Browsing by Author "Afari, E.A."

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Antibody response to 17D yellow fever vaccine in Ghanaian infants
(2001) Osei-Kwasi, M.; Dunyo, S.K.; Koram, K.A.; Afari, E.A.; Odoom, J.K.; Nkrumah, F.K.
To assess the seroresponses to yellow fever vaccination at 6 and 9 months of age; assess any possible adverse effects of immunization with the 17D yellow fever vaccine in infants, particularly at 6 months of age. METHODS: Four hundred and twenty infants who had completed BCG, OPV and DPT immunizations were randomized to receive yellow fever immunization at either 6 or 9 months. A single dose of 0.5 ml of the reconstituted vaccine was administered to each infant by subcutaneous injection. To determine the yellow fever antibody levels of the infants, each donated 1 ml whole blood prior to immunization and 3 months post-immunization. Each serum sample was titred on Vero cells against the vaccine virus. FINDINGS: The most common adverse reactions reported were fever, cough, diarrhoea and mild reactions at the inoculation site. The incidences of adverse reactions were not statistically different in both groups. None of the pre-immunization sera in both age groups had detectable yellow fever antibodies. Infants immunized at 6 months recorded seroconversion of 98.6% and those immunized at 9 months recorded 98% seroconversion. The GMT of their antibodies were 158.5 and 129.8, respectively. CONCLUSIONS: The results indicate that seroresponses to yellow fever immunization at 6 and 9 months as determined by seroconversion and GMTs of antibodies are similar. The findings of good seroresponses at 6 months without significant adverse effects would suggest that the 17D yellow fever vaccine could be recommended for use in children at 6 months in outbreak situations or in high risk endemic areas.
Antibody response to measles immunization at seven months old in rural Ghanaian infants
(Ghana Medical Journal, 1990-03) Sakatoku, H.; Nakano, T.; Afari, E.A.
A serological study was carried out in three rural communities in southern Ghana in order to determine the optimal age for measles immunization. The live hyperattenuated measles vaccine (Schwarz strain) was inoculated subcutaneously; into infants aged three to eleven months. The maternal measles antibodies in the infants started decreasing after 7 months, while the seroconversion rate after the immunization was increasing after 6 months. Forty seven infants were given the measles vaccines at the age of 7 months. The seroconversion rate was 91.5%. There were no side effects. These results indicate that measles immunization can be administered effectively at the age of 7 months.
Antibody response to measles immunization in rural - Ghanaian infants
(1994-10) Sakatoku, H.; Nakano, T.; Arai, S.; Afari, E.A.
We investigated optimal age of measles immunization in infants aged 3-11 months in rural villages of Ghana, and determined seroconversion rate in the same infant population following further attenuated measles vaccination with Schwarz vaccine. The prevalence of passively acquired antibody was 11 per cent in infants younger than 6 months, 10 per cent in infants 6 months old, and 3 per cent in infants 7 months old or older. Seroconversion rates in each age group were less than 50, 87, and 92 per cent, respectively. We then immunized 47 7-month-old infants. The seroconversion rate was 92 per cent in this group. There were no clinical adverse effects due to the vaccination. We conclude that measles vaccination could be administered effectively at the age of 7 months with an excellent seroconversion rate.
Assessing malaria control in the kassena-nankana district of northern Ghana through repeated surveys using the RBM tools
(2007-08-04) Owusu-Agyei, S.; Awini, E.; Anto, F.; Mensah-Afful, T.; Adjuik, M.; Hodgson, A.; Afari, E.A.; Binka, F.
The goal of Roll Back Malaria (RBM) is to reduce malaria morbidity and mortality by 50% by the year 2010, and still further thereafter until the disease becomes no more a threat to public health. To contribute to the monitoring and evaluation process of this goal, two surveys were carried out in 2000 and 2003 in households and health facilities in the Kassena-Nankana district, northern Ghana using the RBM-WHO/AFRO monitoring and evaluation tools for malaria control activities. METHODS: Data were collected from mothers/caretakers on signs/symptoms of the most recent malaria attack for their under five year old children; the management actions that they took and their perception of health services provided at the health facilities, bednet use, antenatal attendance and place of delivery for the most recent pregnancy, malaria prophylaxis during their last pregnancy. Community health workers and herbalist/traditional healers were also interviewed about the types of health services they provide to community members. RESULTS: The results revealed a significant improvement in knowledge among mothers/caretakers over the three-year period; this affected caretakers' initial management of illnesses of their young children. The management in terms of the type and dosage of drugs used also improved significantly (p < 0.0001) over the period. Reported insecticide-treated bed net use among children under-five years and pregnant women significantly increased between 2000 and 2003 (p < 0.0001). Health professionals had improved on adoption of their quality of care roles. The intensification of malaria control activities and awareness creation in this district over a three year period had started demonstrating positive results towards reducing malaria disease burden. CONCLUSION: Periodic performance assessments through surveys as described and prompt feedback of results to stakeholders in the locality serves as a catalyst to improving malaria control in malaria-endemic countries.
