Department of Epidemiology and Disease Control

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    Limiting spread of COVID-19 in Ghana: Compliance audit of selected transportation stations in the Greater Accra region of Ghana
    (PLOS ONE, 2021) Bonful, H.A.; Addo-Lartey, A.; Aheto, J.M.K.; et al.
    Globally, little evidence exists on transmission patterns of COVID-19. Recommendations to prevent infection include appropriate and frequent handwashing plus physical and social distancing. We conducted an exploratory observational study to assess compliance with these recommendations in selected transportation stations in Ghana. A one-hour audit of 45 public transport stations in the Greater Accra region was carried out between 27th and 29th March 2020. Using an adapted World Health Organization (WHO) hand hygiene assessment scale, the availability and use of handwashing facilities, social distancing, and ongoing public education on COVID-19 prevention measures were assessed, weighted, and scored to determine the level of compliance of stations. Compliance with recommendations was categorized as “inadequate” “basic”, “intermediate” and “advanced”, based on the overall score. The majority (80%) of stations in Accra have at least one Veronica Bucket with flowing water and soap, but the number of washing places at each station is not adequate. Only a small minority (18%) of stations were communicating the need to wash hands frequently and appropriately and to practice social/physical distancing while at the station. In most stations (95%), hand washing practice was either not observed, or only infrequently. Almost all stations (93%) did not have alcohol-based hand sanitizers available for public use, while social distancing was rarely practiced (only 2%). In over 90% of the stations, face masks were either not worn or only worn by a few passengers. Compliance with COVID-19 prevention measures was inadequate in 13 stations, basic in 16 stations, intermediate in 7 stations, and advanced in 9 stations. Compliance with COVID-19 prevention measures in public transportation stations in the Greater Accra region remains a challenge. Awareness creation should aim to elevate the COVID-19 risk perception of transportation operators and clients. Transport operators and stations need support and guidance to enforce hand washing and social distancing.
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    Human Papillomavirus (HPV) Infection And Its Association With Cervical Dysplasia Among HIV Positive Women Attending Art Clinic, Korle-Bu Teaching Hospital, Accra
    (University Of Ghana, 2019-07) Amelor, D.K.
    Globally, about 35 million people are living with HIV of which 16 million are women aged 15 years and above, 80% of whom live in the Sub-Saharan African region These women living with HIV (WLHIV), especially those having low CD4 T-cell counts are more likely to be infected with human papillomaviruses (HPV), which are the major cause of cervical cancer and it’s precursor lesions. But less is known about the prevalence of HPV infection and the specific types involved in this particular population of women in Ghana. A cross-sectional study was carried out to establish the distribution of genital HPV genotypes among an unscreened population of WLHIV attending a special HIV outpatient clinic at the Korle-Bu Teaching hospital (KBTH) Accra, Ghana. Cervical swabs were available for 538 eligible women. A nested multiplex PCR (NMPCR) assay was conducted for the detection and typing of HPV genotypes 6/11, 16,18, 31, 33, 35, 39, 42, 43, 44, 45, 51, 52, 56, 58, 59, 66, and 68. Cervical smears were also prepared and examined independently for cytologic abnormalities by two cytologists and confirmed by a pathologist. HPV DNA was detected in 52.0% of all cervical swabs tested, the prevalence of LR (Low Risk) HPV was 10.2% (95% CI: 11.3 – 17.6). while that of HR (High Risk) HPV was 29.7% (95% CI: 27.4 – 35.7). The commonest HR types were, HPV-35 (14.1%), HPV-18 (13.0%;), HPV-58 (7.4%;), HPV-52 (7.2%;), HPV-45 (4.8%;) and HPV 42, a low-risk type, was also common (7.8%;). The frequency of HPV 16 was 2.4%. Cytologicaly, 2.8% had ASCUS, 3.9% LGSIL and 2.8% HGSIL, None of the women was found to have atypical glandular cells or adenocarcinoma. There is a high burden of HPV in women living with HIV attending clinic at the KBTH. I recommend that screening for cervical dysplasia should be done for WLHIV routinely as part of their comprehensive care.
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    Identification And Mapping Of Risk Factors Associated With Cholera In Selected Communities In The Greater Accra Region, Ghana
    (University Of Ghana, 2021-09) Dongdem, A.
