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Objective: The study was conducted to determine the prevalence of radiologically diagnosed pneumonia among COVID-19 patients and associated factors. Design, setting, and participants: A retrospective manual data extraction of 275 medical records of COVID-19 patients was conducted at two COVID-19 national treatment centres in Accra from March to May 2020. All patients had a chest x-ray done. Main outcome and analysis: The main outcome was the presence of pneumonia. Descriptive statistics and Chi-square test of independence were employed to determine the associations between independent variables and the presence of pneumonia. All analysis was performed using Stata 16, and a p-value ≤ 0.05 was deemed significant Results: The prevalence of pneumonia was 44%(95%CI) =38.2-50.0). Chi-square independent test indicated that pneumonia in the COVID-19 patients was associated with educational level, history of domestic and international travel, mass gathering in the past 14 days before diagnosis, and discharge plan (p-value< 0.05). Patients classified as secondary cases (61.5%) and those discharged as fully recovered from the health facility (61.2%) had a higher prevalence of pneumonia. In addition, COVID-19 patients with hypertension (32.1%) and asthma (5.2%) had a significantly higher prevalence of pneumonia. Conclusion: Overall, the prevalence of pneumonia was 44% and was associated with the demographic and personal characteristics of the patients. Early detection through contact tracing and community surveillance should be intensified to pick up more asymptomatic cases. The role of the chest x-ray for triaging patients and for clinical management of symptomatic patients remains key. © 2021 Clinical Archives of Communication Disorders. All rights reserved.

Background The main treatment modalities for chronic kidney disease (CKD) are dialysis and kidney transplantation. While kidney transplantation provides better survival and quality of life outcomes, it is a new treatment option in Ghana. Finding kidney donors for transplant may be a major challenge due to varied views of the public. Methods This cross-sectional study was carried out in 5 purposively selected communities in the Greater Accra region in Ghana. Structured questionnaires and standardized instruments were used to assess sociodemographic characteristics, spirituality, and perception of kidney transplantation. Results The mean age of the 480 participants was 29.60 ± 10.65 years. The proportion of men was 51%. The average score for knowledge of participants on kidney donation was 4.8 ± 2.6. The level of spirituality score was 25.4 ± 3.89. Approximately 48% (231/480) of participants were willing to donate a kidney while still alive. Willingness to donate when dead was 72% (344/480). Willingness to donate a kidney when dead was significantly lower among the participants in the older age groups. High level of knowledge about kidney transplantation, being employed, basic formal education, and never married were associated with willingness to donate kidney (P Conclusion Our results suggest that participants have a low level of knowledge regarding kidney transplantation, while about two-thirds are willing to donate only after death. Continuous public education is key to raise public awareness of the need for kidney transplants. This will support the Ministry of Health in their efforts to institute a kidney transplant program in Ghana.

Tuberculosis (TB) and HIV are strongly linked. There is a 19 times increased risk of developing active TB in people living with HIV than in HIV-negative people with Sub-Saharan Africa being the hardest hit region. According to the WHO, 1.3 million people died from TB, and an additional 300,000 TB-related deaths among people living with HIV. Although some progress has been made in reducing TB-related deaths among people living with HIV due to the evolution of diagnostics, treatment and antiretroviral HIV treatment, multi drug resistant TB is becoming a source of worry. Though significant progress has been made at the national level, understanding the state of the evidence and the challenges will better inform the national response of the opportunities for improved patient outcomes.Keywords: Tuberculosis, management, HIV, MDR TB, GhanaFunding: None

