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Cystic fibrosis (CF) is a severe life-limiting genetic disorder resulting from mutations in the cystic fibrosis transmembrane regulator gene and is reported to be more prevalent among Caucasians than people of African descent. The past three decades have seen a gradual increase in the reporting of CF in non-European populations with CF in all regions including Africa. We report on the first two known Ghanaian children diagnosed with CF presenting early in infancy. The first patient presented with severe acute malnutrition and persistent diarrhea resulting from severe exocrine pancreatic insufficiency. In the second patient, there were recurrent wheeze and recurrent pneumonia, severe dehydration with metabolic alkalosis. Diagnosis of CF in Ghana is challenging due to the absence of diagnostic tools such as sweat testing equipment. In the first patient, sweat testing and genetic testing were done in South Africa. In the second patient, sweat testing was not done but diagnosis was confirmed by genetic testing. Both patients presented with classical CF symptoms including Pseudomonas aeruginosa airway infection before age 6 months. Both children are currently alive and healthy on appropriate treatment. These case reports highlight the growing evidence of CF occurring in people of African descent and the diagnostic challenges faced in Africa.

The emergence of COVID-19 by a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) in 2019 has seen evolving data reporting infrequent infection in children and mostly mild disease for children who contract the infection. A severe form of COVID-19 in children recently reported in Europe and North America describes a multisystem inflammation syndrome in children (MIS-C), presenting as toxic-shock-like and Kawasaki-like syndromes. Data on MIS-C in Africa is being documented with recent reports from South Africa and Nigeria in black children, but information on MIS-C in Ghana is yet to be characterized. We report the first case of multisystem inflammatory syndrome in a child who tested PCR positive to SARS-CoV2 in a tertiary hospital in Ghana. The case describes a 10- year-old boy who reported Kawasaki-like syndrome without shock but with moderate respiratory distress requiring supportive acute care without the need for intensive care. © 2021 Ghana Medical Association. All Rights Reserved.

Vascular rings are rare congenital anomalies that primarily result from an embryological derangement of the paired aortic arches or branching pulmonary arteries. They make up

BackgroundExogenous lipoid pneumonia (ELP) is uncommon in infants. It is caused by inhalation or aspiration of oils and can lead to unresolving pneumonia. Diagnosis of ELP requires a high index of suspicion and confirmation oil ingestion. We report on two term infants, HIV unexposed, with no history of contact with persons with tuberculosis, presenting with persistent cough and history of melted shea butter ingestion. Case 1A 2-month-old infant weighing 4.6kg, presented with a three-week history of persistent cough and intermittent fever. The cough occurred in paroxysms and was not associated with feeding. Further history, mother admitted to giving the baby a teaspoon of melted shea butter orally daily to aid bowel movement since birth.Baby was tachypneic with normal saturation. Induced sputum sample was negative for Mycobacterium tuberculosis by Xpert MTB/RIF. Chest radiograph showed bilateral dense consolidations. She spent 16 days on admission, received broad spectrum intravenous antibiotics for 10 days and oral azithromycin for 14 days. Case 2A 3-month-old infant weighing 3.8kg, with an uneventful neonatal period and up to date immunizations was referred as a case of unresolving pneumonia with persistent cough, fast breathing, and intermittent fever for four weeks. Baby was tachypneic and hypoxic, SpO2 80% in room air with reduced air entry bilaterally and crepitations. Other physical examination findings were unremarkable. All initial investigations were normal.An enhanced chest computed tomography (CT) ruled out the possibility of a congenital airway malformation and suggested dense consolidation with bronchiectatic changes. She required a second admission in which shea butter ingestion was established, she gradually improved on antibiotics and was discharged. Conclusion Among infants with unresolving pneumonia ELP must be considered early as part of differential diagnosis.