    Background Cholera is an acute diarrhoeal disease caused by the toxigenic Vibrio cholerae O1 or O139 strains. Globally, it is estimated to infect over 1.3 million people with over 21, 000 deaths annually with the most affected countries being in Africa and Asia. In Ghana, cholera has become endemic in some communities in the Greater Accra Region (GAR) with reported focal epidemics. The factors contributing to its persistence and spread in these communities are not well understood. To prevent future epidemics, it is important to identify the specific risks in these communities that may account for its persistence. This study, therefore, identified and mapped risk factors associated with cholera at the household and community levels in the GAR. Methods A community-based cross-sectional comparative study was conducted in 24 (12 each) from cholera endemic and non-endemic communities from March 2019 to March 2020. The multistage cluster sampling procedure was used in selecting households and a structured questionnaire was used to collect data from the head of households. Drinking water from selected households was sampled for water quality and the community water bodies were assessed for the presence of toxigenic strains of V. cholerae during the wet and dry seasons. A sanitation inspection guide was used to assess the sanitation conditions of the communities and GPS coordinates of the identified risk taken. Data were analysed using STATA version 14 software. Associations between the history of cholera and the independent variables were determined using Chi-square/Fisher exact test and multivariable penalized logistic regression. The differences in bacterial counts were determined using the Kruskal Wallis rank test. A p-value less than 0.05 was considered significant for the associations. Principal Component Analysis was used to categorize the household wealth index and the environmental sanitation conditions. Significantly identified risk factors were mapped with the historical cholera cases using Arc GIS. Results Results of the multivariable penalized logistic regression showed that the presence of waste dumpsites (AOR=2.96, 95% CI: 1.11-7.88, p=0.030) and big open drainage (AOR=5.78, 95% CI: 1.89-17.72, p=0.002) were predictors of cholera occurrence. Whereas cooking in a detached kitchen (AOR=0.22, 95% CI: 0.06-0.82. P=0.024), or in yard (AOR=0.42, 95% CI: 0.21-0.86, p=0.017), and the availability of public toilets in the neighbourhood (AOR=0.28, 95% CI: 0.08-0.97, p=0.046) were significantly protective against cholera. The household drinking water was mostly contaminated with faecal coliforms with counts exceeding the zero cfu/100ml standard. Klebsiella penumoniae and Escherichia coli were the dominant organisms isolated. The household stored water was more contaminated than that obtained from the direct source and the differences were significant. The contamination was generally higher in the wet season than in the dry season. No toxigenic Vibrio cholerae O1 or O139 was isolated from the household drinking water and the environmental water bodies. However, Vibrio fluvialis and Vibrio algionolyticus were isolated from the environmental water bodies. Environmental sanitation revealed 66.2% (300/453) of the endemic communities to have poor sanitation compared to the 67.5% (306/453) of the non-endemic communities with good sanitation conditions. Conclusion/Recommendation The presence of public toilets, waste dumpsites, and open drainage systems close to each other and their combined effect may account for the cholera endemicity in the endemic communities. Household drinking water contaminated with faecal coliforms is an indicator of high risk for cholera transmission. The absence of toxigenic strains of Vibrio cholerae O1 or O139 in the drinking and environmental water bodies could predict the absence of cholera occurrence. Vibrio fluvialis and Vibrio algionolyticus emerging cholera-like diarrhoea pathogens were isolated from the environmental water bodies. Poor environmental sanitation is still prevalent in the endemic communities. It is recommended that sanitation laws and the treatment of household drinking water at the point-of-used as well as siting of public toilets, waste dumpsites, and open drainages beyond 500 m from households are enforced.
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    Epidemiology Of Leishmania Infection And Insecticide Treated Bed Net Use In Three Communities Of Oti Region, Ghana
    (University of Ghana, 2020-06) Akuffo, R.J.
