Browsing by Author "Adu-Sarkodie, Y."
Now showing 1 - 10 of 10
Results Per Page
Sort Options
Item Community-based mass treatment with azithromycin for the elimination of yaws in GhanaÐResults of a pilot study(PLOS Neglected Tropical Diseases, 2018-03-22) Abdulai, A.A.; Agana-Nsiire, P.; Biney, F.; Kwakye-Maclean, C.; Kyei-Faried, S.; Amponsa-Achiano, K.; Simpson, S.V.; Bonsu, G.; Ohene, S.; Ampofo, W.K.; Adu-Sarkodie, Y.; Addo, K.K.; Chi, K.; Danavall, D.; Chen, C.Y.; Pillay, A.; Sanz, S.; Tun, Y.; Mitjà, O.; Asiedu, K.B.; Ballard, R.C.Introduction The WHO yaws eradication strategy consists of one round of total community treatment (TCT) of single-dose azithromycin with coverage of > 90%.The efficacy of the strategy to reduce the levels on infection has been demonstrated previously in isolated island communities in the Pacific region. We aimed to determine the efficacy of a single round of TCT with azithromycin to achieve a decrease in yaws prevalence in communities that are endemic for yaws and surrounded by other yaws-endemic areas. Methods Surveys for yaws seroprevalence and prevalence of skin lesions were conducted among schoolchildren aged 5±15 years before and one year after the TCT intervention in the Abamkrom sub-district of Ghana. We used a cluster design with the schools as the primary sampling unit. Among 20 eligible primary schools in the sub district, 10 were assigned to the baseline survey and 10 to the post-TCT survey. The field teams conducted a physical examination for skin lesions and a dual point-of-care immunoassay for non-treponemal and treponemal antibodies of all children present at the time of the visit. We also undertook surveys with non-probabilistic sampling to collect lesion swabs for etiology and macrolide resistance assessment. Results At baseline 14,548 (89%) of 16,287 population in the sub-district received treatment during TCT. Following one round of TCT, the prevalence of dual seropositivity among all children decreased from 10.9% (103/943) pre-TCT to 2.2% (27/1211) post-TCT (OR 0.19; 95%CI 0.09±0.37). The prevalence of serologically confirmed skin lesions consistent with active yaws was reduced from 5.7% (54/943) pre-TCT to 0.6% (7/1211) post-TCT (OR 0.10; 95% CI 0.25±0.35). No evidence of resistance to macrolides against Treponema pallidum subsp. pertenue was seen. Discussion A single round of high coverage TCT with azithromycin in a yaws affected sub-district adjoining other endemic areas is effective in reducing the prevalence of seropositive children and the prevalence of early skin lesions consistent with yaws one year following the intervention. These results suggest that national yaws eradication programmes may plan the gradual expansion of mass treatment interventions without high short-term risk of reintroduction of infection from contiguous untreated endemic areas.Item Comparative efficacy of low-dose versus standard-dose azithromycin for patients with yaws: a randomised non-inferiority trial in Ghana and Papua New Guinea(The Lancet Global Health, 2018-04) Marks, M.; Mitjà, O.; Bottomley, C.; Kwakye, C.; Houinei, W.; Bauri, M.; Adwere, P.; Abdulai, A.A.; Dua, F.; Boateng, L.; Wangi, J.; Ohene, S.A.; Wangnapi, R.; Simpson, S.V.; Miag, H.; Addo, K.K.; Basing, L.A.; Danavall, D.; Chi, K.H.; Pillay, A.; Ballard, R.; Solomon, A.W.; Chen, C.Y.; Bieb, S.V.; Adu-Sarkodie, Y.; Mabey, D.C.W.; Asiedu, K.; Study teamBackground: A dose of 30 mg/kg of azithromycin is recommended for treatment of yaws, a disease targeted for global eradication. Treatment with 20 mg/kg of azithromycin is recommended for the elimination of trachoma as a public health problem. In some settings, these diseases are co-endemic. We aimed to determine the efficacy of 20 mg/kg of azithromycin compared with 30 mg/kg azithromycin for the treatment of active and latent yaws. Methods: We did a non-inferiority, open-label, randomised controlled trial in children aged 6–15 years who were recruited from schools in Ghana and schools and the community in Papua New Guinea. Participants were enrolled based on the presence of a clinical lesion that was consistent with infectious primary or secondary yaws and a positive rapid diagnostic test for treponemal and non-treponemal antibodies. Participants were randomly assigned (1:1) to receive either standard-dose (30 mg/kg) or low-dose (20 mg/kg) azithromycin by a computer-generated random number