon treatment with PMVs. Again, TGF-?1-bearing PMVs reduced the proliferation of HL-60 cells and caused them to exit the cell cycle at G0/G1. It was also shown that PMVs from HL60 or THP-1 cells but not from MCF-7 cells significantly reduce the growth rate of HL-60 cells and the reduction in proliferation was dependent on TGF-?1 delivered by the PMVs. Conclusion: This work showed that PMVs (isolated from HL-60 and THP-1 cells) carry TGF-β1 on their membrane surface. These TGF-β1-bearing PMVs can modulate the growth rate of HL-60 promonocytes without inducing apoptosis, the cells exiting the cell cycle at G0/G1. In addition, dramatic changes in the morphology of PMV-treated cells were observed as they became increasingly irregular in shape with membrane extensions resembling pseudopodia. It might therefore be prudent to look at PMV-releasing agents, as potential alternative drugs in differentiation therapy against APL. Background: Acute promyelocytic leukaemia (APL) represents 5-15% of all adult leukaemias. One of the approaches to treat APL is differentiation therapy which works by inducing differentiation of leukaemic promonocytes into mature non-replicative cell types that eventually undergo apoptosis. Plasma Membrane-derived Vesicles, (PMVs) are a heterogeneous group of small, membrane-coated vesicles with phospholipid rich particles, membrane receptors as well as other proteins inherent in their parental cells. There is evidence that PMVs are involved in differentiation in the hematopoietic environment in the bone marrow which suggests a possible involvement in leukaemia myeloid development, and possibly monocytic haematopoiesis. This work aimed to show principally whether PMVs can initiate differentiation/stop proliferation in HL-60 cells (promonocytes) and cause their differentiation into macrophages. This way, PMVs can be considered for differentiation therapy. Methods: PMVs were induced from cells using differential centrifugation. We also employed flow cytometry, ELISA, fluorescent microscopy analysis, SDS-PAGE, western blotting, growth inhibition & differentiation assays, nitroblue tetrazolium assay and cell cycle analysis to conduct our experiments. Results: HL-60 cells treated with PMVs showed a dose-dependent increase in adherence and increased expression of CD11b and CD14 as a sign of differentiation. Morphological changes were induced in HL-60 as well as phosphorylation of the TGF-?/Smad signaling pathway upon treatment with PMVs. Again, TGF-?1-bearing PMVs reduced the proliferation of HL-60 cells and caused them to exit the cell cycle at G0/G1. It was also shown that PMVs from HL60 or THP-1 cells but not from MCF-7 cells significantly reduce the growth rate of HL-60 cells and the reduction in proliferation was dependent on TGF-?1 delivered by the PMVs. Conclusion: This work showed that PMVs (isolated from HL-60 and THP-1 cells) carry TGF-β1 on their membrane surface. These TGF-β1-bearing PMVs can modulate the growth rate of HL-60 promonocytes without inducing apoptosis, the cells exiting the cell cycle at G0/G1. In addition, dramatic changes in the morphology of PMV-treated cells were observed as they became increasingly irregular in shape with membrane extensions resembling pseudopodia. It might therefore be prudent to look at PMV-releasing agents, as potential alternative drugs in differentiation therapy against APL.

Objective. This study aimed at determining the microbial content of “bowl water” used for communal handwashing in preschools within the Accra Metropolis.Method. Six (6) preschools in the Accra Metropolis were involved in the study. Water samples and swabs from the hands of the preschool children were collected. The samples were analysed and tested for bacteria, fungi, parasites, and rotavirus.Results. Eight different bacteria, two different parasites, and a fungus were isolated while no rotavirus was detected. Unlike the rest of the microbes, bacterial isolates were found among samples from all the schools, withStaphylococcusspecies being the most prevalent (40.9%). Out of the three schools that had parasites in their water, two of them hadCryptosporidium parvum. The fungus isolated from two out of the six schools wasAspergillus niger. All bacteria isolated were found to be resistant to cotrimoxazole, ciprofloxacin, and ampicillin and susceptible to amikacin and levofloxacin.Conclusion. Although handwashing has the ability to get rid of microbes, communal handwashing practices using water in bowls could be considered a possible transmission route and may be of public concern.