    ABSTRACT Background: Leishmaniasis is a neglected tropical disease caused by parasites of the genus Leishmania and is transmitted by various species of female sand flies. In Ghana, the DNA of Leishmania parasites has been identified in skin lesions from some patients suspected to have cutaneous leishmaniasis (CL) and also from some female sand flies sampled from the Ho municipality of the Volta Region. Systematic reviews have demonstrated that the application of insecticides against sand fly vectors is effective in reducing incidence of leishmaniasis. Methods: Using a community-based cross-sectional study design, the prevalence of Leishmania infection, insecticide treated bed (ITN) use, and the occurrence of sand flies in three communities of the Oti region of Ghana were investigated. Awareness about CL, CL experience, and CL related knowledge among household heads were also investigated. Results: A total of 3,440 participants from 587 households comprising 189 (32.2%), 200 (34.1%), and 198 (33.7%) households from Ashiabre, Keri, and Sibi Hilltop respectively, participated in this study. Leishmanin skin test (LST) results for 1091, 848, and 1132 participants from Ashiabre, Keri, and Sibi Hilltop, indicated an overall prevalence of Leishmania infection of 41.8% and individual community prevalence of 39.4%, 55.1%, and 34.2% respectively. An overall prevalence of 31.9% and individual community prevalence of 23.2%, 29.8%, and 36.8% for CL in Ashiabre, Keri, and Sibi Hilltop respectively was observed. Being male (AOR=1.27; CI: 1.09, 1.49), and living in Keri (AOR=1.83; CI: 1.43, 2.34) were associated with an increase in the odds of exposure to Leishmania infection using LST. Being 5-15 years old (AOR=1.49; CI: 1.31, 1.98), 16-45 years old (AOR=3.31; CI: 2.44, 4.47), and >45 years old (AOR=4.85; CI: 3.29, 7.15) were also significantly associated with increased odds of being exposed to Leishmania infection. Nonuse of ITN was not significantly associated with Leishmania infection. The proportion of all study households that owned at least one ITN was 97.1%. 97.4% of households in Sibi Hilltop and 97.0% of households in both Ashiabre and Keri owned at least one ITN. Cumulatively, the number of households having at least one ITN for every two members was 386 (65.8%) while 63.5%, 68.0%, and 65.7% of households in Ashiabre, Keri, and Sibi Hilltop owned at least one ITN for every two household members. Of the 3639 de facto household population comprising 1116, 864, and 1179 in Ashiabre, Keri, and Sibi Hilltop, the overall population with access to ITN was 3159 (86.8%) while 87.3%, 87.9%, and 85.6% of the household populations in Ashiabre, Keri, and Sibi Hilltop respectively, had access to ITN. The overall household population that slept in ITN the night before this survey was 2370 (65.1%) while in Ashiabre, Keri, and Sibi Hilltop, it was 66.4%, 65.1%, and 64.0% respectively. Of 2181 population in households with ITN access, 1581 (72.5%) persons slept in ITN the night before the survey. Lack of household access to ITN (AOR=1.80; CI: 1.31, 2.47), having a family size of more than 10 members (AOR=2.53; CI: 1.20, 4.24), having more than 10 rooms for sleeping in a household (AOR=10.18; CI: 1.28, 81.00), having 2-4 screened windows (AOR=1.49; CI: 1.00, 2.20), and having 8-10 screened windows (AOR=3.57; CI: 1.25, 10.17) were significantly associated with increased odds of not sleeping in ITN the night before the survey. All household heads were aware of CL with 243 (41.4%) of them demonstrating good knowledge about it. A total of 45.3% of household heads (57.1%, 35.0%, and 44.4% in Ashiabre, Keri, and Sibi Hilltop) indicated that at least one member of their household had experienced CL two years prior to this study. A total of 193 female sand flies were trapped from various locations within the study communities. Conclusions: This study demonstrated exposure to Leishmania infection in the study communities and confirmed CL which suggests an active cycle of transmission of Leishmania infection. Being male, living in Keri and being five years or older were associated with Leishmania infection. The non-use of ITNs was not significantly associated with Leishmania infection. Household ITN access of 65.8% and usage by 65.1% of the study population suggests a need for strategies to improve both access to ITN and its usage. Factors associated with nonuse of ITN were Lack of household access to ITN, having a family size of more than 10 members, having more than 10 rooms for sleeping, and having 2-4 or 8-10 screened windows. The occurrence of sand flies was confirmed and suggests a need for investigation of the sand fly species and their possible role in Leishmania transmission. Demonstration of good knowledge about CL by less than half of household heads calls for strategies to improve knowledge about CL.
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    Adherence to Hepatitis B Virus Infection Prevention Protocol among Health Care Workers in Selected Public Health Facilities in the Greater Accra Region
    (University Of Ghana, 2019-07) Senoo, V.E.