Assessment of Household Solid Waste Management Practices in the Sunyani West District
(University of Ghana, 2016-07) Asante, J.; Afari, E.A.; University of Ghana, College of Health Sciences, School of Public Health
Background: Sanitation is an important foundation for health, economic development and well-being hence waste management (Bartram &Cairncross2010; WSP 2010).The perception of household waste as unwanted material with no intrinsic value has dominated attitudes towards it management. Waste management is therefore defined as the collection, storage, transportation, processing, treatment, recycling and final disposal of waste. The study was conducted in the sunyani west district. The objective of the study is to assess household solid waste management practices in the sunyani west district. Methods: The study employed a descriptive cross sectional study design and used mixed methods such as quantitative and qualitative for data collection. The sample size for the study is 384. The sampling method used was simple random sampling method. Ethical approval was received from the ethics review committee of the Ghana health service for this study. Permission was also sought from district health directorate as well as district assembly. Data was analyzed using stata version 13. Results: the study reveals that more than half (52.30%) of the waste generated by households are food debris, (28.60%) are plastic waste and (19.10%) for that of bottles and cans. More than half (73.4%) of the participant dispose their waste indiscriminately and that of designated site contributed to (26.6%). Majority of the respondent engages in inappropriate practices (57.0%) of household solid waste management practices whiles that of appropriate practices contributed to 43.0% in the study. It was discovered that gender, level of education, monthly earnings, residential unit and household sizes were significantly associated with household solid waste management practices (p<0.05). Conclusion: In conclusion Socio-economic, behavioral and institutional support factors were potential factors influencing household solid waste management practice. Intensive education of the public, provision of bins and piles of containers, enforcement of waste management laws could help contribute to good household waste management practices.
Assessment of Strategic Management Practice of Malaria Control in the Dangme West District, Ghana
(University of Ghana, 2007-09) Adelaide, M.; Wurapa, F.K.; Afari, E.A.; Asante, R.K.O.; University of Ghana, College of Health Sciences, School of Public Health
Objective: To assess the strategic management practice for malaria control in the Dangme West district. Methods: Strategic management (SM) practice was assessed in all HCFs both in the public and private and some chemical shops within the Dangme West district using semistructured questionnaires and question guides. In-depth interviews were carried out with healthcare providers in their clinical setting. The status of key malaria control indicators was assessed by interviewing 385 healthcare consumers and 100 pregnant women who were selected by multi-stage cluster sampling from 21 communities. The study utilized both qualitative and quantitative methods in describing the SM practice and assessing status of key malaria control indicators. In addition to the above data was also collected through desk top reviews of HCFs‟ records, district‟s health annual reports, published and unpublished literature, textbooks, etc. Results: Healthcare managers were using all the elements of SM in the management of malaria but these were not holistically coordinated. Present were short ranged informal planning based on the objectives of NMCP and day-to-day operation of the HCFs especially with Ghana Health Service facilities. Due to homogenous nature of Dangme West district, management of culture wasn‟t given much attention by healthcare managers though healthcare providers were acutely aware of its importance to quality service delivery. Competition was woefully absent in the healthcare environment. No formal structure has been created for the management of malaria control activities with the exception of the involvement of Community Based agents. The district was widely implementing all the strategies of the NMCP with favourable outcomes. Conclusions: The practice of strategic management though present in the district, it was fragmented. Hence, while there was significant improvement in the status of key malaria control indicators, this could have been further enhanced if the practice of strategic management has been carried out in a more holistic way. Thus, the assumption; the degree to which malaria control is systematically managed using the process of SM will enhance the status of key malaria control programme indicators is true. HCFs should be able to define their needs based on the realistic needs of the communities and develop plans, which would creatively lead to competitive advantage. There should be adequate involvement of chemical sellers in training programmes for healthcare providers with keen supervision and monitoring of their activities within the district. BCC should target groups to make it more acceptable using local approaches. Strategic Management should be developed as a taught course for In-Service Training within the service for all staff in leadership and management positions. Key words: Assessment,