Background Toxoplasma gondii infection can lead to severe disease outcomes in immune-compromised people. This study sought to determine the seroprevalence of anti-T. gondii antibodies among pregnant women, hospitalized children (

Background As part of malaria characterization study in the South-Tongu district of Ghana, the current study was conducted to explore relationships between malaria, schistosomiasis, soil transmitted helminths and malnutrition in riparian community settings that had hitherto encountered episodes of mass deworming exercises. Methods School-age children were enrolled in a cross-sectional study from April through July 2012. Stool and urine samples were examined respectively for helminths and Schistosoma haematobium. Blood samples were analyzed for malaria parasites and haemoglobin (Hb) concentrations, respectively. Anthropometric indices were measured. Relationships were determined using generalized linear models. Results The results show low numbers of asymptomatic Plasmodium falciparum (9.2 %, n = 37/404) and S. haematobium (2.5 %, n = 10/404) infections. The associations between significance terms in the multivariate analysis for P. falciparum infections were further assessed to test the significance of the product terms directly i.e., age in years [adjusted odds ratio (AOR), 3.1; 95 % confidence interval (CI) 1.1–5.6], Hb concentration (AOR = 0.71; 95 % CI 0.42–2.3), and stunted malnutrition (AOR, 8.72; 95 % CI 4.8–25.1). The P. falciparum-associated decrease in mean Hb concentration was 2.82 g/dl (95 % CI 1.63–4.1 g/dl; P = 0.001) in stunted children, and 0.75 g/dl (95 % CI 1.59–0.085 g/dl; P = 0.076) in the non-stunted cohort. The anaemia-associated decrease in mean parasitaemia in stunted children was 3500 parasites/µl of blood (95 % CI 262.46–6737.54 parasites/µl of blood; P = 0.036), and in non-stunted children 2127 parasites/µl of blood (95 % CI −0.27 to 4.53; P = 0.085). Stunted malnutrition was the strongest predictor of S. haematobium infection (AOR = 11; 95 % CI 3.1–33.6) but significant associations as described for P. falciparum infections were absent. The population attributable risk of anaemia due to P. falciparum was 6.3 % (95 % CI 2.5–9.3), 0.9 % (95 % CI 0.4–2.3) for S. haematobium, and 12.5 % (95 % CI 9.11–19.52) for stunted malnutrition. Conclusion Plasmodium falciparum, S. haematobium, intestinal helminths and their co-infections were uncommon in our school-age children. Stunting exacerbated the extent to which malaria was associated with loss in Hb concentration. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-2025-3) contains supplementary material, which is available to authorized users.

Introduction: though giardiasis is an important public health problem in Ghana, several aspects of its epidemiology, particularly the molecular epidemiology has not been investigated adequately. This could be a major hindrance to effective surveillance and control of giardiasis in the country. The study was carried out to determine the prevalence, risk factors and genotypes of Giardia lamblia infecting children at a paediatric hospital in Ghana. Methods: a total of 485 patients including 365 diarrhoea and 120 non-diarrhoea children were enrolled into the study. Stool samples were collected and analysed for parasite presence using microscopy, ELISA and PCR. Positive samples were subsequently characterized into assemblages by PCR-RFLP, and further confirmed with sequencing of the glutamate dehydrogenase (gdh) gene. Epidemiological data on demographic, clinical and behavioral features of the study subjects were also collected. Results: prevalence of G. lamblia infections in diarrhea and non-diarrhea children were 5.8% and 5% respectively (P>0.5). Sequence data confirmed Giardia lamblia assemblage B as the predominant genotype in both diarrhoea and non-diarrhoea cases. There was no significant association of G. lamblia infection with any of the epidemiological variables investigated. Conclusion: our findings suggest that assemblage B could be the predominant genotype causing giardiasis in children. Increased public health education focusing on good sanitary practices, particularly among mothers and children, could decrease the risk of G. lamblia infection.The Pan African Medical Journal 2016;24