    Introduction: The World Health Organization global disease burden from sharp injuries revealed that 37% of Hepatitis B Virus (HBV) infections among Health Care Workers (HCWs) was as a result of occupational exposures to blood and body fluids. In Sub Saharan Africa alone, about 40-65% of HBV infections among HCWs occur as a result of percutaneous occupational exposures to contaminated blood and body fluids of patients. The prevalence of HBV among the Ghanaian population is high and occupational exposures to blood and body fluids that could potentially result in HBV infection is on a surge among HCWs. International health organizations have made recommendations regarding the prevention of occupational exposure and subsequent acquisition of HBV infection. In Ghana, the occupational health and safety policy guideline for the health sector was developed in accordance with international recommendations with the aim of providing policy direction towards efforts aimed at HCW protection from HBV. Seven years following the development and dissemination of the policy guideline, this present study was undertaken to access the level of adherence to preventive practices among HCWs in the Greater Accra Region. Methods: A hospital based cross-sectional survey involving HCWs drawn from five health institutions in the Greater Accra Region was undertaken between January and April 2018. Stratified random sampling procedure was used to select 363 health care workers for the study. A structured pretested questionnaire was used to collect data from all consenting health care workers. Approximately 5 mls of venous blood was collected from all consenting HCWs and screened qualitatively for the presence of five serological markers of HBV. Enzyme Linked Immunosorbent Assay (ELISA) procedures were subsequently undertaken to detect IgM HBcAb and to quantify anti-HBs. Data were analyzed using SPSS version 20.0. Chi-square test or fisher’s exact were performed followed by binary logistic regression with level of significance set at <0.05. Analysis of variance procedure was undertaken following tests of normality and heterogeneity of variances to determine differences between overall adherence scores and post exposure prophylaxis knowledge. Adherence and knowledge scores were categorized into three levels namely: poor, intermediate and good using three interval scoring system of low (≤50%), intermediate (51-74%) and high (≥75-100%). Results: Complete data were available for 340 out of 363 HCWs sampled for the study giving a response rate of 93.70%. Mean age, height and weight of participants were 34.55 years (SD ±7.68), 162.80cm (SD±7.83) and 72.55 kg (SD±13.83) respectively. Overall HBV vaccination uptake was 60.9% (207/340) (95% CI= 55.7%-66.1%). Complete vaccination measured as adherence to 3 doses regimen was 46.8% (159/340). High risk perception (aOR= 4.0; 95% CI=1.3-12.5) and previous training in infection prevention (aOR= 2.8; 95% CI=1.1-7.5) were both seen to be significantly associated with adherence to receipt of three doses of HBV vaccine. Adherence to recommended vaccination schedule of 0, 1, 6 interval was intermediate 62.3% (159/207). Adherence to post vaccination serological testing was poor 21.3% (44/207) with HCWs working at regional hospital having the least odds of adhering to this vaccination component (aOR= 0.1; 95% CI=0.0-0.6). Overall vaccination adherence mean score was 53.46% (95% CI=49.86-57.05) with no statistically significant difference between the various cadre of staff (F=0.85; P=0.51). Adherence to overall HBV vaccination recommendation was extremely low in the population with 6.2% of the entire HCW population and 3.80% of vaccinated HCWs adhering completely. Post Exposure Prophylaxis (PEP) for HBV knowledge was generally poor (overall mean score was 47.85; 95% CI=44.35-51.35) with significant differences among HCW categories (F=3.11; P=0.010). Exposure reporting was good 76.3% (29/38) with significant difference between the various facility levels (ꭓ 2 =17.990; p=<0.001). All the components of PEP (Evaluation for eligibility for PEP, Timeliness of PEP initiation and post-PEP follow-up visits) were observed to have good level of adherence (adherence was >75%) except PEP usage that was intermediate with a coverage of 70% (7/10). The predominant HBV maker among the population was Anti- HBs; 57.4% (195/340) and the least was HBeAg; 1.5% (5/340). One third (123/340) of the HCWs were naïve to HBV. Lifetime exposure to HBV (Anti-HBc) prevalence was 8.2% (28/340) (95% CI= 5.0%-11.0%). Females had 4 times lower odds of being exposed to HBV (aOR=0.4; 95 % CI=0.1-0.9). HCWs without training in prevention of blood borne infections had almost three times higher odds of being exposed to HBV in their lifetime (aOR=2.6; 95 % CI=1.1-6.4). HCWs in lower level facilities also demonstrated two times higher odds of being exposed to HBV (uOR=2.1; 95 % CI=1.1 -4.7). The overall prevalence of current HBV infection (HBsAg) was 5.9 % (20/340) (95% CI =3%- 8%). Prevalence was highest among males, orderlies and those working at CHPs facility. Conclusions: The findings of this study suggest that despite the high susceptibility to HBV infection among the HCWs, adherence to recommendations regarding HBV vaccination and PEP usage are sub-optimal. Therefore, to avert the serious consequences of HBV infection among HCWs in the Greater Accra Region, immediate interventions are required from employers and all stakeholders. HCWs of all categories working at all the five levels of care would need support to promote adherence to pre and post exposure modalities against HBV infection. Apart from making vaccines and immunoglobulin available to HCWs, training in blood borne infections and programs targeted at increasing risk perception for HBV among HCWs could improve adherence and subsequently prevent new infections.