Assessment of Strategic Management Practice of Malaria Control in the Dangme West District, Ghana
(University of Ghana, 2007-09) Ofei, A.M.A.; Wurapa, F.K.; Afari, E.A.; Asante, R.K.O.; University of Ghana, College of Health Sciences, School of Public Health
Objective: To assess the strategic management practice for malaria control in the Dangme West district. Methods: Strategic management (SM) practice was assessed in all HCFs both in the public and private and some chemical shops within the Dangme West district using semi- structured questionnaires and question guides. In-depth interviews were carried out with healthcare providers in their clinical setting. The status of key malaria control indicators was assessed by interviewing 385 healthcare consumers and 100 pregnant women who were selected by multi-stage cluster sampling from 21 communities. The study utilized both qualitative and quantitative methods in describing the SM practice and assessing status of key malaria control indicators. In addition to the above data was also collected through desk top reviews of HCFs‟ records, district‟s health annual reports, published and unpublished literature, textbooks, etc. Results: Healthcare managers were using all the elements of SM in the management of malaria but these were not holistically coordinated. Present were short ranged informal planning based on the objectives of NMCP and day-to-day operation of the HCFs especially with Ghana Health Service facilities. Due to homogenous nature of Dangme West district, management of culture wasn‟t given much attention by healthcare managers though healthcare providers were acutely aware of its importance to quality service delivery. Competition was woefully absent in the healthcare environment. No formal structure has been created for the management of malaria control activities with the exception of the involvement of Community Based agents. The district was widely implementing all the strategies of the NMCP with favourable outcomes. vConclusions: The practice of strategic management though present in the district, it was fragmented. Hence, while there was significant improvement in the status of key malaria control indicators, this could have been further enhanced if the practice of strategic management has been carried out in a more holistic way. Thus, the assumption; the degree to which malaria control is systematically managed using the process of SM will enhance the status of key malaria control programme indicators is true. HCFs should be able to define their needs based on the realistic needs of the communities and develop plans, which would creatively lead to competitive advantage. There should be adequate involvement of chemical sellers in training programmes for healthcare providers with keen supervision and monitoring of their activities within the district. BCC should target groups to make it more acceptable using local approaches. Strategic Management should be developed as a taught course for In-Service Training within the service for all staff in leadership and management positions.
Comparison of AIK-C measles vaccine in infants at 6 months with schwarz vaccine at 9 months: A randomized controlled trial in Ghana
(1998) Nkrumah, F.K.; Osei-Kwasi, M.; Dunyo, S.K.; Koram, K.A.; Afari, E.A.
In a randomized controlled trial in a measles endemic area, standard-dose (4.0 log10pfu) AIK-C measles vaccine administered at 6 months of age was compared to standard-dose Schwarz vaccine (3.7log10pfu) given at 9 months. Seroconversion rates at 3 and 6 months after immunization in the two groups were comparable and similar. The geometric mean titres achieved were, however, significantly higher in the Schwarz group (P < 0.05). No immediate serious side-effects were observed with either vaccine. We conclude that standard-dose AIK-C measles vaccine can be recommended for measles immunization in children below 9 months of age, especially in highly endemic and high-risk areas in developing countries. PIP: The seroresponse of standard-dose heat-stable AIK-C measles vaccine administered to infants at 6 months of age was compared to that of standard-dose Schwarz vaccine administered at 9 months of age in a measles-endemic area in West Africa. The study was conducted in Asamankese, the capital town of Ghana's East Akim District. Infants 24-27 weeks of age who had been attending the Asamankese maternal-child health clinic regularly and had received all the required immunizations were enrolled and randomly assigned to receive the AIK-C (n = 184) or the Schwarz (n = 193) vaccine. No severe adverse reactions were reported during the 10-day follow-up period in either vaccine group. In the AIK-C group, 96.9% of infants who were seronegative at preimmunization and 79.4% of those with preexisting antibodies had seroconverted by 3 months after immunization; at 6 months after immunization, these rates were 97.3% and 100%, respectively. In the Schwarz group, 98.2% of infants seronegative at immunization and 100% of those with preexisting antibodies seroconverted by 3 months after immunization; at 6 months, these rates were 99.1% and 80%, respectively. Although the geometric mean titres achieved were significantly higher in the Schwarz vaccine group, these titres were above the protective level of 200 mIU in the AIK-C group. Administration of measles vaccine at a younger age may be more easily incorporated into current Expanded Program on Immunization schedules.