Ayeh-Kumi, P. F., Ali, I. M., Lockhart, L. A., Gilchrist, C. A., Petri, W. A., Jr., and Hague, R. 2001. Entamoeba histolytica: Genetic diversity of clinical isolates from Bangladesh as demonstrated by polymorphisms in the serine-rich gene Experimental Parasitology 99, 80–88. The varied organ tropisms and clinical presentations of infection by Entamoeba histolytica have stimulated interest in the role of parasite genetic diversity in virulence. We investigated genetic diversity among 54 E. histolytica isolates from Bangladesh by analyzing polymorphism in the serine-rich gene by nested PCR on DNA extracted from stool and liver aspirate pus. We detected both size and restriction site polymorphisms among the isolates within this endemic area. A combination of the nested PCR results and the Alu I digestion of the PCR products examined yielded 25 distinct DNA banding patterns among the 42 stool isolates and an additional 9 distinct patterns among the 12 liver abscess isolates. Approximately half of the isolates had unique polymorphisms. Interestingly, the majority of E. histolytica from the liver had polymorphisms which were not present in intestinal isolates from the same geographic area. These data are consistent with the existence of genetic differences between E. histolytica which cause intestinal and those which cause hepatic disease. We conclude that there is genetic diversity within E. histolytica isolates from an endemic population as reflected in serine-rich E. histolytica protein gene polymorphism. The correlation of genetic differences with the pathogenic potential of E. histolytica strains and the implications of genetic diversity for the immunoprophylaxis of amebiasis require further study.

Objective: To determin the extent to which parvovirus B19 (B19V) and co-infection of B19V and malaria contribute to risk of anaemia in children. Methods: B19V DNA and malaria parasites were screened for 234 children at the PML Children’s Hospital in Accra. The role of B19V and coinfection with B19V and malaria in anaemia was evaluated by analysing full blood cell counts, malaria and B19V DNA results from these children. Results: The prevalence of B19V, malaria and co-infection with B19V and malaria was 4.7%, 41.9% and 2.6%, respectively. Malaria posed a greater risk in the development of mild anaemia compared to severe anaemia (OR=5.28 vrs 3.15) whereas B19V posed a higher risk in the development of severe anaemia compared to mild anaemia (OR=4.07 vrs 1.00) from a non-anaemic child. Persons with co-infection with B19V and malaria had 2.23 times the risk (95% CI=0.40-12.54) of developing severe anaemia should they already have a mild anaemia. The degree of anaemia was about three times affected by coinfection (Pillai’s trace=0.551, P=0.001) as was affected by malaria alone (Pillai’s trace=0.185, P=0.001). B19V alone did not significantly affect the development of anaemia in a non-anaemic child. Microcytic anaemia was associated with B19V and co-infection with B19V and malaria more than normocytic normochromic anaemia. Conclusions: B19V was associated with malaria in cases of severe anaemia. The association posed a significant risk for exacerbation of anaemia in mild anaemic children. B19V and co-infection with B19V and malaria may be associated with microcytic anaemia rather than normocytic normochromic anaemia as seen in cases of B19V infection among persons with red cell abnormalities.