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    Malaria in Early Infancy: Effect of Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp) and Maternally Transferred Antibodies in the Kassena-Nankana District.
    (University of Ghana, 2019-03) Achembona, A.F.
    Background Beneficial effects of Intermittent Preventive Treatment in pregnancy (IPTP-SP) on the mother and birth outcomes are known. The few studies on the effects of IPTp-SP beyond in utero have been contradictory and tended to focus on late infancy and beyond. Mechanisms and targets explaining effects of IPTp-SP beyond in utero remain largely unknown. This study determined if IPTp-SP use was associated with risk of malaria and all cause mortality in early infancy and if maternally transferred antibody levels (Total IgG) to malarial antigens could explain observed IPTp-SP effects or were independently associated with the aforementioned outcomes. Methods This study was undertaken by conducting secondary analyses of the whole data from a five year cohort of 2279 newborns enrolled between 2006 and 2007 in the Kassena-Nankana Districts. Analysis was restricted to early infancy. Survival techniques (Cox Proportional hazards and Kaplan-Meier plots) were used to estimate frequency of IPT-SP doses and risk of malaria and all cause mortality. ELISA assays performed on a subset of the cohort (672), measured total IgG antibody titres to selected malaria antigens and frequency of IPTp-SP doses. Analyses of variance (ANOVA), simple regression techniques and box plots were employed to determine associations between antibody titres and frequency of IPTp-SP doses. IPTp-SP dosing frequency, Antibody types and risk of malaria and all cause mortality were also measured. Statistical significance was set at 5% with 95% confidence interval. Results Infants of mothers who had one dose of IPTp-SP had 44% less risk of parasitaemia [Hazards Ratio (HR) =0.60(95%CI= 0.45, 0.79), P<001], 41% less riskof uncomplicated malaria, [HR=0.59(95%CI =0.40, 0.86), P=005], and 41% less risk of severe malaria [HR=0.58(95%CI =0.41, 0.80), P<0.001]. Higher dosing frequencies of IPTp-SP did not significantly impact risk of malaria in early infancy, compared to none. None of the dosing frequencies of IPTp-SP was significantly associated with a decrease in all cause mortality. Antibody titres to malarial antigens (MSP3, N-MSP3, C-MSP3, GLURP-R0, GLURP-R2, and GMZ2) did not differ with frequency of IPTp-SP dosing. . Antibodies to GLURP-R2 were associated with less risk of parasitaemia [HR=0.65 (95%CI =0.50,0 .84), P=001], uncomplicated malaria [HR=0.66 (95%CI =0.45,0.95), P=0.026] and severe malaria [HR=0.66 (95%CI= 0.49,0.90), P=0.009] . Antibodies to N-MSP3 and C-MSP3 were associated with less risk of uncomplicated malaria [HR=0.76 (95%CI= 0.62, 0.93), P=0.007] and [HR=0.64(95%CI= 0.46, 0.90), P=0.009], and respectively. Antibodies to MSP3 were associated with less risk of severe malaria [HR=0.80, (95%CI =0.67, 0.96), P=0.016]. Conclusions IPTp-SP beyond in utero reduces risk of malaria in early infancy in the KNDs but dosing frequency of IPTp-SP does not significantly alter titres of maternally transferred antibodies (total IgG) to the malaria antigens MSP3, N-MSP3, C-MSP3, GLURP-R0, GLURP-R2 and GMZ2. However, total IgG to N-MSP3, C-MSP3 and GLURP-R2 are independently associated with less risk of malaria in early infancy.
