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In settings with high tuberculosis (TB) endemicity, distinct genotypes of the Mycobacterium tuberculosis complex (MTBC) often differ in prevalence. However, the factors leading to these differences remain poorly understood. Here we studied the MTBC population in Dar es Salaam, Tanzania over a six-year period, using 1,082 unique patient-derived MTBC whole-genome sequences (WGS) and associated clinical data. We show that the TB epidemic in Dar es Salaam is dominated by multiple MTBC genotypes introduced to Tanzania from different parts of the world during the last 300 years. The most common MTBC genotypes deriving from these introductions exhibited differences in transmission rates and in the duration of the infectious period, but little differences in overall fitness, as measured by the effective reproductive number. Moreover, measures of disease severity and bacterial load indicated no differences in virulence between these genotypes during active TB. Instead, the combination of an early introduction and a high transmission rate accounted for the high prevalence of L3.1.1, the most dominant MTBC genotype in this setting. Yet, a longer co-existence with the host population did not always result in a higher transmission rate, suggesting that distinct life-history traits have evolved in the different MTBC genotypes. Taken together, our results point to bacterial factors as important determinants of the TB epidemic in Dar es Salaam.

Diarrheal disease remains a major global health problem particularly in children under 5 years and the emergence of antibiotic-resistant strains of causative pathogens could slow control efforts, particularly in settings where treatment options are limited. This surveillance study conducted in Ghana aimed to determine the prevalence and antimicrobial susceptibility profile of diarrhea-causing bacteria. This was a cross-sectional study carried out in five health facilities in the Ga West Municipality of Ghana between 2017 and 2021. Diarrheic stool samples from patients were collected and cultured on standard differential/selective media and isolates identified by standard biochemical tests, MALDI-TOF assay, and serological analysis. The antibiogram was determined using Kirby-Bauer disk diffusion and Microscan autoScan4 MIC panels which were used for extended-spectrum beta-lactamase (ESBL) detection. Bacteria were isolated from 97.5% (772/792) of stool samples, and 167 of the isolates were diarrheagenic and met our inclusion criteria for antimicrobial resistance (AMR) analysis. These included Escherichia coli (49.1%, 82/167), Salmonella species (23.9%, 40/167), Vibrio species (16.8%, 28/167), and Shigella species (10.2%, 17/167). Among 24 Vibrio species, we observed resistances to cefotaxime (21/24, 87.5%), ceftriaxone (20/24, 83.3%), and ciprofloxacin (6/24, 25%), including four multi-drug resistant isolates. All 13 Vibrio parahaemolyticus isolates were resistant to cefazolin. All 17 Shigella isolates were resistant to tetracycline with resistance to shigellosis drugs such as norfloxacin and ciprofloxacin. Salmonella isolates were highly susceptible to norfloxacin (40/40, 100%) and tetracycline (12/34, 35%). Two ESBL-producing E. coli were also identified with marked susceptibility to gentamicin (66/72, 91.7%) and amikacin (57/72, 79.2%) prescribed in the treatment of E. coli infections. This study showed the different bacteria implicated in diarrhea cases in Ghana and the need for differential diagnoses for better treatment outcomes. Escherichia coli, Shigella, Salmonella, and Vibrio have all been implicated in diarrhea cases in Ghana. The highest prevalence was E. coli and Salmonella with Shigella the least prevalent. Resistance to commonly used drugs found in these isolates may render bacteria infection treatment in the near future nearly impossible. Routine antimicrobial susceptibility testing, effective monitoring, and nationwide surveillance of AMR pathogens should be implemented to curb the increase of antimicrobial resistance in Ghana.

The emergence of SARS-CoV-2 variants with superior transmissibility or immune evasion advantages may cause outbreaks and dominate transmission in a population (1). Thus, keeping track of the dynamics of variant [...]

Acute gastroenteritis associated with diarrhea is considered a serious disease in Africa and South Asia. In this study, we examined the trends in the causative pathogens of diarrhea and the corresponding gut microbiota in Ghana using microbiome analysis performed on diarrheic stools via 16S rRNA sequencing. In total, 80 patients with diarrhea and 34 healthy adults as controls, from 2017 to 2018, were enrolled in the study. Among the patients with diarrhea, 39 were norovirus-positive and 18 were rotavirus-positive. The analysis of species richness (Chao1) was lower in patients with diarrhea than that in controls. Beta-diversity analysis revealed significant differences between the two groups. Several diarrhea-related pathogens (e.g., Escherichia-Shigella, Klebsiella and Campylobacter) were detected in patients with diarrhea. Furthermore, co-infection with these pathogens and enteroviruses (e.g., norovirus and rotavirus) was observed in several cases. Levels of both Erysipelotrichaceae and Staphylococcaceae family markedly differed between norovirus-positive and -negative diarrheic stools, and the 10 predicted metabolic pathways, including the carbohydrate metabolism pathway, showed significant differences between rotavirus-positive patients with diarrhea and controls. This comparative study of diarrheal pathogens in Ghana revealed specific trends in the gut microbiota signature associated with diarrhea and that pathogen-dependent dysbiosis occurred in viral gastroenteritis.