sequence. Health-care workers assessing clinical outcomes in the field were not blinded to the patient's treatment, but investigators involved in statistical or laboratory analyses and the participants were blinded to treatment group. We followed up participants at 4 weeks and 6 months. The primary outcome was cure at 6 months, defined as lesion healing at 4 weeks in patients with active yaws and at least a four-fold decrease in rapid plasma reagin titre from baseline to 6 months in patients with active and latent yaws. Active yaws was defined as a skin lesion that was positive for Treponema pallidum ssp pertenue in PCR testing. We used a non-inferiority margin of 10%. This trial was registered with ClinicalTrials.gov, number NCT02344628. Findings: Between June 12, 2015, and July 2, 2016, 583 (65·1%) of 895 children screened were enrolled; 292 patients were assigned a low dose of azithromycin and 291 patients were assigned a standard dose of azithromycin. 191 participants had active yaws and 392 had presumed latent yaws. Complete follow-up to 6 months was available for 157 (82·2%) of 191 patients with active yaws. In cases of active yaws, cure was achieved in 61 (80·3%) of 76 patients in the low-dose group and in 68 (84·0%) of 81 patients in the standard-dose group (difference 3·7%; 95% CI −8·4 to 15·7%; this result did not meet the non-inferiority criterion). There were no serious adverse events reported in response to treatment in either group. The most commonly reported adverse event at 4 weeks was gastrointestinal upset, with eight (2·7%) participants in each group reporting this symptom. Interpretation: In this study, low-dose azithromycin did not meet the prespecified non-inferiority margin compared with standard-dose azithromycin in achieving clinical and serological cure in PCR-confirmed active yaws. Only a single participant (with presumed latent yaws) had definitive serological failure. This work suggests that 20 mg/kg of azithromycin is probably effective against yaws, but further data are needed. Funding: Coalition for Operational Research on Neglected Tropical Diseases. © 2018 World Health OrganizationItem Electronic Learning and Open Educational Resources in the Health Sciences in Ghana(Ghana medical journal, 2010-12) Adanu, R.M.K.; Adu-Sarkodie, Y.; Opare-Sem, O.; Nkyekyer, K.; Donkor, P.; Lawson, A.; Engleberg, N.C.Objectives: To determine whether a group of Ghanaian students are able to easily use electronic learning material and whether they perceive this method of learning as ac-ceptable. Setting: The University of Ghana Medical School (UGMS) and the School of Medical Sciences (SMS), Kwame Nkrumah University of Science and Technology (KNUST) Participants: One hundred and fifty third year medical students at SMS and nineteen fifth year medical students at UGMS Methods: Two e-learning materials were developed, one on the polymerase chain reaction and the other on total abdominal hysterectomy and these were distributed to selected medical students. Two weeks after the distribu-tion of the programmes, a one-page, self-administered questionnaire was distributed to the target groups of stu-dents at the two institutions. Results: Ninety three percent (139) of respondents at KNUST and 95% (18) at UG report having access to a computer for learning purposes. All of the UG students viewed the TAH programme; 82% (130) of the KNUST students viewed the PCR animations. All students who viewed the programmes at both institutions indicated that the e-learning pro-grammes were “more effective” in comparison to other methods of learning. Conclusion: Computer ownership or availability at both medical schools is sufficient to permit the distribution and viewing of e-learning materials by students and the medical students considered both programmes to be very helpful.Item Genetic analysis of HIV type 2 from Ghana and Guinea-Bissau, West Africa(AIDS Research and Human Retroviruses, 2001-12) Ishikawa, K.; Janssens, W.; Banor, J.S.; Shinno, T.; Piedade, J.; Sata, T.; Ampofo, W.K.; Brandful, J.A.M.; Koyanagi, Y.; Yamamoto, N.; Canas-Ferreira, W.F.; Adu-Sarkodie, Y.; Kurata, T.The phylogenetic variability of part of the long terminal repeat (LTR) region of HIV-2 strains isolated in 1995 from five individuals residing in Bissau, the capital city of Guinea-Bissau, and collected from seven persons from Kumasi, Ghana in 1996-1997, was analyzed. All Guinean samples and all but one Ghanaian sample clustered with HIV-2 subtype A. One Ghanaian sample (14%) was classified as HIV-2 subtype B. This study adds to previous reports on HIV-2 subtype distribution in West Africa indicating local prevalence of HIV-2 subtype B in Ivory Coast and neighboring Ghana. © 2001 Mary Ann Liebert, Inc.Item Knowledge, attitudes and practices towards yaws and yaws-like skin disease in Ghana(PLoS Neglected Tropical Diseases, 2017-08) Marks, M.; Kwakye-Maclean, C.; Doherty, R.; Adwere, P.; Aziz Abdulai, A.; Duah, F.; Ohene, S.