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    Assessment of Genetic Diversity, Complexity of Infection of Plasmodium Falciparum and Resistance to Antimalarial Drugs in Two Ecological Zones in Ghana
    (University of Ghana, 2018-12) Mensah, B.A.
    Introduction: One major challenge to the global agenda for the elimination of malaria is the extensive genetic diversity of the parasite population, resulting in the development of drug resistance and variation in antigens targeted for vaccine development. The aim of this study was to decipher any ecological difference in the evolution of drug resistance and to determine how much the increased use of artemisinin-based combination therapies (ACTs) and other control interventions are shaping the genetic diversity of the Plasmodium falciparum population in two ecologically distinct populations in Ghana. Methods: A total of 803 dried blood spots (DBS) collected on filter paper from symptomatic children, aged 6 months to 14 years, with P. falciparum mono-infection in the coastal savanna (Cape-Coast) and the forest (Begoro) zones of Ghana from 2014 to 2017. In addition, a total of 991 P. falciparum infected DBS were collected from asymptomatic school children, aged 6 years to 14 years from 2013 to 2017. The study leveraged the high specificity and relatively low-cost of targeted next generation sequencing using molecular inversion probes for targeting and sequencing on the illumina MISEQ platform for sequencing of P. falciparum genes (pfcrt, pfdhfr, pfdhps, pfmdr1 and pfk13) implicated in anti-malarial resistance to chloroquine (CQ), sulfadoxine pyrimethamine (SP), lumefantrine, amodiaquine and artemisinin. The Plasmodium falciparum Apical Membrane Antigen 1 (pfama1) gene was also sequenced for the genetic diversity and complexity of P. falciparum infections (COI) analysis. Genetic diversity was compared between the two study populations and the sequences from Ghana were compared with sequences from West Africa, East Africa and South East Asia obtained from the gene bank. Results: The result showed high genetic diversity in pfama1 in Ghanaian sequences with a total of 164 pfama1 haplotypes and a haplotype diversity of 0.993. There was no genetic differentiation between the two study populations in Ghana. Parasite isolates from the two ecological zones in Ghana showed a moderate genetic differentiation with sequences from Thailand (Fst=0.054) and low differentiation with sequences from Kenya (Fst=0.004). Seventy three percent (73%) of the infections were monoclonal. The major molecular marker associated with CQ resistance pfcrt K76T significantly reduced over the four years of the study (χ² = 40.57; p<0.001). The rate of re-expansion of chloroquine sensitive strains pfcrt K76 was higher in the forest ecological zone compared to the coastal savanna zone. The pfmdr1 184F mutant associated with lumefantrine resistance remained high over the years (68% to 83%). The prevalence of the quadruple mutation (IRNGK), associated with sulfadoxine-pyrimethamine resistance is almost at fixation, whilst pfdhps 540E has remained very low in Ghana. In addition, the study found low prevalence of pfdhps 581G mutation associated with sulfadoxine resistance, which has not been previously reported in these parts of Ghana. The South East Asian pfK13 mutations that confer resistance to artemisinin were not found in these study sites of Ghana Conclusion: This study provides new data which gives valuable information for developing an effective pfama1-based malaria vaccine. The detected of pfdhps 581G mutation associated with sulfadoxine resistance and the absence of South East Asian pfK13 mutations associated with artemisinin resistance in these parts of Ghana provides relevant information for the national malaria control programme. The ecological differences observed in the re-expansion of chloroquine sensitive strains provide useful information on hotspots that can be targeted in the design of malaria control strategies in Ghana.
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    Risk Factors for Acute Respiratory Infections in Shai-Osudoku and Ningo-Prampram Districts in the Greater Accra Region of Ghana
    (University of Ghana, 2017-07) Adjabeng, M.J.
