Department of Oral Pathology and Medicine

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    Factors Influencing the Uptake of Intermittent Preventive Treatment of Malaria among Pregnant Women in the Gushegu District, Northern Region, Ghana
    (University of Ghana, 2014-06) Atasige, S.A.; Wurapa, F; University of Ghana College of Health Sciences , School of Medicine and Dentistry, Department of Oral Pathology and Medicine
    Background: Despite reducing from 451 in 2007 to 350 in 2010 per 100,000 live births, Ghana has a high maternal mortality rate. NMCP target for IPTp2 is 80%, Ghana‟s coverage was 64.4% in 2011.This contrasts with 84.7% ANC attendance coverage for at least 4 visits. Northern Regional IPTp2 coverage is lower than the national average at 51.2%. In Gushegu 44% registered pregnant women received IPTp2 in 2013. Low IPTP coverage is a threat to reducing malaria incidence and maternal mortality. The primary objective of the study was to determine the client and facility related factors associated with adequate uptake of IPTp. Methods: A cross sectional study was conducted among ANC clients and staffs of the Gushegu RCH. Questionnaires were administered to 330 conveniently sampled nursing mothers and filled by ANC staff. A checklist was used for health facility observations. Univariate analyses of variables were expressed as frequencies and proportions. Bivariate analysis was used to show associations between the various independent and the dependent variables, Results: A total of 8.5% and 91.5% of respondents took inadequate (≤1dose) and adequate (≥2doses) IPTp-SP respectively. 85.4% respondents made early first ANC attendance, 92% are unemployed and 80% multiple gravidae. Mean ANC visits is 5. Mean gestational age at first attendance for inadequate and adequate dosage is 6 and 4 respectively. 25% and 15.5% reported side effects and malaria infection after SP use respectively. The odds ratios at 95%CI of Unemployment, single gravidae and late first ANC visit to predicting inadequate SP uptake were OR4.9 (1.88-13.14.), OR3.38 (1.52-7.55) and OR6.8 (2.96-15.40) respectively. DOT practice, good staff attitude and health talks at the facility was observed and confirmed by 96.7%, 94% and 87.2% of clients. ITNs coverage is 23% and usage72%. Conclusion: Adequate uptake of SP among respondents was high. Majority were unemployed, have had multiple pregnancies and made early first ANC visits. The mean number of ANC visits meets WHO standards. Unemployment, single parity and late first ANC visits are significantly associated with taking inadequate SP dose.ANC staff attitude and practices are satisfactory. The coverage of ITNs is low but its use is high among the respondents.
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    An Immunohistochemical Study of Cytokine and Adhesion Molecule Expression In Human Brain in Fatal Cerebral Malaria.
    (University of Ghana, 2003-07) Armah, H.; Wiredu, E. K.; Adjei, A. A.; Tettey, Y.; University of Ghana, College of Health Sciences, School of Medicine and Dentistry, Department of Oral Pathology and Medicine
    Introduction: Although the role of systemic proinflammatory cytokines, IL-ip and TNF-a, and their up-regulation of adhesion molecules, ICAM-1, VCAM-1 and E-Selectin, in the pathogenesis of cerebral malaria (CM) is well established, the role of local cytokine release remain unclear. Methods: Immunohistochemistry (IHC) was used to compare the expression of ICAM-1, VCAM-1, E-Selectin, IL-ip, TNF-a and TGF- P at light microscopic level in cerebral, cerebellar and brainstem postmortem cryostat sections from 10 CM, 5 severe malarial anaemia (SMA), 1 purulent bacterial meningitis (PBM), 2 non-central nervous system infections (NCNSI) and 3 non-infections (NI) deaths in Ghanaian children. Results: Fatal malaria and Salmonella sepsis showed significantly higher vascular expression of all 3 adhesion molecules, though their expression in the sepsis case was not as intense as that in the fatal malaria sections. There was highly significant co-localization of receptor expression with sequestration in the malaria cases, though there was negligible difference in their expression between the CM and SMA sections. TGF-P showed intravascular and perivascular distribution in all cases, but expression was most intense in the PBM case and CM group. TNF-a and IL-ip showed prominent brain parenchymal staining, in addition to intravascular and perivascular staining, in only the PBM case and CM group. The increased expression of the adhesion molecules was associated with increased local proinflammatory cytokine release in the CM sections, but not in the SMA group. The maximal expression of all 6 antigens studied was in the cerebellar sections of the malaria cases. Conclusions: Endothelial activation is a feature of fatal malaria and Salmonella sepsis, with adhesion molecule expression being highly co-localized with sequestration in fatal malaria. IL-ip and TNF-a are expressed in only cases with neurodegenerative lesions, whilst TGF-P is present in all cases. Both cytokines and adhesion molecules were maximally expressed in the cerebellar sections of the malaria cases.
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    Maternally transferred antibody levels and IgG3 hinge region length polymorphisms in the risk of clinical malaria in infants in a birth cohort at Kintampo, Ghana.
    (University of Ghana, 2014-07) Opoku-Mensah, J.; Dodoo, D.; Asante, P. K.