Background Parapneumonic effusions (PPE) and Empyema are serious complications of pneumonia in children that are associated with higher morbidity and prolonged hospital stay. The introduction of the pneumococcal conjugate vaccines (PCV 13) have led to a reported decline in the episodes of complicated pneumonia in children. The organisms commonly associated with PPE and Empyema are Streptococcus pneumoniae and Staphylococcus aureus though Mycobacterium tuberculosis has also been reported. There is paucity of data on children with PPE and Empyema in Ghana. We aimed to describe the profile, mode of presentation and outcomes in children admitted with PPE and Empyema to the Komfo Anokye Teaching Hospital. Methods A retrospective review of medical records (folders) and electronic data on children with PPE and Empyema admitted to the pulmonology unit from January 2018 to December 2020 were retrieved. Demographic records, immunization status, clinical presentation, length of hospital stay and outcome of admission were extracted using a Microsoft Excel. Data was then analysed with STATA version 16. Results Records were available for 51 children; the median age was 42 months IQR (22.5-96) and 68.6% (n=35) were males. In all 84.2% (n=38), had received all immunisations up to date for age. At presentation, 9.5% (n=4/42) had oxygen saturation 38oC. The median respiratory rate was 47.5 IQR (32.8-57). The Median white cell count was 15.84 X10 9/l IQR (11.9-24.73) and median hemoglobin was 9.6 g/dl IQR (8.6-11.7). Pleural aspirate culture isolated Staphylococcus aureus for 6 patients. The rest were either not available or had no bacterial growth. Amoxicillin clavulanic acid and ceftriaxone were the most commonly used antibiotics. The median length of hospital stay was 9 days IQR (7-12) while the median length of chest tube insertion was 7 days IQR (5.5-9). In all 7.8 (n-4/51) patients died. Conclusion Both young and older children are affected with PPE/empyema. There is a good uptake of vaccines among children admitted for PPE/empyema, Staphylococcus aureus is the most common bacterial isolated from pleural aspirate culture. Most children admitted with complicated PPE/Empyema survived.

BackgroundChildhood pneumonia is a leading cause of hospitalisation and death in Low- and Middle-Income Countries (LMIC). Despite remarkable achievements in global mortality trends in children under 5 nearly 700 000 children die annually from pneumonia. In Ghana, an estimated 4,700 children under 5 died from pneumonia in 2017. Hypoxia is a known predictor of death among children hospitalised with pneumonia. Few studies in Ghana have described the predictors of mortality among children with pneumonia. This study aimed to determine the factors associated with mortality among children hospitalized for pneumonia to the Paediatric Emergency Unit (PEU) of Komfo Anokye Teaching Hospital (KATH). MethodsMedical records of children admitted to the PEU of KATH from January 2016 to December 2020 were reviewed. Data was cleaned and exported to STATA version 16 for analysis. Outcomes measures of interest were survival and mortality. Results Records for 482 children hospitalised with pneumonia to the unit were available of which 55 per cent (n=265) were males, 94 per cent (n= 455) were less than five years and 51 per cent (n=265) were younger than 12 months old. In all, 77 per cent (n=301), had received three doses of the pneumococcal conjugate vaccine. Twenty-one percent (n=89), presented with hypoxia and 15% (n= 77), died from pneumonia. There was a significant association between death as an outcome and hypoxia at presentation [?2 (1)= 13.29, p < .001(OR 2.6, 95% CI 1.42 to 4.75)], axillary temperature of 38oC or more at presentation [?2 (1)= 5.03, p = .025 (OR 2.09 (95% CI 1.08 to 4.02)], fast breathing at presentation [?2 (1) = 5.45, p = .020 (OR 2.12 95% CI 1.11 – 4.01)] and having received all 3 doses of pneumococcal vaccine [?2 (1) = 9.78, p = .002 (OR 0.45 95% CI 0.27 – 0.75). Conclusion Hypoxia at presentation, axillary temperature of 38oC or greater, fast breathing, are likely predictors of mortality in children under 5 hospitalised for pneumonia. Pneumococcal conjugate vaccine uptake is high among children with pneumonia, receiving all 3 doses likely protects children with pneumonia from death.