    Background: Acute Respiratory Infections (ARIs) result in a large public health burden worldwide, especially in developing countries. The populations at greatest risk for developing fatal respiratory infections are the very young, the aged, and the immunocompromised. In developing countries, 30% of all patient consultation and 25% of all paediatric admissions are ARIs. In the Shai-Osudoku (SO) and Ningo-Prampram (NP) districts, ARls have continuously ranked second in the top ten causes of morbidity for hospital attendance. Despite the availability of influenza vaccines, Ghana and other West African countries are yet to establish routine immunization policies due to limited information. This study sought to determine the risk factors of ARls by investigating the characteristics of patients with respiratory illness in the two districts. Methods: A health facility-based case-control study was conducted among residents of Shai-Osudoku (SO) and Ningo-Prampram (NP) Districts. Prospective cases were selected from a facility-based surveillance on Acute Respiratory Infections which captured Influenzalike Illness and Severe Acute Respiratory Infection syndromes in residents of SO and NP Districts from April to November 2016. One hundred and forty-seven influenza viruspositive case-patients and 294 influenza virus-negative control-patients were identified to assess the risk factors of influenza among Influenza-like Illness patients. The study also investigated factors for Severe Acute Respiratory Infection (SARI) by identifying 134 SARI patients and 402 out-patients with non-respiratory illness as controls. Crude and adjusted odds ratios were calculated. A purposive selection logistic regression was used for the adjusted modelling. Results: The study identified Influenza A(H3N2) and Influenza B subtypes as the predominant circulating influenza viruses in the two districts from March to November of 2016. Study participants had poor knowledge on the causes and prevention of acute respiratory illness. The Osudoku Health Centre in Shai-Osudoku district reported the highest proportion (29.9%, p = 0.01) of influenza-positive III cases. The crude analysis had the highest odds of an influenza-positive infection in the 5 to <15 years age group (OR:7.80; 95%CI: 2.52 - 24.12). Factors associated with influenza virus infection among Ills were Chills (aOR:4.57; 95%CI: l.51 - 13.76) and a recent travel history in past 2 weeks (aOR:3.05; 95%CI: 1.07 - 8.73). For SARI, Males were more at risk (OR:2.13; 95%CI: 1.40 - 3.23). Just as has been found in some studies, the less than 5-year group formed the majority (42.5%; p
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    The Prevalences of Human Papillomavirus Infections and Cervical Lesions, and the Patterns of Risk Behaviour Characteristics of Women in a High Risk Community: Akuse sub-district, Ghana
    (University of Ghana, 2014-06) Awuah, A.K.
    Background: Ghana continues to lack population based empirical data on the burden of cervical pre-cancer lesions, HPV infection and the identification of communities at risk. These together are hampering the control of cervical cancer in Ghana. Therefore, this study was designed to determine the distribution of HPV infections, cervical lesions and the known ri sk factors for cervical cancer among women living in the Akuse sub-district, Ghana. Methods: A cross sectional study was designed with a house-based recruitment of women between the ages of 15 and 70 years. Although a single strategy was designed for reporting for specimen collection in the study, three strategies were used. The additional strategies were a result of an initial low response rate resulting from the women not making time off their daily and economic activities to attend the Hospital for specimen collection and also based on the information and suggestions from the subsequent interaction with the women. These strategies were, a) reporting to the hospital within a short time period after recruitment at home, b) reporting to the hospital within a long time period after recruitment at home and c) reporting at a location within a community after recruitment at home. Each participant had the option of providing a specimen by either or both self-specimen collection and health personnel specimen collection. Human Papillomaviruses were detected in each of the pair of the specimen by a multiplex-nested PCR amplification and genotyped by the xMAP technology. Results: Of the 38 genotypes detected with both specimen collection methods, the following were the commonest detected with self-specimen; HPV16 (5.9%; 95% C13.0% - 9.0%), HPV35 (4.7%; 95% C] 2.0% - 8.0%) and HPV40 (4.7%; 95% C] 2.0% - 8.0%). The commonest detected with the health-personnel collected specimen were HPV35 (2.8%; 95% C] 1.0%- 5.0%) and HPV58 (2.8%; 95% C] 1.0% - 5.0%). A significant difference was obtained between the overall HPV prevalence determined with the self-collected specimen [43 . 1 % (95% C] 38.0% - 51.0%)] and that with the health-personnel collected specimens [23.3% (95% C] of 19.0% - 31.0%)]. Varying reporting rates were observed for the three reporting strategies as well as varying preferences for the specimen collection methods. All the women were negative for cervical cancer and showed no dyskaryosis (intraepitheliallesion). Conclusion: The findings of this study provide the necessary baseline data needed to contribute to the development of a cervical cancer prevention plan and indicate that the Akuse sub-district is a high risk community for HPV infection and a low risk community for cervical cancer.