Determinants of low birth weight in neonates born in three hospitals in Brong Ahafo region, Ghana, 2016- an unmatched case-control study
(BMC Pregnancy and Childbirth, 2019-04-25) Nortey, P.; Adam, Z.; Ameme, D.K.; Afari, E.A.; Kenu, E.
Background: Each year, about 20 million Low Birth Weight (LBW) babies are born with very high proportion (96.5%) occurring in developing countries. In the last decade, the incidence of LBW in Ghana has not declined. Brong Ahafo Region of Ghana recorded a LBW prevalence of 11% which was higher than the national average of 10%. This study identified determinants of LBW delivery in the Brong Ahafo Region. Methods: We conducted a 1:2 unmatched case control study among mothers with singleton deliveries in 3 major health facilities in the Brong Ahafo Region. A case was defined as a mother who delivered a baby weighing less than 2500g in any of the three selected health facilities between 1st December, 2015 and 30th April, 2016. A control was defined as a mother who within 24 h of delivery by a case, delivered a baby weighing at least 2500g and not exceeding 3400g in the same health facility. Deliveries that met the inclusion criteria for cases were selected and two controls were randomly selected from the pool of deliveries that meet criteria for controls within 24 h of delivery of a case. A total of 120 cases and 240 control were recruited for the study. We computed odds ratios at 95% confidence level to determine the associations between low birth weight and the dependent factors. Results: After controlling for confounders such as planned pregnancy, mode of delivery, parity and previous LBW in stepwise backward logistic regression, first trimester haemoglobin < 11 g/dl (aOR 3.14; 95%CI: 1.50–6.58), delivery at 32-36 weeks gestation (aOR 13.70; 95%CI: 4.64–40.45), delivery below 32 weeks gestation (aOR 58.5; 95%CI 6.7–513.9), secondary education of mothers (aOR 4.19; 95%CI 1.45–12.07), living with extended family (aOR 2.43; 95%CI 1.15–5.10, living alone during pregnancy (aOR 3.9; 95%CI: 1.3–11.7), and not taking iron supplements during pregnancy (aOR 3.2; 95%CI: 1.1–9.5) were found to be significantly associated with LBW. Conclusion: Determinants of LBW were: preterm delivery, mothers with secondary education, living alone during pregnancy, not taking daily required iron supplementation and mothers with first trimester haemoglobin below 11 g/dl. Education during antenatal sessions should be tailored to address the identified risk factors in the mother and child health care services.
Differences in age-specific HPV prevalence between self-collected and health personInfectious Agents and Cancernel collected specimen in a cross-sectional study in Ghana
(Infectious Agents and Cancer, 2017) Awua, A.K.; Adanu, R.M.K.; Wiredu, E.K.; Afari, E.A.; Severini, A.
Background: Solid medical waste (SMW) in households is perceived to pose minimal risks to the public compared to SMW generated from healthcare facilities. While waste from healthcare facilities is subject to recommended safety measures to minimize risks to human health and the environment, similar waste in households is often untreated and co-mingled with household waste which ends up in landfills and open dumps in many African countries. In Ghana, the management of this potentially hazardous waste stream at household and community level has not been widely reported. The objective of this study was to investigate household disposal practices and harm resulting from SMW generated in households and the community. Methods: A cross-sectional questionnaire survey of 600 households was undertaken in Ga South Municipal Assembly in Accra, Ghana from mid-April to June, 2014. Factors investigated included socio-demographic characteristics, medication related practices, the belief that one is at risk of diseases associated with SMW, SMW disposal practices and reported harm associated with SMW at home and in the community. Results: Eighty percent and 89% of respondents discarded unwanted medicines and sharps in household refuse bins respectively. A corresponding 23% and 35% of respondents discarded these items without a container. Harm from SMW in the household and in the community was reported by 5% and 3% of respondents respectively. Persons who believed they were at risk of diseases associated with SMW were nearly three times more likely to report harm in the household (OR 2.75, 95%CI 1.15-6.54). Conclusion: The belief that one can be harmed by diseases associated with SMW influenced reporting rates in the study area. Disposal practices suggest the presence of unwanted medicines and sharps in the household waste stream conferring on it hazardous properties. Given the low rates of harm reported, elimination of preventable harm might justify community intervention. © 2017 The Author(s).