Viral infections, ranging from the common cold to severe illnesses like HIV/AIDS, Ebola, and SARS-CoV-2, are a major public health concern. The Noguchi Memorial Institute for Medical Research (NMIMR) has a comprehensive research program on viral diseases. During the seventh annual research meeting (ARM), presentations highlighted NMIMR's role in Ghana's preparedness for epidemic-prone diseases, national surveillance, and policy support. NMIMR hosts several key centres, including the National Influenza Centre and the Regional Reference Laboratories for Polio and Rotavirus. During the COVID-19 pandemic, NMIMR established Ghana's first testing facility and expanded testing capacity through training and novel methodologies like sample pooling. The Institute has tested hundreds of thousands of samples and conducted genomic sequencing to track SARS-CoV-2 variants. NMIMR's polio laboratory, the WHO Regional Reference Lab for Africa, processes samples from several West African countries. The lab's genomic sequencing has been crucial for tracking poliovirus and informing immunisation strategies. The institute also plays a key role in monitoring viral hemorrhagic fevers (VHF), and diagnosing diseases like Lassa fever, yellow fever, and Marburg. NMIMR's research and surveillance efforts have been pivotal in shaping Ghana's response to viral diseases, ensuring timely diagnosis, effective outbreak management, and informed policy-making. [ABSTRACT FROM AUTHOR]

Background: Stigma related to skin neglected tropical diseases like Buruli ulcer (BU) and yaws has remained underexplored and existing studies are limited to individual diseases despite the WHO call for integration in disease management. Within two districts in central Ghana, we explored stigma associated with BU and yaws to understand overlaps and disease-specific nuances to help guide integrated interventions. Methodology/Principal findings: In-depth interviews were conducted with 31 current or formerly affected individuals to assess the experiences, effects and coping strategies adopted to manage disease related stigma. Data were analysed along broad themes based on the sociological construct of macro and micro interaction and Goffman's treatise on stigma. Disapproving community labels fueled by misconceptions were noted among BU participants which contributed to macro stigma experiences, including exclusion, discrimination and avoidance. In contrast, a high level of social acceptance was reported among yaws participants although some micro-level stigma (anticipated, felt and self-stigma) were noted by individuals with both diseases. While younger participants experienced name-calling and use of derogatory words to address affected body parts, older participants and caregivers discussed the pain of public staring. Stigma experiences had negative consequences on psychosocial well-being, schooling, and social relations, particularly for BU affected people. Problem-focused strategies including confrontation, selective disclosure and concealment as well as emotion-focused strategies (religious coping and self-isolation) were noted. Conclusions and significance: The types and levels of stigma varied for BU and yaws. Stigma experiences also differed for adults and children in this setting and these differences should be accounted for in integrated interventions for these skin NTDs. School health programs need to prioritize educating school teachers about skin NTDs and the negative impact of stigma on the wellbeing of children. Author summary: Stigma related to Neglected Tropical Diseases (NTDs) constitutes a burden on the social and economic life of affected people, their caregivers and communities. Current evidence on stigma has been limited to a small number of NTDs. The WHO recommends integration approaches to NTDs are therefore understanding stigma and its differential impact is important. We explored stigma experiences, effects and coping strategies simultaneously in BU and yaws in two districts in central Ghana. Findings showed nuances for macro-level stigma associated with BU; individuals were stigmatized by community members; interestingly, this was not noted for yaws. Negative effects of stigma found included psychosocial burden, effects on academic work and straining of social relationships. Some affected individuals dealt with the source of stigma actively avoiding disclosure, selective disclosure, concealment with clothing and confrontation. Emotion-focused strategies such as religious coping and self-isolation were reported; these were noted to aggravate psychosocial problems being experienced by affected people. We propose that, the differences in stigma among people affected by BU and yaws, and the role of age in determining types of stigma identified in this study should be considered in integrated interventions for skin NTDs. School health programs are encouraged to educate teachers about skin NTDs and the negative effects of stigma on students. [ABSTRACT FROM AUTHOR]