Background Global surveillance for vaccine preventable invasive bacterial diseases has been set up by the World Health Organization to provide disease burden data to support decisions on introducing pneumococcal conjugate vaccine (PCV). We present data from 2010 to 2016 collected at the 2 sentinel sites in Ghana. Methods Data were collected from children, The number of children

Ghana introduced the monovalent rotavirus vaccine (Rotarix) into its national paediatric vaccination programme in May2012. Vaccine introduction was initiated nationwide and achieved85% coverage within a few months. Rotavirus strain distribution pre- and post-RV vaccine introduction is reported.Stool samples were collected from diarrhoeic children5 years of age hospitalized between 2009 and 2016 at sentinel sites across Ghana and analyzed for the presence of group A rotavirus by enzyme immunoassay. Rotavirus strains were characterized by RT-PCR and sequencing.A total of 1363 rotavirus EIA-positive samples were subjected to molecular characterization. These were made up of 823 (60.4%) and 540 (39.6%) samples from the pre- and post-vaccine periods respectively. Rotavirus VP7 genotypes G1, G2 and G3, and VP4 genotypes P[6] and P[8] constituted more than 65% of circulating G and P types in the pre-vaccine period. The common strains detected were G1P[8] (20%), G3P[6] (9.2%) and G2P[6] (4.9%). During the post-vaccine period, G12, G1 and G10 genotypes, constituted more than 65% of the VP7 genotypes whilst P[6] and P[8] made up more than 75% of the VP4 genotypes. The predominant circulating strains were G12P[8] (26%), G10P[6] (10%) G3P[6] (8.1%) and G1P[8] (8.0%). We also observed the emergence of the unusual rotavirus strain G9P[4] during this period.Rotavirus G1P[8], the major strain in circulation during the pre-vaccination era, was replaced by G12P[8] as the most predominant strain after vaccine introduction. This strain replacement could be temporary and unrelated to vaccine introduction since an increase in G12 was observed in countries yet to introduce the rotavirus vaccine in West Africa. A continuous surveillance programme in the post-vaccine era is necessary for the monitoring of circulating rotavirus strains and the detection of unusual/emerging genotypes.

Chronic respiratory illnesses cause a significant burden on health and premature death worldwide. Optimising respiratory health in early life and even antenatally has emerged as critical to address this. Physiological measures of lung function are available and feasible even in young children. This paper reviewed the recent findings of existing and emergent lung function tests in the assessment of childhood chronic lung disease, with a focus on high burden respiratory diseases. Emergent lung function techniques applicable to pre-school children and useful in detecting lung disease are available. Lung function impairments are variable even within specific diseases, reflecting the heterogeneity and continuum of disease related pathophysiology. Spirometry is limited used alone, consideration should be given to using more comprehensive tools. Further research to assess the ability of current and emerging tests to diagnose and manage lung disease in children and young people and a more nuanced, disease specific approach is needed.

Pneumonia is the highest cause of death in children under five (5) especially in sub-Saharan Africa. It accounts for 16 % of all deaths in Africa, deadlier than Malaria. Sub-Saharan Africa carries about half of the burden of the world’s under-five deaths. Progress in the fight against pneumonia has slacked behind that of the others. Pneumonia mortality rates in children have fallen by just 50 per cent compared to an 85 per cent decline in measles deaths, and 60 per cent in deaths from malaria, AIDS and tetanus in the last 15 years. The global funding to address the burden of pneumonia in children is low and this is potentially hindering the effort to reduce the mortalities associated with the disease.