Purpose The updated World Health Organization guidelines recommend efavirenz (EFV) 400 mg as the preferred alternate first-line antiretroviral therapy to dolutegravir, with EFV 600 mg recommended only in special situations. We examined the pharmacokinetic (PK) properties of EFV 600 mg/d during pregnancy and post partum to inform EFV dosing decisions in pregnant women. Methods Ghanaian pregnant women with HIV infection initiating tenofovir disoproxil fumarate 300 mg/lamivudine 300 mg/EFV 600 mg fixed-dose combination tablet once daily were enrolled. Efavirenz concentrations were measured at 4 weeks of antiretroviral therapy initiation during pregnancy and 6 weeks post partum using validated LC-MS/MS assays. Efavirenz PK parameters were calculated using noncompartmental analysis, and within-group parameters between the 2 periods were compared. Findings Of 25 enrolled women, 19 completed PK sampling during pregnancy and post partum. The Cmax, Cmin, AUC0–24h, and CL/F for EFV during pregnancy were similar to values at 6 weeks post partum. The pregnancy/postpartum geometric mean ratios for EFV Cmax, Cmin, AUC0–24, and CL/F were 1.10 (95% CI, 0.93–1.31), 0.88 (95% CI, 0.67–1.17), 0.84 (95% CI, 0.71–0.98), and 1.20 (95% CI, 1.02–1.40), respectively. Viral load suppression (HIV RNA Implications We found that the PK parameters of EFV 600 mg once daily during pregnancy were similar to those in the postpartum period. Our findings suggest that EFV dose adjustment during pregnancy is not necessary in our study population.

Background: We assessed sexual experiences among adolescent and young adults living with HIV (AYALHIV) attending the adolescent HIV care clinic in Korle Bu Teaching Hospital (KBTH)Design: Cross-sectional study conducted in 2015.Setting: HIV clinic at KBTHParticipants: AYALHIV who attended the adolescent HIV care clinicInterventions: AYALHIV were interviewed with a structured questionnaire to obtain data on their socio-demographic characteristics and sexual experiences. The data was analyzed with STATA version 13.Main outcome measures: sexual experiences of adolescents and young people living with HIVResults: Of 101 participants, 60.4% (61/101) were males. The mean age of respondents was (18±3.2) years with an average age at sexual debut (16.2±4.2) years. A third of the respondents (34/101) had had sex before and out of them 76.5% (26/34) were males. Seventeen percent (4/23) had multiple sexual partners and 38.1% (8/21) of sexually active use condom at last sexual intercourse. Eighty-six percent (87/101) of respondents knew their HIV status, 66.7% (58/87) of them were males. There was a significant association (p

Objective: We identified socio-demographic, health system and psycho-social barriers to Early Infant Diagnosis (EID) of HIV in the Upper West Region of Ghana.Design: An unmatched case control study of 96 cases and 96 controls was conducted in the ART centers in Lawra district and Wa Municipality between December 2014 and April 2015.Setting: A public health facilityParticipants: We defined a case as an HIV positive mother with an exposed infant who received EID service between January 2011 and December 2014. A control was defined as HIV Positive Mother with an exposed infant who did not receive EID services between January 2011 and December 2014.Main outcome: EID by dry blood spot Deoxyribonucleic acid Polymerase chain reaction.Results: A total of 192 mother-infant pairs were assessed. The mean age of infants at testing for cases was 17.3±14.9 weeks. Mother-to-child-transmission-rate was 2.3%. Factors associated with EID testing included: mother being formallyemployed (cOR=2.0: 95%CI:1.1-3.8), maternal formal education (cOR=2.0, 95%CI: 1.1-3.6) and maternal independent source of income (cOR 2.2, 95%CI 1.2-4.1). After adjusting for confounders, maternal independent incomebsource was associated with EID testing (aOR 2.2, 95%CI 1.2-4.1). Median turn-around time of EID result was 11 weeks (IQR 4-27weeks).Conclusion: Women need to be empowered to gain an independent source of income. This can help maximize the benefits of e-MTCT and increase EID in the Upper West Region of Ghana.Keywords: Barriers; HIV; early infant diagnosis; DNA-PCR; GhanaFunding: This work was funded by the authors