Direct observation of outpatient management of malaria in a rural ghanaian district
(Pan African Medical Journal, 2014-12) Ameme, D.K.; Afari, E.A.; Nyarko, K.M.; Malm, K.L.; Sackey, S.; Wurapa, F.
Introduction: in Ghana, malaria continues to top outpatient morbidities; accounting for about 40% of all attendances. Effective case-management is key to its control. We evaluated case-management practices of uncomplicated malaria in Kwahu South District (KSD) health facilities to determine their conformity to guidelines.Methods: we conducted a cross sectional survey at all public health facilities in three randomly selected sub-districts in KSD. A non-participatory observation of suspected malaria consultations was conducted. Suspected malaria was defined as any person with fever (by history or measured axillary temperature > or equal 37.5 oC) presenting at the selected health facilities between 19th and 29th April 2013. Findings were expressed as frequencies, relative frequencies, mean (± standard deviation) and median.Results: of 70 clinical observations involving 10 prescribers in six health facilities, 40 (57.1%) were females and 16 (22.9%) were below five years. Median age was 18 years (interquartile range: 5-33). Overall, 63 (90.0%) suspected case-patients had diagnostic tests. Two (3.6%) were treated presumptively. All 31 confirmed and 10 (33.3%) of the test negative case-patients received Artemisinin-based Combination Therapies (ACTs). However, only 12 (27.9%) of the 43 case-patients treated with ACT received Artesunate-Amodiaquine (AA). Only three (18.8%) of the under-fives were examined for non-malarial causes of fever. Mean number of drugs per patient was 3.7 drugs (± 1.1). Only 45 (64.3%) patients received at least one counseling message.Conclusion: conformity of malaria case-management practices to guidelines in KSD was suboptimal. Apart from high rate of diagnostic testing and ACT use, prescription of AA, physical examination and counseling needed improvement. © Donne Kofi Ameme et al.
Epidemiological link of a major cholera outbreak in Greater Accra region of Ghana, 2014
(BioMed Central Ltd., 2017) Ohene-Adjei, K.; Kenu, E.; Bandoh, D.A.; Addo, P.N.O.; Noora, C.L.; Nortey, P.A.; Afari, E.A.
Background: Cholera remains an important public health challenge globally. Several pandemics have occurred in different parts of the world and have been epidemiologically linked by different researchers to illustrate how the cases were spread and how they were related to index cases. Even though the risk factors associated with the 2014 cholera outbreak were investigated extensively, the link between index cases and the source of infection was not investigated to help break the transmission process. This study sought to show how the index cases from various districts of the Greater Accra Region may have been linked. Methods: We carried out a descriptive cross sectional study to investigate the epidemiological link of the 2014 cholera outbreak in the Greater Accra region of Ghana. An extensive review of all district records on cholera cases in the Greater Accra region was carried out. Index cases were identified with the help of line lists. Univariate analyses were expressed as frequency distributions, percentages, mean ± Standard Deviation, and rates (attack rates, case-fatality rates etc.) as appropriate. Maps were drawn using Arc GIS and Epi info software to describe the pattern of transmission. Results: Up to 20,199 cholera cases were recorded. Sixty percent of the cases were between 20 and 40 years and about 58% (11,694) of the total cases were males. Almost 50% of the cases occurred in the Accra Metro district. Two-thirds of the index cases ate food prepared outside their home and had visited the Accra Metropolis. Conclusions: The 2014 cholera outbreak can be described as a propagated source outbreak linked to the Accra Metropolis. The link between index cases and the source of infection, if investigated earlier could have helped break the transmission process. Such investigations also inform decision-making about the appropriate interventions to be instituted to prevent subsequent outbreaks.
Evaluation of bacterial meningitis surveillance data of the northern region, Ghana, 2010-2015
(University of Ghana, 2017) Kaburi, B.B.; Kubio, C.; Kenu, E.; Ameme, D.K.; Mahama, J.Y.; Sackey, S.O.; Afari, E.A.