Neglected Tropical Diseases (NTDs) are a group of 20 diseases associated with poverty that the World Health Organization aims to control or eliminate. Significant progress has been made in the past two decades with international commitments towards their control and elimination. NTDs in Africa, which account for 40% of the global burden, affect child development, pregnancy outcomes, and productivity. The seventh Annual Research Meeting (ARM) of the Noguchi Memorial Institute for Medical Research (NMIMR) at the University of Ghana featured numerous presentations on NTDs. These highlighted the NTD research landscape and elimination challenges, emphasising the need for government commitment and innovative financial mechanisms due to the extensive funding required. NTD research at NMIMR has informed local and global policies, contributing to capacity building by training students and health professionals. Novel tools and strategies are essential to address ongoing challenges and achieve NTD control and elimination targets. [ABSTRACT FROM AUTHOR]

Non-communicable diseases (NCDs) result from lifestyle and genetic factors and are not infectious. They include cardiovascular diseases, diabetes, obesity, cancers, mental illnesses, and chronic respiratory, liver, and kidney diseases. NCDs account for 74% of global deaths, predominantly in low- and middle-income countries, with a significant rise in sub-Saharan Africa, including Ghana. The interplay between infectious diseases and NCDs, which can alter disease outcomes, requires urgent attention. At the seventh Annual Research Meeting (ARM) of the Noguchi Memorial Institute for Medical Research (NMIMR), presentations highlighted the impact of infectious diseases on NCDs, underscoring the need for integrated approaches to manage NCDs and infectious diseases. The presentations also emphasised early detection, treatment, and the need for novel therapeutic strategies. [ABSTRACT FROM AUTHOR]

Malaria is a leading cause of mortality in Ghana, especially among children under five and pregnant women. The Noguchi Memorial Institute for Medical Research (NMIMR) has collaborated with the National Malaria Elimination Programme (NMEP) to meet control and elimination targets. The seventh Annual Research Meeting (ARM) of the NMIMR highlighted the institute's decades-long contributions to malaria control in Ghana. Topics discussed included NMIMR's malaria research and its policy impacts, noting the Institute's support for public health programs that have shaped malaria policies in epidemiology, diagnosis, treatment, and prevention - including vector control. NMIMR continues to generate scientific data to support Ghana's malaria elimination efforts. [ABSTRACT FROM AUTHOR]

Health system research is crucial for identifying problems and evaluating solutions, ensuring the robustness, safety, effectiveness, and accessibility of health systems. It incorporates people-centred approaches, integrating individual and community perspectives into co-designed interventions. Community engagement in health services promotes equity and sustainability. Several papers focused on strengthening health systems and community engagement during the seventh Annual Research Meeting (ARM) of the Noguchi Memorial Institute for Medical Research (NMIMR) at the University of Ghana. Topics included improving child welfare clinic (CWC) attendance beyond immunisation periods, understanding neglected tropical diseases (NTDs), adolescent girls' knowledge of diet and hormonal imbalance, and public engagement activities regarding antimicrobial use (AMU) among rural livestock farmers. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is rapidly advancing, surpassing the development of new control measures and posing significant threats to patient care, public health, agriculture, economic growth, and global security, particularly in Sub-Saharan Africa. Bacterial infections, responsible for about 7.7 million deaths annually, are often caused by AMR bacteria. The WHO has identified several bacteria, including Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae, and Mycobacterium tuberculosis, as priority pathogens for global surveillance due to their resistance to common antimicrobials. At the 2022 Annual Research Meeting (ARM) of the Noguchi Memorial Institute for Medical Research, University of Ghana, the prevalence of AMR among humans, animals, and the environment in Ghana was highlighted. Studies revealed the widespread presence of the blaCTX-M gene in K. pneumoniae and E. coli from surgical site infections in Accra, posing significant public health threats. Additionally, global clones of Carbapenemase-producing E. coli with resistance to fluoroquinolones and other antibiotics were reported. Research also noted the lack of data on AMR bacteria in water for human use, finding high levels of coliforms and AMR bacteria in drinking water and lettuce irrigated with contaminated water. Whole genome sequencing of bacterial pathogens from febrile patients revealed multi-drug resistant Salmonella spp. Continuous AMR surveillance and advanced genomic tools are recommended to generate detailed data for better treatment decisions and surveillance strategies. [ABSTRACT FROM AUTHOR]

The Seventh Annual Research Meeting of the Noguchi Memorial Institute for Medical Research at the University of Ghana is a significant event that showcases research findings on diseases of public health importance. Established in 1979, the NMIMR conducts research on infectious and non-communicable diseases, nutrition, and environmental impacts on health. The institute plays a crucial role in disease surveillance, policy-making, and training postgraduate students in biomedical sciences, contributing to the health and safety of the Ghanaian population. [Extracted from the article]