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    Verification Of The Absence Of Wuchereria Bancrofti Transmission After Ten Years Of Albendazole And Ivermectin Administration In Four Districts, Ghana
    (University of Ghana, 2017-03) Owusu, I.O.
    Lymphatic filariasis (LF) is one of the seven neglected tropical diseases (NTDs) identified by the World Health Organization (WHO) as controllable and potentially eliminable with effective interventions. It is a vector borne parasitic infection transmitted by mosquitoes which belong to the Anopheles, Culex, Aedes, Mansonia, Coquillettidia and Ochlerotatus genera. The nematode parasites responsible for causing the disease are Wuchereria bancrofti, Brugia malayi and Brugia timori. These parasites have no animal reservoir and are largely found in rural areas even though they can be found in urban areas. Mass drug administration (MDA) is the approved strategy for elimination of the disease. Between 4 and 6 rounds of yearly MDA with at least 65% treatment coverage has been found to be enough to interrupt transmission. Transmission Assessment Surveys (TAS) is the primary tool recommended for deciding when to stop MDA and for post-MDA surveillance in LF elimination programs. In Ghana, four districts, Awutu Senya, Effutu, Agona East and West have stopped MDA after ten rounds with microfilaria and antigen prevalence below 1% and 2% respectively. Surveillance is ongoing in these areas to ensure the detection of early recrudescence. These areas have passed the pre-TAS based on the WHO criteria for an area to pass pre-TAS or otherwise and therefore the need to conduct TAS to monitor for recrudescence in both humans and vectors of the disease. The aim of this study was to conduct post-MDA surveillance in four endemic areas that have stopped MDA to detect early recrudescence using periodic surveys. Three surveys were conducted; school-based, household and xenomonitoring surveys. Approximately 1,600 school children aged 6-10 years from selected schools and 1,000 community members aged 11-60 years were sampled annually for four years to participate in the longitudinal school-based and household surveys respectively. Daytime finger-prick blood samples were collected from all consenting participants and tested using a rapid card test (ICT) and Enzyme Linked Immunosorbent Assays (OG4C3 and Wb123). Night time blood was collected for blood smear from participants who tested positive for ICT. Mosquitoes were captured from households using the Pyrethrum Spray Catch (PSC) method for the xenomonitoring survey. All mosquito species were pooled by community with an average pool size of fifteen mosquitoes. Loop Mediated Isothermal Amplification (LAMP) and Polymerase Chain Reaction (PCR) assays were conducted to detect Wuchereria bancrofti parasites in the mosquitoes. Results obtained show that microfilaria prevalence in humans remained below the 2% threshold required for post-MDA surveillance to be conducted and was fairly stable over the study period [2010=0.07%, 2012=0%, 2013=0.12%, 2014= 0.12%] among 6-10-year-old children sampled and tested as well as the older population [2010=1.1%, 2012=1.0%, 2013=0.17%, 2014=0.60%]. Mosquitoes collected in 2013 and 2014 numbered 7,268. This consisted of 4628 Anopheles gambiae s.l., 146 An. funestus, 5 An. pharoensis, 2430 Culex spp. and 59 Mansonia spp. Six (0.08%) pools (five An. gambiae spp. and one Culex spp.) tested positive for W. bancrofti. Surveys in both humans and mosquitoes revealed very low antigen, antibody and microfilaria prevalence four years after last MDA. Mosquito biting rates were low (2013 = 0.057; 2014 = 0.058) but infection rates were high; 0.97 (CI: 0.17-3.17) in 2013 and 1.3 (CI: 0.36-3.65) in 2014 per 1,000 mosquitoes for Anopheles gambiae complex, while that for Culex species was 0.86 (CI: 0.05-4.15) in 2013 per 1,000 mosquitoes. These results depicted that mosquitoes harbored parasites making recrudescence possible. However, results from this study have shown that four years post-MDA is not enough to detect recrudescence and therefore the earliest occurrence of recrudescence goes beyond four years post-MDA. Continued surveillance is therefore recommended.