Introduction: Bacterial meningitis is a disease of major public health importance especially for countries such as Ghana; whose northern part lies within the meningitis belt. The Northern region of Ghana has been recording cases with outbreaks over the years. In order to generate evidence to improve surveillance, we described the epidemiology of bacterial meningitis using surveillance data of the northern region. Methods: Bacterial meningitis datasets from January 2010 to December 2015 for all the 26 districts of the Northern region were retrieved from line lists. Data were analyzed in terms of person, place, time, and identity of causative organisms using descriptive statistics. The results were presented as proportions, rates, tables and graphs. Results: A total of 1,176 cases were reported. Of these, 53.5% (629/1,176) were males. The proportion of cases aged 0 to 29 years was 77.4%. The Overall Case Fatality Rate (CFR) was 9.7% (114/1,176). About 65% of all cases were recorded from January to April. Only 23.7% (279/1,176) of cases were laboratory-confirmed. Neisseria meningitides and Streptococcus pneumonia accounted for 91.4% of confirmed cases. Over the period, the incidence reduced from 9.0/100,000 population to 3.8/100,000 population and CFR reduced from 16.6% to 5.7%. Conclusion: Most cases of bacterial meningitis were recorded in the dry season and in persons younger than 30 years. Less than a quarter of cases were laboratory confirmed, and no new bacteria species were identified. Both morbidity and mortality rates were on the decline. There is the need to consolidate these gains by intensifying meningitis surveillance and improving on the rate of laboratory case confirmation. © Basil Benduri Kaburi et al.
Exposure of Small Scale Gold Miners in Prestea to Mercury, Ghana
(University of Ghana, 2012-07) Mensah, E.K.; Afari, E.A.
Background: Mercury is commonly used in Artisanal Small-Scale Gold Mining (ASGM) to amalgamate gold. Mercury use in ASGM is a global public health problem, since it is the world’s fastest source of mercury contamination. Mercury is toxic even at low concentration and exposure is of great concern since it is a potent neurotoxicant. Mercury poisoning among small scale gold miners has been observed in many small scale gold mining regions across the world. ASGM is a rapidly growing industry in Prestea where miners handle mercury without personal protective equipment (PPE). This study seeks to assess occupational exposure of small scale gold miners in Prestea to mercury. Method: Morning urine samples were collected from 343 consenting small scale gold miners at their work sites in Prestea. A structured questionnaire was used to collect information from the miners. A work place assessments and interviews were conducted at the small scale gold mines. Urine samples were analyzed at the laboratory for elemental mercury. Univariate analysis was expressed as frequencies, percentages, mean±SD, tables and figures. Association between mercury exposure; adverse health effects and occupational exposure was determined at 95% CL. Results: Of the 343 participants urine samples, 160(46.65%) of them exceeded the guideline value for individuals not occupationally exposed to mercury (<5.0ug/L). Of the 160 (46.65%) participants exposed to mercury, 122 (35.57%) of them, their urine mercury level was between (5.00-20.00ug/L), while the remaining 38(11.08%) had urine mercury level (>20.00ug/L). There were no significant association between mercury exposure; and complaints of skin rashes (χ 2 =3.49, p=0.062), red eyes (χ 2 =3.22, p=0.073), and metallic taste (χ 2 =3.72, p=0.054). Complaints of numbness, however, were significantly associated with mercury exposure among participants who have previously worked at other small scale gold mines before moving to Prestea (χ 2 =4.96, p=0.026). Standing in a pool of water or stream whiles working at the mining site (OR: 1.31, 95% CI: 0.81-2.09), sucking of excess mercury from the amalgam for re-use with the mouth (OR: 1.37, 95% CI: 0.78-2.39) and amalgamating with mercury (OR: 2.14, 95% CI: 0.77- 5.94) were associated with mercury exposure; however, these were not significant. Majority 335 (97.7%) had no occupational safety training in handling mercury and the use of PPE among the participants was very low. Retorts for burning amalgam was not found at mining sites visited. Conclusion: Small scale gold miners in Prestea are experiencing mercury exposure in excess of occupational exposure guidelines, and are at risk of mercury intoxication. Prestea Huni-Valley District Health Directorate, the Environmental Protection Agency and the Minerals Commission should organize regular medical screening and occupational safety training in handling mercury; and also mobilize retorts for burning gold amalgam for the small scale gold mining communities in Prestea.
Health centre versus home presumptive diagnosis of malaria in southern Ghana: Implications for home-based care policy.
(2000) Dunyo, S.K.; Afari, E.A.; Koram, K.A.; Ahorlu, C.K.; Abubakar, I.; Nkrumah, F.K.