Despite available guidelines for disclosure of HIV status to children, most children living with HIV are unaware of their diagnosis. We sought to characterize the concepts of illness and treatment among children living with HIV who do not know their status. As part of the Sankofa trial we interviewed 435 children aged 6-18 enrolled in clinical care at pediatric HIV clinics at two teaching hospitals in Ghana. Theoretic thematic analysis generated themes among responses. The children believe they come to the clinic to collect medication, to address specific symptoms, to prevent and treat 'sickness', or as part of their routine. Most children learned of their 'illness' from a family member. A majority (73.5%) of children had never talked about their 'illness' with anyone else; many feared consequences. Children living with HIV who do not know their status exhibit signs of anticipated and internalized stigma regarding their unknown 'illness.' An understanding of the way children conceptualize their illness has implications for health promotion and the provision of appropriate information to children living with HIV.ClinicalTrials.gov Identifier NCT01701635.A pesar de las pautas disponibles para la divulgación del estado del VIH a los niños, la mayoría de los niños que viven con el VIH desconocen su diagnóstico. Intentamos describir los conceptos de enfermedad y tratamiento entre los niños que viven con el VIH que no conocen su estado de infeccion. Como parte del ensayo Sankofa, entrevistamos a 435 niños de 6 a 18 años inscritos en atención clínica cuidado en clínicas pediátricas de VIH en dos hospitales docentes en Ghana. El análisis temático teórico generó temas entre las respuestas obtenidas. Los niños creen que vienen a la clínica a recoger medicamentos, a tratar síntomas específicos, a prevenir y tratar “condiciones” o como parte de su cuidado rutinario. A traves de entrevistas, aprendimos que la mayoría de los niños aprendieron de su "enfermedad" de un miembro de la familia. Esta mayoría (73.5%) nunca habían hablado sobre su "enfermedad" con nadie más; debido a muchas consecuencias temidas. Los niños que viven con VIH que no conocen su estado, exhiben signos de estigma anticipado e internalizado con respecto a su "enfermedad" desconocida. El entender la forma en que los niños conceptualizan su enfermedad tiene implicaciones para la promoción de la salud y el suministro de información adecuada a los niños que viven con el VIH.

Young people living with HIV (YPLH) are at risk for poor treatment adherence. Short message service (SMS) interventions can improve adherence, yet few exist for YPLH. Our study investigated preferences for a game-based SMS intervention among YPLH in Ghana. Thirty-two YPLH, ages 18 to 24, were recruited from an HIV clinic to complete in-depth interviews. Content analysis of interview data revealed areas of technology use relevant to intervention implementation, including mobile communication preferences, internet access, and mobile game use. Participants reported high perceived utility towards intervention features: treatment reminders, gamification components, and involvement of supportive individuals (e.g., providers). Issues with privacy, literacy, and cultural/developmental appropriateness were among concerns raised. Suggestions were made for strengthening basic SMS features (e.g., using code words to protect privacy) and incorporating advanced features (e.g., simplifying game interactions). This novel approach may help engage YPLH in HIV care if carefully developed with attention towards its mechanisms and user preferences.

With the introduction of antiretroviral therapy (ART), many HIV-infected children are growing into adolescence and adulthood. A facility-based cross-sectional study was conducted at the Fevers Unit of one of the teaching hospitals in Ghana. The Morisky Medication Adherence Scale (MMAS-8) and pill count were used to assess adherence, while measured viral load levels of participants were used to assess viral suppression. The rate of viral suppression (

Introduction COVID-19 is a new disease, knowledge on the mode of transmission and clinical features are still evolving, new tests are being developed with inherent challenges regarding interpretation of tests results. There is generally, a gap in knowledge on the virus globally as the pandemic evolves and in Ghana, there is dearth of information and documentation on the clinical characteristics of the virus. With these in mind, we set out to profile the initial cohort of COVID-19 patients who recovered in Ghana. Methods: We reviewed clinical records of all confirmed cases of COVID-19 who had recovered from the two main treatment centres in Accra, Ghana. Descriptive data analysis was employed and presented in simple and relational tables. Independent t-test and ANOVA were used to determine differences in the mean age of the sexes and the number of days taken for the first and second retesting to be done per selected patient characteristics. Results: Of the 146 records reviewed, 54% were male; mean age of patients was 41.9 ± 17.5 years, nearly half were asymptomatic, with 9% being severely ill. The commonest presenting symptoms were cough (22.6%), headache (13%) and sore throat (11%) while the commonest co-morbidities were hypertension (25.3%), diabetes mellitus (14%) and heart disease (3.4%). Conclusion: COVID-19 affected more males than females; nearly half of those infected were asymptomatic. Cough, headache and sore throat were the commonest symptoms and mean duration from case confirmation to full recovery was 19 days. Further research is required as pandemic evolves