At peripheral health facility levels, the diagnosis of malaria is difficult due to lack of infrastructure. In the study reported here, the diagnostic performance of a batch of ‘DiaMed OptiMAL-IT’ (Cressier, Switzerland) rapid antigen tests were examined in parallel with routine microscopy for a select population of high risk individuals: 202 pregnant women and 200 children less than 5 years old in an endemic setting in Ghana. Results of both diagnostic methods were compared to that of cross-checking microscopy, taken as gold standard, at the Navrongo Health Research Centre. Of the 402 patients, 218 (54.2%) were confirmed with Plasmodium falciparum infections by cross-checking. All 218 patients (100%) were accurately diagnosed with malaria by routine microscopy. Of these, 151 (69.3%) were positive by DiaMed OptiMAL-IT test (26 false positives, 67 false negatives). DiaMed OptiMAL-IT had the following performance indicators for detection of P. falciparum among pregnant women and children less than 5 years respectively: Sensitivity—50.5% [95% CI (40.6–60.3)], 87.7% [95% CI (78.7–92.1)]; Specificity—82.5% [95% CI (73.1–89.1)], 89.6% [95% CI (80.8–94.8)]; Predictive values for positive tests—75.7% [95% CI (63.7–84.8)], 91.6% [95% CI(85.2–95.8%)]; Predictive values for negative tests—60.6% [95% CI (51.7–68.9)], 83.8% [95% CI (74.5–90.3)]; Likelihood ratio for positive tests—2.88, 10.8; Likelihood ratio for negative tests—0.59, 0.19; Cohens Kappa values—0.33 [95% CI (0.20–0.43), 0.76 [95% CI (0.65–0.83)]. Our results suggest that DiaMed OptiMAL-IT tests should not replace microscopy in our endemic setting.

Diarrhea is a major public health problem that affects the development of children. Anthropometric data were collected from 274 children with (N = 170) and without (N = 104) diarrhea. Stool specimens were analyzed by conventional culture, polymerase chain reaction for enteroaggregative Escherichia coli (EAEC), Shigella, Cryptosporidium, Entamoeba, and Giardia species, and by enzyme-linked immunosorbent assay for fecal lactoferrin levels. About 50% of the study population was mildly to severely malnourished. Fecal lactoferrin levels were higher in children with diarrhea (P = 0.019). Children who had EAEC infection, with or without diarrhea, had high mean lactoferrin levels regardless of nutritional status. The EAEC and Cryptosporidium were associated with diarrhea (P = 0.048 and 0.011, respectively), and malnourished children who had diarrhea were often co-infected with both Cryptosporidium and EAEC. In conclusion, the use of DNA-biomarkers revealed that EAEC and Cryptosporidium were common intestinal pathogens in Accra, and that elevated lactoferrin was associated with diarrhea in this group of children.

Objective: To determine the correlates of hepatitis E virus infection (HEV) in a sample of persons who work with pigs. Design: Cross-sectional study. Setting: Three pig farms in the Greater Accra Region of Ghana. Subjects: Persons who work with pigs seen at the selected pig farms between the months of January and May 2008. Results: One hundred and five persons who work with pigs voluntarily completed a risk-factor questionnaire and provided blood samples for unlinked anonymous testing for the presence of antibodies to HEV. The median age of participants was 36.5 ± 15.0 years (range 12-65 years). Of the 105 subjects tested, HEV seroprevelance was 38.1%. On multivariate analysis, the independent determinants of HEV infection were being employed on the farm for less than six months (odds ratio (OR) 9.1; 95% confidence interval (95% CI) 1.0-81.4 and having piped water in the household and/or on the farm (OR 3.9; 95% CI 0.4-90.8). Conclusion: Consistent with similar studies worldwide, the results of our studies revealed a high prevalence of HEV infection in persons who work with pigs. Further studies need to be done to isolate, characterise the virus and define the clinical and epidemiological significance of HEV infection in this population.