A study was conducted in 1997 to compare the accuracy of presumptive diagnosis of malaria in children aged 1-9 years performed by caretakers of the children to that of health centre staff in 2 ecological zones in southern Ghana. Similar symptoms were reported in the children at home and at the health centre. In the home setting, symptoms were reported the same day that they occurred, 77.6% of the children with a report of fever were febrile (axillary temperature ≥ 37.5°C)and 64.7% of the reports of malaria were parasitologically confirmed. In the health centre, the median duration of symptoms before a child was seen was 3 days (range 1-14 days), 58.5% of the children with a report of fever were febrile and 62.6% of the clinically diagnosed cases were parasitologically confirmed. In the 2 settings almost all the infections were due to Plasmodium falciparum. Parasite density was 3 times higher in the health centre cases compared to the home-diagnosed cases. Early and appropriate treatment of malaria detected in children by caretakers may prevent complications that arise as a result of persistence of symptoms and attainment of high parasitaemic levels.
Human T-cell recognition of synthetic peptides representing conserved and variant sequences from the merozoite surface protein 2 of plasmodium falciparum
(1997-06) Theander, T.G.; Hviid, L.; Dodoo, D.; Afari, E.A.; Jensen, J.B.; Rzepczyk, C.M.
Merozoite surface protein 2 (MSP2) is a malaria vaccine candidate currently undergoing clinical trials. We analyzed the peripheral blood mononuclear cell (PBMC) response to synthetic peptides corresponding to conserved and variant regions of the FCQ-27 allelic form of MSP2 in Ghanaian individuals from an area of hyperendemic malaria transmission and in Danes without exposure to malaria. PBMC from 20-39% of Ghanaians responded to each of the peptides by proliferation and 29-36% had PBMC which produced interferon-gamma (IFN-gamma) in response to peptide stimulation. In Danes, there was no proliferation to two of the peptides and only PBMC from 5% of the individuals proliferated to the other three peptides. IFN-gamma production was not detected to any peptide. In both Danes and Ghanaians in only a few instances was IL-4 detected in the PBMC cultures. Overall PBMC from 79% of the Ghanaians responded by proliferation and/or cytokine secretion to at least one of three peptides tested, whereas responses were only observed in 14% of Danes (P = 0.002). These data suggest that the Ghanaians had expanded peripheral blood T-cell populations recognizing the peptides as a result of natural infection. The findings are encouraging for the development of a vaccine based on these T-epitope containing regions of MSP2, as the peptides were broadly recognized suggesting that they can bind to diverse HLA alleles and also because they include conserved MSP2 sequences. Immunisation with a vaccine construct incorporating the sequences present in these peptides could thus be expected to be immunogenic in a high percentage of individuals and lead to the establishment of memory T-cells, which can be boosted through natural infection.
Impact of primary health care on child morbidity and mortality in rural Ghana: The Gomoa experience
(Central African Journal of Medicine, 1995-05) Afari, E.A.; Nkrumah, F.K.; Nakana, T.; Sakatoku, H.; Hori, H.; Binka, F.
The impact of a combination of PHC intervention activities on child survival, growth, morbidity and mortality was assessed in three selected rural communities (Gomoa Fetteh, Gomoa Onyadze/Otsew Jukwa and Gomoa Mprumem) in the Central Region of Ghana from 1987 to 1990. EPI, provision of basic essential drugs and supplies for the treatment of common childhood diseases, treatment of the sick child, growth monitoring, health education, provision of antenatal services, family planning, training and supervision of Community Health Workers, disease surveillance and special studies were the major PHC strategies used to improve the health of the child and the pregnant woman in the three communities. These activities in their totality have had significant impact on morbidity and mortality in children under five and on maternal mortality in children under five and on maternal mortality over the study period 1987 to 1990. Although malaria, acute respiratory infections and diarrhoea diseases continue to be major causes of childhood morbidity, deaths due to these diseases have dramatically declined. Measles and other vaccine preventable diseases no longer contribute significantly to childhood morbidity and mortality. Infant and under five mortality have been reduced from 114.6/1000 and 155.6/1000 live births to 40.8/1000 and 61.2/1000 live births respectively. The crude birth rates however, remain almost the same over the five year period (43 to 48/1000 pop.) but crude death rates have declined (11 to 12.4/1000 pop.).(ABSTRACT TRUNCATED AT 250 WORDS)
Impact of primary health care on child morbidity and mortality in rural Ghana: The Gomoa experience [corrected].