Carriage of pneumococcus is considered as the precursor for development of pneumococcal disease. In sub-Saharan Africa, very little research has been done on the pneumococcus in relation to people with HIV infection in the era of pneumococcal conjugate vaccines. This study investigated pneumococcal carriage among HIV/AIDS patients in southern Ghana to determine the prevalence, risk factors, serotypes and antibiotic resistance of the organism. This was a cross sectional study involving 245 HIV/AIDS patients recruited from Korle Bu Teaching Hospital and Princess Marie Louis Hospital in Accra from November 2016 to March 2017. Epidemiological data on demographic, household and clinical features of the study participants were collected. Nasopharyngeal (NP) swabs were also collected from the study participants and cultured for Streptococcus pneumoniae; the isolates were serotyped by latex agglutination and Quellung reaction. Antimicrobial disc susceptibility was performed on the isolates, and antibiotics tested included tetracycline, erythromycin, cotrimoxazole, levofloxacin, oxacillin and ceftriaxone. Prevalence of pneumococcal carriage among the study participants was 11% (95% CI: 7.4 to 15.6); carriage among children and adults was 25% (95% CI: 14% to 38.9%) and 7.3% (95% CI: 4% to 11.9%) respectively. School attendance (p=0.001) and history of pneumococcal disease in the past year (p=0.001) were significantly associated with pneumococcal carriage. The most prevalent pneumococcal serotypes carried by the study participants were 19A (15.4%) and 23F (15.4%). Serotype coverage of the various pneumococcal vaccines were PCV10 (23.1%), PCV13 (42.3%) and PPV23 (50%). The prevalence of pneumococcal multidrug resistance was 18.5%. In conclusion, pneumococcal carriage among HIV-infected children was three-fold higher compared to carriage among HIV-infected adults. Pneumococcal carriage among both HIV-infected children and adults in the study area tends to be characterized by a predominance of non-vaccine serotypes and a considerable level of multidrug resistance.

BACKGROUND: Anti-TB drugs dosing based on weight alone may contribute to suboptimal drug concentrations and poor treatment outcomes in malnourished children. We examined the effect of malnutrition on the pharmacokinetics (PK) of first-line anti-TB drugs in children.METHODS: Drug concentrations were measured in Ghanaian children during the intensive phase of TB treatment. Weight-for-age (WFA), height-for-age (HFA), weight-for-height (WFH) and body mass index-for-age (BFA) were calculated and children with Z-scores < -2 SD (standard deviations) were considered as having malnutrition. PK differences of anti-TB drugs were compared by nutritional status.RESULTS: Of 100 participants, 24/48 (50.0%) of those younger than 5 years had wasting, 58/86 (67.4%) were underweight, and 56/99 (56.6%) had stunting; 22/51 (43.1%) children aged ≥5 years had low BFA. Children with stunting were more likely than controls to have lower mean peak concentration (Cmax) and area under the curve (AUC0–8h) of rifampin (RIF) and pyrazinamide (PZA), as well as a higher frequency of Cmax below the normal range. Wasting and underweight were associated with lower mean ethambutol (EMB) Cmax and AUC0–8h.CONCLUSIONS: The current WHO-recommended dosages were associated with lower plasma exposure of RIF, PZA and EMB in children with stunting, wasting and underweight. Anti-TB drugs dosing models for children may need to include height.