Background: The recent introduction of sachet water to consumers was to provide safe, hygienic and affordable instant drinking water to the public. Although this is a laudable idea current trends seem to suggest that sachet drinking water could be a route of transmission of enteric pathogens. Objective: To assess the safety of sachet drinking water. Materials and Methods: Twenty seven different brands of 500ml sachet water samples randomly selected and purchased from various vendors in Accra were subjected to microscopic examinations to determine the presence of parasitic protozoa. The study was carried out between January and May 2005. Results: Seventy-seven percent of the samples contained infective stages of pathogenic parasitic organisms. Common pathogens identified include, Microsporidia sp 14/27 (51.2%), Cryptosporidium parvum 17/27 (63.0%), Cyclospora cayetenensis 16/27 (59.3%), Sarcocystis sp. 18/27 (66.7%). Rotifers 5/27 (18.5%), and Charcoat Leyden crystals 12/27 (44.4%). Ninety-three percent of the samples contained unidentified impurities/artifacts. 29.6% of the samples contained at least one type of parasite, 14.8% contained at least 2 types of parasites, 25.9% contained at least three types of parasites, while 29.6% contained four types of parasites. Conclusion: The study indicated the presence of contaminants of feacal and zoonotic origin in some of the sachet water examined. This has grim public health implications as the organisms identified can cause water related diseases which have serious complications in children and adults particularly immunocompromised individuals. Sachet water should be constantly monitored for its microbial quality.

BACKGROUND Acquired immunodeficiency syndrome is a major public health concern worldwide, particularly in Ghana, where recent reports indicate an increase of the disease. A close association between infection with human immunodeficiency virus (HIV) and tuberculosis (TB) is well known. A previous study showed a 16.8% seroprevalence of HIV in TB patients on admission at the chest clinic of the Korle-Bu teaching hospital. However this was in severely ill patients on admission and there was a likely selection bias. This study was therefore designed to determine the prevalence of HIV infection among patients suspected of TB attending the laboratory of the chest clinic of the Korle-Bu Teaching hospital, Accra, Ghana. METHODS Pulmonary TB was diagnosed using clinical, sputum smear microscopy and chest x-ray features. HIV was determined using particle agglutination test (HIV-1 and HIV-2) and synthetic peptide-based immunoassay (Peptilav I and II ELISA). RESULTS Of the 277 subjects examined, 108 (39%) were diagnosed as TB. The seroprevalence of HIV was 46.2% in all TB suspect patients. It was 47.2% and 45.6% in those with and without tuberculosis, respectively. in both groups, the peak age distribution of subjects positive for HIV antibodies was from 20 to 59 years. CONCLUSION The results show a great increase in HIV seroprevalence in TB patients in Korle-Bu. The high HIV seroprevalence suggests that subjects suspected of TB should be tested for HIV as well.

Background: Micronutrients such as coper, zinc and selenium are essential to the functioning of the nervous system and their deficiencies is a critical concern for cerebral palsy children. The aim of this study was to investigate micronutrient levels and antioxidant status in pediatric cerebral palsy patients and compare them to neurologically normal children in Accra, Ghana. Method: Twenty seven patients with cerebral palsy (0-14 years) and 17 age-bracket matched neurological normal controls were recruited. Three milliliters of venous blood was drawn from each participant into an EDTA tube and transferred on ice to the laboratory. Activity of the antioxidant enzyme superoxide dismutase (SOD) as well as micronutrient status for copper, zinc and selenium were analyzed. Results: About 86.2% of cases (n = 25/29) compared to 11.7% of controls (n= 2/17) had copper concentrations below the normal physiologic range; mean copper concentration was significantly lower in cases than in control. Serum zinc levels were normal in only 20.1% (n = 6/29) of cases, but in 59% (n = 10/17) of controls; however, mean concentration of zinc was not statistically different among. Selenium concentration below normal physiologic range was recorded to be about 94% in both cases (n = 27/29) and controls (n = 16/17); but the mean selenium concentration was significantly higher in cases compared to control. Also, the mean SOD activity was significantly lower in cases than in controls. Moreover, negative correlation was observed between the age of children with cerebral palsy and SOD levels. Conclusion: Copper, zinc and selenium deficiencies contributed disproportionately to oxidative stress and this may be a common feature in Ghanaian children with cerebral palsy. There is the need for micronutrient supplementation.