-A.; Mitja, O.; Oguti, B.; Solomon, A.W.; Mabey, D.C.W.; Adu-Sarkodie, Y.; Asiedu, K.; Ackumey, M.M.Introduction: Yaws is endemic in Ghana. The World Health Organization (WHO) has launched a new global eradication campaign based on total community mass treatment with azithromycin. Achieving high coverage of mass treatment will be fundamental to the success of this new strategy; coverage is dependent, in part, on appropriate community mobilisation. An understanding of community knowledge, attitudes and practices related to yaws in Ghana and other endemic countries will be vital in designing effective community engagement strategies. Methods: A verbally administered questionnaire was administered to residents in 3 districts in the Eastern region of Ghana where a randomised trial on the treatment of yaws was being conducted. The questionnaire combined both quantitative and qualitative questions covering perceptions of the cause and mechanisms of transmission of yaws-like lesions, the providers from which individuals would seek healthcare for yaws-like lesions, and what factors were important in reaching decisions on where to seek care. Chi-square tests and logistic regression were used to assess relationships between reported knowledge, attitudes and practices, and demographic variables. Thematic analysis of qualitative data was used to identify common themes. Results: A total of 1,162 individuals participated. The majority of individuals (n = 895, 77%) reported that “germs” were the cause of yaws lesions. Overall 13% (n = 161) of respondents believed that the disease was caused by supernatural forces. Participants frequently mentioned lack of personal hygiene, irregular and inefficient bathing, and washing with dirty water as fundamental to both the cause and the prevention of yaws. A majority of individuals reported that they would want to take an antibiotic to prevent the development of yaws if they were asymptomatic (n = 689, 61.2%), but a substantial minority reported they would not want to do so. A majority of individuals (n = 839, 72.7%) reported that if they had a yaws-like skin lesion they would seek care from a doctor or nurse. Both direct and indirect costs of treatment were reported as key factors affecting where participants reported they would seek care. Discussion: This is the first study that has explored community knowledge, attitudes and practices in relation to yaws in any endemic population. The belief that ‘germs’ are in some way related to disease through a variety of transmission routes including both contact and dirty water are similar to those reported for other skin diseases in Ghana. The prominent role of private healthcare providers is an important finding of this study and suggests engagement with this sector will be important in yaws eradication efforts. Strategies to address the substantial minority of individuals who reported they would not take treatment for yaws if they were currently asymptomatic will be needed to ensure the success of yaws eradication efforts. The data collected will be of value to the Ghana Health Service and also to WHO and other partners, who are currently developing community mobilisation tools to support yaws eradication efforts worldwide. © 2017 Marks et al.Item Modeling the relationship between precipitation and malaria incidence in children from a holoendemic area in Ghana.