(1995) Afari, E.A.; Nkrumah, F.K.; Nakana, T.; Sakatoku, H.; Hori, H.; Binka, F.
The impact of a combination of PHC intervention activities on child survival, growth, morbidity and mortality was assessed in three selected rural communities (Gomoa Fetteh, Gomoa Onyadze/Otsew Jukwa and Gomoa Mprumem) in the Central Region of Ghana from 1987 to 1990. EPI, provision of basic essential drugs and supplies for the treatment of common childhood diseases, treatment of the sick child, growth monitoring, health education, provision of antenatal services, family planning, training and supervision of Community Health Workers, disease surveillance and special studies were the major PHC strategies used to improve the health of the child and the pregnant woman in the three communities. These activities in their totality have had significant impact on morbidity and mortality in children under five and on maternal mortality in children under five and on maternal mortality over the study period 1987 to 1990. Although malaria, acute respiratory infections and diarrhoea diseases continue to be major causes of childhood morbidity, deaths due to these diseases have dramatically declined. Measles and other vaccine preventable diseases no longer contribute significantly to childhood morbidity and mortality. Infant and under five mortality have been reduced from 114.6/1000 and 155.6/1000 live births to 40.8/1000 and 61.2/1000 live births respectively. The crude birth rates however, remain almost the same over the five year period (43 to 48/1000 pop.) but crude death rates have declined (11 to 12.4/1000 pop.).
In vitro response of P.falciparum to chloroquine, amodiaquine, quinine and sulfadoxine/pryrimethamine in Ghana.
(Ghana Medical Journal, 1989-12) Akanmori, B.D.; Afari, E.A.; Nakano, T.; Ofori-Adjei, D.; Gyan, B.; Owusu-Adjei, S.; Adjei, A.A.
In Vitro asexual parasite sensitivity to chloroquine, amodiaquine, quinine, and sulfadoxine/pyrimethamine (SDZ/PYR) combination was determined for Plasmodium falciparum isolates from children in three schools at Nima (Urban), Madina (Peri urban) and Gomoa Fetteh (Rural), during the rainy season. Chloroquine resistance was present in 625% of children at Nima, 69.6% (23136) of children at Madina and 50% (16132) of those in Gomoa Fetteh. Resistance of P. falciparum to amodiaquine was recorded in 30% (6/20),35.7% (5/14) and 12.5% (1/8) of children in Nima, Madina and Gomoa Fetteh respectively. In addition parasite resistance to SDX/PYR was found in children in Nima, Madina and in one child at Gomoa Fetteh. Resistance to both chloroquine and amodiaquine was present in 3 children at Nima, 5 at Madina and in a single child at Gomoa Fettteh. Resistance to both chloroquine and SDX/PYR and to Amodiaquine and SDXIPYR was restricted to only Nima (2/15, 1/15) .and Madina 3/14, 2/15). There was no resistance to quinine in any of the areas studied. A progressive increase in minimum inhibitory concentrations (IC9O) for chloroquine was observed from Nima and Madina to rural Gomma Fetteh. Similarly, IC90 for amodiaquine was highest in Madina. The presence of multiple-drug resistant P. falciparum in these children represents a challenge to the control and management of falciparum malaria and this data serves as a baseline for monitoring any changes in parasite sensitivity to antimalarial drugs in the study areas
In vitro responses of P. falciparum parasites to chloroquine, amodiaquine and quinine in two ecological zones in Ghana
(1993-07) Afari, E.A.; Akanmori, B.D.; Nakano, T.; Ofori-Adjei, D.
Blood specimens were taken from 318 school children with at least 1,000 and not more than 80,000 P. falciparum asexual parasites per microliter of blood for a 30 hour in vitro microtest of P. falciparum asexual parasites responses to chloroquine, amodiaquine and quinine. The study was conducted in primary schools in four urban and three rural communities in the costal and forest zones in Ghana between June 1988 and December 1990. Chloroquine resistance was present in 58.7 pc (54/92) and 3.9 pc (4/103) of the successful in vitro tests in the coastal and forest zones respectively. Resistance to amodiaquine was recorded in 28.6 pc (12/42) of the successful tests in coastal zone. There was no resistance to quinine in any of the ecological zones. Concentrations of the three drugs in pmol required for 90 pc inhibition of schizont maturation were generally higher in communities in the coastal zone than those in the forest zone. The results suggest an increase in sensitivity or a reduction in resistance of P. falciparum to the drugs from the coast to the forest zone.