Background Cystic fibrosis (CF) is described more commonly in Caucasian populations in whom p.Phe508del is the most common mutation. There is a paucity of data of CF in black African children. The aim of this study was to describe and compare the presentation and outcomes of black African children with CF to those with p.Phe508del genotype. Methods A retrospective case-controlled study was conducted from January 2000 – March 2018 of children with CF attending two CF centres in South Africa. Presentation, genotype, nutrition and pulmonary function outcomes of black African children were compared to matched controls with the p.Phe508del mutation. Results Thirty-four black African children (cases) with median age of diagnosis (5.5 months, IQR 2.0-15.0) were matched to 34 controls. Among cases, 3120+1G->A CFTR mutation was most commonly identified; homozygous n=22 (64.7%) and heterozygous=7(20.5%). Compared to controls, cases at diagnosis were more malnourished and fewer presented with neonatal bowel obstruction [cases n=2 (5.9%) vs. controls n=10 (29.4%); p = 0.03]. Nutrition and pulmonary function (FEV1 in children ≥ 6 years) outcomes and changes over time from ages 3-16 years were similar in both groups; median FEV1 z-score at age 6,10 and 14 years was -0.9 (±1.5), -1.8 (±2.0) and -1.8 (±1.9) respectively for all patients. Deaths were recorded in three cases (8.8%) and one control (2.9%) (p = 0.6). Conclusion Black African children with CF were more malnourished at diagnosis, and fewer presented with neonatal bowel obstruction. Cases and controls had comparable nutritional, pulmonary function and early mortality outcomes.

BackgroundPneumonia remains the foremost cause of death in children under 5 years of age especially in sub-Saharan Africa killing nearly 1 million annually.Aim Identify pneumonia prevalence, mortality rate and associated factors among children under five admitted to Komfo Anokye Teaching Hospital (KATH) in Ghana.MethodsUsing a prospective cross-sectional study method, a consecutive sample of 157 children under 5 admitted to the KATH for pneumonia from June to August 2016 was selected. A structured questionnaire was used to collect primary data from their caregivers and secondary data from the patient record using a structured data extraction form. Continuous and categorical variables were described and chi-square test employed to determine the associated factors of pneumonia mortality. Multivariate logistics regression model was used to test for the strength of the association to unearth the risk factors of pneumonia mortality.Results The study found a prevalence of pneumonia of 18.40% with a mortality rate of 12.74%. Pneumonia mortality was found to be associated with maternal education (p

Background. Pharmacokinetic data on the first-line antituberculosis drugs using the World Health Organization (WHO) revised dosages for children are limited. We investigated the pharmacokinetics of these drugs in children who were mostly treated with revised dosages. Methods. Children with tuberculosis on first-line therapy for at least 4 weeks had blood samples collected at predose, 1, 2, 4, and 8 hours postdose. Drug concentrations were determined by validated liquid chromatography mass spectrometry methods, and pharmacokinetic parameters were calculated using noncompartmental analysis. Factors associated with plasma peak concentration (Cmax) and the area under the time–concentration curve 0–8 hours (AUC0–8h) of each drug was examined using univariate and multivariate analysis. Results. Of the 62 children, 32 (51.6%) were male, 29 (46.8%) wereyounger than 5 years old, and 28 (45.2%) had human immunodeficiency virus (HIV) coinfection. Three patients had undetectable pyrazinamide and ethambutol concentrations. The median (interquartile range) AUC0–8h for isoniazid was 17.7 (10.2–23.4) µg·h mL –1 , rifampin was 26.0 (15.3–36.1) µg·h mL –1 , pyrazinamide was 144.6 (111.5–201.2) µg·h mL –1 , and ethambutol was 6.7 (3.8–10.4) µg·h mL –1 . Of the children who received recommended weight-band dosages, 44/51 (86.3%), 46/56 (82.1%), 27/56 (48.2%), and 21/51 (41.2%) achieved target Cmax for isoniazid, pyrazinamide, ethambutol, and rifampin, respectively. In multivariate analysis, age, sex, HIV coinfection status, and drug dosage in milligrams per kilogram were associated with the drugs’ plasma drug Cmax or AUC0–8h. Conclusions. The revised dosages appeared to be adequate for isoniazid and pyrazinamide, but not for rifampin or ethambutol in this population. Higher dosages of rifampin and ethambutol than currently recommended may be required in most children.