(2011) Kriefis, A.C.; Schwarz, N.G.; Kruger, A.; Fobil, J.N.; Nkrumah, B.; Acquah, S.; Loag, W.; Sarpong, N.; Adu-Sarkodie, Y.; Ranft, U.; May, J.Climatic factors influence the incidence of vector-borne diseases such as malaria. They modify the abundance of mosquito populations, the length of the extrinsic parasite cycle in the mosquito, the malarial dynamics, and the emergence of epidemics in areas of low endemicity. The objective of this study was to investigate temporal associations between weekly malaria incidence in 1,993 children < 15 years of age and weekly rainfall. A time series analysis was conducted by using cross-correlation function and autoregressive modeling. The regression model showed that the level of rainfall predicted the malaria incidence after a time lag of 9 weeks (mean = 60 days) and after a time lag between one and two weeks. The analyses provide evidence that high-resolution precipitation data can directly predict malaria incidence in a highly endemic area. Such models might enable the development of early warning systems and support intervention measures.Item National health insurance coverage and socio-economic status in a rural district of Ghana.(2010) Sarpong, N.; Loag, W.; Fobil, J.N.; Meyer, C.G.; Adu-Sarkodie, Y.; May, J.; Schwarz, N.G.OBJECTIVE: To explore the association between socio-economic status (SES) and health insurance subscription to the Ghanaian National Health Insurance Scheme (NHIS) of residents of the Asante Akim North district of the Ashanti Region, Ghana. METHODS: In the course of a community survey, data on asset variables (e.g. electricity, housing conditions and other variables) and on NHIS subscription were collected on the household level in 99 villages. Using principal components analysis, households were classified into three categories of SES (20% high, 40% middle and 40% low SES). Odds ratios of NHIS subscription were calculated for all SES categories, using the low category as the reference group and adjusting for travelling time to health facilities by public transport. RESULTS: Of the 7223 households surveyed, 38% subscribed to the NHIS, of these 21% were low, 43% middle and 60% high SES households. SES was significantly associated with NHIS subscription (high SES: OR 4.9, 95% CI 4.3-5.7; middle SES: OR 2.5, 95% CI 2.2-2.9; low SES: OR 1, reference group). CONCLUSION: Four years after its introduction, the NHIS has reached subscription rates of 38% in the district surveyed. However, to achieve the aim of assuring universal access to health care facilities for all residents of Ghana, in particular for individuals living under socio-economic constraints, increasing subscription rates are necessary.Item Prevalence of hepatitis G virus and characterization of viral genome in Ghana.(Hepatology Research, 1999) Saito, T.; Ishikawa, K.; Osei-Kwasi, M.; Kaneko, T.; Brandful, J.A.M.; Nuvor, V.; Aidoo, S.; Ampofo, W.; Apeagyei, F.A.; Ansah, J.E.; Adu-Sarkodie, Y.; Nkrumah, F.K.; Abe, K.The prevalence of hepatitis G virus (HGV) infection was investigated in 85 human immunodeficiency virus (HIV)-infected and 30 uninfected individuals' sera obtained from Ghanaians. HGV RNA in serum was identified by a nested reverse transcription polymerase chain reaction (RT-PCR) using primers derived from the 5′-noncoding region. We also tested for hepatitis C virus by nested RT-PCR and for hepatitis B surface antigen (HBsAg) by passive hemagglutination method. HGV RNA was detected in 17 of 85 (20%) HIV sero-positive and three of 30 (10%) sero-negative Ghanaians, respectively. The prevalence of HGV infection was much greater than hepatitis C (0.9%) and hepatitis B virus (7.8%) infections in the present study. Ninety four percent of HGV infected patients were seronegative for hepatitis B and C virus infections. The nine different Ghanaian isolates in the 5′-untranslated region of the HGV genome had one nucleotide deletion at the same position when compared with other HGV isolates. Phylogenetic analysis showed that all Ghanaian isolates belonged to type 1 (West Africa type) of the HGV genotypes. Moreover, we determined nearly full-length nucleotide sequence of the HGV genome (denoted HGV-GA128) recovered from a Ghanaian infected with HIV. The HGV-GA128 was composed of 9231 nucleotides and had a single open reading frame, encoding 2843 amino acid residues. This isolate differed from previously reported HGV/GBV-C isolates by 10–15% of the nucleotide sequence and 2–5% of the amino acid sequence. Our data indicate a high prevalence of HGV, especially genotype 1, in Ghana.Item A Single Dose Oral Azithromycin versus Intramuscular Benzathine Penicillin for the Treatment of Yaws-A Randomized Non Inferiority Trial in Ghana(Public Library of Science, 2017) Kwakye-Maclean, C.; Agana, N.; Gyapong, J.; Nortey, P.; Adu-Sarkodie, Y.; Aryee, E.; Asiedu, K.; Ballard, R.; Binka, F.Background: Yaws is a treponemal infection that was almost eradicated fifty years ago; however, the disease has re-emerged in a number of countries including Ghana. A single-dose of intramuscular benzathine penicillin has been the mainstay of treatment for yaws. However, intramuscular injections are painful and pose safety and logistical constraints in the poor areas where yaws occurs. A single center randomized control trial (RCT) carried out in Papua New Guinea in 2012 demonstrated the efficacy of a single-dose of oral azithromycin for the treatment of yaws. In this study, we also compared the efficacy of a single oral dose of azithromycin as an alternative to intramuscular benzathine penicillin for the treatment of the disease in another geographic setting. Methodology: We conducted an open-label, randomized non-inferiority trial in three neighboring yaws-endemic districts in Southern Ghana. Children aged 1–15 years with yaws lesions were assigned to receive either 30mg/kg of oral azithromycin or 50,000 units/kg of intramuscular benzathine penicillin. The primary end point was clinical cure rate, defined as a complete or partial resolution of lesions 3 weeks after treatment. The secondary endpoint was serological cure, defined as at least a 4-fold decline in baseline RPR titre 6 months after treatment. Non- inferiority of azithromycin treatment was determined if the upper bound limit of a 2 sided 95% CI was less than 10%. Findings: The mean age of participants was 9.5 years (S.D.3.1, range: 1–15 years), 247(70%) were males. The clinical cure rates were 98.2% (95% CI: 96.2–100) in the azithromycin group and 96.9% (95% CI: 94.1–99.6) in the benzathine penicillin group. The serological cure rates at 6 months were 57.4% (95% CI: 49.9–64.9) in the azithromycin group and 49.1% (95% CI: 41.2–56.9) in the benzathine penicillin group, thus achieving the specified criteria for non-inferiority. Conclusions: A single oral dose of azithromycin, at a dosage of 30mg/kg, was non-inferior to a single dose of intramuscular benzathine penicillin for the treatment of early yaws among Ghanaian patients, and provides additional support for the WHO policy for use of oral azithromycin for the eradication of yaws in resource-poor settings. Trial Registration: Pan African Clinical Trials Registry PACTR2013030005181 http://www.pactr.org/ © 2017 Public Library of Science. All Rights Reserved.Item Systemic bacteraemia in children presenting with clinical pneumonia and the impact of non-typhoid salmonella (NTS).(2010) Schwarz, N.G.; Sarpong, N.; Hunger, F.; Acquah, S.E.K.; Agyekum, A.; Nkrumah, B.; Loag, W.; Hagen, R.M.; Evans, J.A.; Dekker, D.; Fobil, J.N.; Meyer, C.G.; May, J.; Adu-Sarkodie, Y.BACKGROUND: The diagnosis and antimicrobial treatment of pneumonia in African children in the absence of diagnostic means such as x-ray facilities or microbiological laboratories relies primarily on clinical symptoms presented by the patients. In order to assess the spectrum of bacterial pathogens, blood cultures were performed in children fulfilling the clinical criteria of pneumonia. METHODS: In total, 1032 blood cultures were taken from children between 2 months and 5 years of age who were admitted to a rural hospital in Ghana between September 2007 and July 2009. Pneumonia was diagnosed clinically and according to WHO criteria classified as "non-severe pneumonia" and "severe pneumonia" ("severe pneumonia" includes the WHO categories "severe pneumonia" and "very severe pneumonia"). RESULTS: The proportion of bacteriaemia with non-typhoid salmonella (NTS) was similar in children with pneumonia (16/173, 9.2%) compared to children hospitalized for other reasons (112/859, 13%). NTS were the predominant organisms isolated from children with clinical pneumonia and significantly more frequent than Streptococcus pneumoniae (8/173, 4.6%). Nine percent (9/101) of children presenting with severe pneumonia and 10% (7/72) of children with non-severe pneumonia were infected with NTS. Nineteen out of 123 NTS isolates (15%) were susceptible to aminopenicillins (amoxycillin/ampicillin), 23/127 (18%) to chlorampenicol, and 23/98 (23%) to co-trimoxazole. All NTS isolates were sensitive to ceftriaxone and ciprofloxacin. CONCLUSION: In Sub-saharan Africa, sepsis with NTS should be considered in children with symptoms of pneumonia and aminopenicillins might often not be the adequate drugs for treatment.