    Introduction: Plasmodium falciparum malaria remains a global public health threat especially for children under five years. Fetuses receive maternal immunoglobulins in utero by passive transfer and this is believed to protect infants at least for the first six months after delivery. IgG3 among the IgG subclasses is known to be more protective because of the long hinge region making the molecule flexible and easier to link antigens and Fc receptors for antigen elimination. However, there are hinge region polymorphisms among the IgG3 molecules that may have an impact on their protective potential. Aim: This study investigated the relationship between maternally transferred total IgG (IgG) levels and their subclasses against GLURP R0 and MSP1-19. Also to investigate the role of infants’ IgG3 hinge region length polymorphisms in the risk of clinical malaria in a birth cohort at Kintampo, Ghana. Methodology: Serum and blood blots samples with the clinical data of participants were taken from a previous birth cohort study conducted in Kintampo. Serum samples were taken from cord blood at birth (month 0), month 3 and month 6 from 202 infants for immunoglobulins level measurement against GLURP R0 and MSP1-19 using indirect ELISA. IgG with its subclasses were measured at month 0 and IgG3 levels measured at months 3 and 6. One hundred and forty blood blots were selected to determine infants’ IgG3 hinge region length polymorphisms using polymerase chain reaction (PCR). Results: Among 202 infants, 112 (55.45%) were not protected from clinical malaria (presence of parasites and fever), 68 (33.66%) had asymptomatic parasitaemia (protected) and 22 (10.89%) had no parasites and no fever (indeterminate group). There weresignificant differences in anti-GLURP R0 and anti-MSP1-19 total IgG levels at birth (p < 0.05) between protected and non-protected infants but not so for the subclasses. There was a sharp decrease in IgG3 levels against both antigens from month 0 to month 3. Among the 138 infants whose IgG3 hinge region length polymorphisms (IgG3HRLPs) were genotyped, 93.33% had clinical malaria in first year of life. Four IgG3HRLP genotypes were found. The homozygote medium (MM) polymorphism had the highest frequency of 53.33%, followed by the homozygote long (LL) polymorphism with a frequency of 42.22%. The homozygote short (SS) and heterozygote long-medium (LM) polymorphisms were very few among these infants. Conclusion: Maternally transferred anti-GLURP R0 and anti-MSP1-19 IgG levels at birth were associated with protection against clinical malaria in infants but the subclasses were not. Infants’ IgG3HRLPs was not associated with protection from clinical malaria after one year.
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    Assessment of the Viability of Adult Onchocerca Volvulus in Tissue Sections using Enzyme Histochemical Demonstration of Lactate Dehydrogenase Activity
    (University of Ghana, 2003) Abdulai, S.M.; Wiredu, E.K.; Adjei, A.A.; University of Ghana, College of Health Sciences, School of Medicine and Dentistry, Department of Oral Pathology and Medicine
    Current methods of assessing the viability of adult Onchocercs volvulus in drug evaluations are mainly based on in-vitro and histological techniques. The in-vitro method is efficient in detecting live and dead worms while the histological method is more efficient in determining the number of worms in the nodules. Despite their capabilities in some areas, these techniques have certain methodical deficiencies which often lead to inaccurate interpretation of results or marked variations between individuals assessing the viabilities of worms in the same nodules.The deficiencies associated with these techniques are partly responsible for the delay in developing safe and effective drugs for the treatment of onchocerciasis. Based on principles underlying lactate production and tetrazolium reduction tests used in in-vitro techniques for testing the viabilities of adult worms, an enzyme histochemical staining technique was employed to determine the presence of lactate dehydrogenase (LDH) in adult O. volvulus tissue sections and then used to determine their viabilities. Eleven onchocerciasis infected volunteers donated a total of sixty-one O. volvulus nodules for this study. Out of the total number of nodules donated, unfixed cryostat sections were obtained from thirty-two of the nodules (including two nodules which were heated in distilled water at 60°C to obtain heat-killed worms). The sections were incubated in a substrate containing sodium DL-lactate, nicotinamide adenine dinucleotide (NAD), magnesium chloride and nitro blue tetrazolium compound (NBT) at 37°C for an hour. The same nodules were fixed in phosphate buffered formalin after the cryostat sections were obtained from them and processed by the paraffin method to obtain paraffin processed sections which were stained by the haematoxylin and eosin technique. The other twenty-nine O. Volvulus nodules from the total number of nodules obtained from the volunteers (including two heat-killed nodules) were fixed in phosphate-buffered formalin and paraffin processed sections obtained from them and stained by the haematoxylin and eosin technique. Light microscopic examination of the three sets of sections revealed that worm-sections which were morphologically well preserved in their paraffin sections showed the presence of LDH activity in their corresponding cryostat sections and therefore were adjudged to be sections of live worms. On the other hand worm-sections which were morphologically degenerated in paraffin sections did not show any LDH activity in their cryostat sections and were adjudged to be sections of dead worms. This observation implied that the presence of LDH activity in worm sections were indications that the sections belonged to live worms and those sections which did not show enzyme activity belonged to dead worms.There was no significant difference between the enzyme technique and histology in determining the number of adult worms in the nodules examined. This suggested that the enzyme histochemical method has the same advantage that the histological method have over the in-vitro technique in determining the number of worms in the nodules. All the three worms detected in the heat-killed nodules were morphologically well preserved in their paraffin sections while their cryostat sections did not show enzyme activity. They were therefore alive histologically but declared dead by the enzyme technique indicating that the enzyme method is capable of detecting dead worms which are unable to maintain the activity of their enzymes even without any significant morphological degenerations. Since degenerative processes that must show on histology to determine dead worms occur several months after the death of the worm, the study indicates that the enzyme method may be able to detect the death of adult worms much earlier than the histological method. This is regarded as a possible advantage of the enzyme technique over the histological method, however, this assertion needs to be confirmed on a larger sample size. The results showed that, the enzyme histochemical technique can be used as a more reliable alternative to the histological technique in determining the viability of adult 0. volvulus during drug evaluations. It can also be used along with the histological technique in order to obtain early results during drug trials to be followed by histological results which often takes several weeks to process. Comparative analysis of the two sets of paraffin processed sections confirmed that statistical comparisons of the results from different groups of nodules are acceptable for drug investigations.