BackgroundThe Plasmodium falciparum pre-erythrocytic stage candidate vaccine RTS,S is being developed for protection of young children against malaria in sub-Saharan Africa. RTS,S formulated with the liposome based adjuvant AS01(E) or the oil-in-water based adjuvant AS02(D) induces P. falciparum circumsporozoite (CSP) antigen-specific antibody and T cell responses which have been associated with protection in the experimental malaria challenge model in adults.MethodsThis study was designed to evaluate the safety and immunogenicity induced over a 19 month period by three vaccination schedules (0,1-, 0,1,2- and 0,1,7-month) of RTS,S/AS01(E) and RTS,S/AS02(D) in children aged 5-17 months in two research centers in Ghana. Control Rabies vaccine using the 0,1,2-month schedule was used in one of two study sites.ResultsWhole blood antigen stimulation followed by intra-cellular cytokine staining showed RTS,S/AS01(E) induced CSP specific CD4 T cells producing IL-2, TNF-α, and IFN-γ. Higher T cell responses were induced by a 0,1,7-month immunization schedule as compared with a 0,1- or 0,1,2-month schedule. RTS,S/AS01(E) induced higher CD4 T cell responses as compared to RTS,S/AS02(D) when given on a 0,1,7-month schedule.ConclusionsThese findings support further Phase III evaluation of RTS,S/AS01(E). The role of immune effectors and immunization schedules on vaccine protection are currently under evaluation.Trial registrationClinicalTrials.gov NCT00360230.

BACKGROUND The target delivery channel of RTS,S candidate malaria vaccines in malaria-endemic countries in Africa is the World Health Organisation Expanded Program on Immunization. As an Adjuvant System, age de-escalation and schedule selection step, this study assessed 3 schedules of RTS,S/AS01(E) and RTS,S/AS02(D) in infants and young children 5-17 months of age in Ghana. METHODOLOGY A Phase II, partially-blind randomized controlled study (blind to vaccine, not to schedule), of 19 months duration was conducted in two (2) centres in Ghana between August 2006 and May 2008. Subjects were allocated randomly (1:1:1:1:1:1) to one of six study groups at each study site, each defining which vaccine should be given and by which schedule (0,1-, 0,1,2- or 0,1,7-months). For the 0,1,2-month schedule participants received RTS,S/AS01(E) or rabies vaccine at one center and RTS,S/AS01(E) or RTS,S/AS02(D) at the other. For the other schedules at both study sites, they received RTS,S/AS01(E) or RTS,S/AS02(D). The primary outcome measure was the occurrence of serious adverse events until 10 months post dose 1. RESULTS The number of serious adverse events reported across groups was balanced. One child had a simple febrile convulsion, which evolved favourably without sequelae, considered to be related to RTS,S/AS01(E) vaccination. Low grade reactions occurred slightly more frequently in recipients of RTS,S/AS than rabies vaccines; grade 3 reactions were infrequent. Less local reactogenicity occurred with RTS,S/AS01(E) than RTS,S/AS02(D). Both candidate vaccines were highly immunogenic for anti-circumsporozoite and anti-Hepatitis B Virus surface antigen antibodies. Recipients of RTS,S/AS01(E) compared to RTS,S/AS02(D) had higher peak anti-circumsporozoite antibody responses for all 3 schedules. Three dose schedules were more immunogenic than 2 dose schedules. Area under the curve analyses for anti-circumsporozoite antibodies were comparable between the 0,1,2- and 0,1,7-month RTS,S/AS01(E) schedules. CONCLUSIONS Both candidate malaria vaccines were well tolerated. Anti-circumsporozoite responses were greater with RTS,S/AS01(E) than RTS,S/AS02(D) and when 3 rather than 2 doses were given. This study supports the selection of RTS,S/AS01(E) and a 3 dose schedule for further development in children and infants. TRIAL REGISTRATION ClinicalTrials.gov NCT00360230.

Acute renal failure developed in glucose-6-phosphate-dehydrogenase (G.-6-P.D.) deficient adult Ghanaians—three men and three women—who were admitted to hospital with febrile illness. There was evidence of anaemia and urinary-tract infection at the time of renal failure in all six patients. Treatment with appropriate antibiotics and conservative management of the renal failure led to full recovery. It is suggested that anaemia (whether haemolytic or not) and urinary-tract infection are among the main precipitating factors in acute failure in G.-6–P.D. deficient patients.