Background Maternal retention in HIV care is lower for women in the postpartum period than during pregnancy, but the reasons are poorly understood. We examined key differences in barriers to retention in HIV care during and after pregnancy. Methods We conducted semi-structured, in-depth interviews with 30 postpartum women living with HIV. Participants were recruited from two tertiary facilities implementing Option B+ for prevention of mother-to-child HIV transmission in Accra, Ghana. We collected data from mothers who had disengaged from HIV care and those who were still engaged in care. The interviews were analyzed using principles adapted from grounded theory. Results Participants’ experiences and narratives showed that retention in HIV care was more challenging during the postpartum period than during pregnancy. Poor maternal physical health (from birth complications and cesarean section), socio-cultural factors (norms about newborn health and pregnancy), and economic difficulties linked to childbirth (such as unemployment, under-employment, and debt) made the costs of retention in HIV care more economically and socially expensive in the postpartum period than during pregnancy. Some participants also shared that transportation costs and resulting dependence on a partner to pay increased during the postpartum period because of a strong shift in maternal preference for private modes of transportation due to HIV stigma and the desire to protect the newborn. These factors played a larger role in the postpartum period than during pregnancy and created a significant barrier to retention. A conceptual model of how these factors interrelate, the synergy between them, and how they affect retention in the postpartum period is presented. Conclusions In Ghana, lower retention in HIV care in the postpartum period compared to in pregnancy may be primarily driven by social, economic, and newborn health factors. Multifaceted economic-based and stigma-reduction interventions are needed to increase retention in maternal HIV care after childbirth.

Background: The Ghanaian population aged 60 years and older will almost double to reach 14% of the total population by 2050. Ascertaining the pattern of health expenditures among this growing population group is important to inform policy makers about the targets for financial risk protection as part of achieving Universal Health Coverage (UHC) by 2030. This study aimed to estimate household expenditures among older adults and determine their direct medical costs.Methods: The World Health Organization's Study on global AGEing and adult health (SAGE) Wave 2 was conducted in China, Ghana, India, Mexico, Russian Federation, and South Africa between 2014 and 2015, as a follow-up to Wave 0 in 2003 to 2004 and Wave 1 in 2007 to 2010. Survey questions explored sources of income and total directhousehold expenditures in the year preceding the interview. SAGE Ghana was implemented using face-to-face interviews in a nationally representative sample of persons aged 50+ years with a comparison sample of younger adults aged 18–49 years. Findings: Analyses included a total of 4,735 participants, with 1,948 (43.8%) males and 2,787 (56.2%) females, with a mean age of 57.6 (±16.7). The average annual household expenditure was US$ 2,458 (±7,374). Older adults had higher expenditure levels at US$ 2,501 (±8,307), as compared to younger adults, US$ 2,309 (±3,056). Direct health-related and food costs accounted for 10% and 35% respectively of the total household expenditure. The prevalence of catastrophic health expenditure in households of older adults in Ghana was 7.5% (95% CI 6.0% - 9.3%).Conclusion: These updated estimates on household expenditure among older adults provide needed evidence to support the inclusion of social protection mechanisms in the national ageing agenda. The National Health Insurance reduced the burden of direct health expenditure for households with older adults.

Care for low birthweight (LBW) infants can contribute to psychological difficulties and stigma among mothers living with HIV, creating challenges for antiretroviral therapy (ART) adherence and retention in HIV care. We explored how caring for LBW infants affects maternal ART adherence and retention in care. We conducted 30 in-depth interviews with postpartum women living with HIV in Accra, Ghana: 15 with LBW infants and 15 with normal birthweight (NBW) infants. Compared to mothers with NBW infants, mothers with LBW infants described how caring for their newborns led to increased caregiver burden, prolonged hospital stays, and stigma-contributing to incomplete ART adherence and missed clinical appointments. For a few women, care for LBW infants created opportunities for re-engagement in HIV care and motivation to adhere to ART. Results suggest women living with HIV and LBW babies in Ghana face increased challenges that impact their adherence to care and ART.

PURPOSE To estimate and investigate the global lifetime prevalence and correlates of skin bleaching. METHODS A meta-analysis and meta-regression analysis was performed based on a systematic and comprehensive literature search conducted in Google Scholar, ISI Web of Science, ProQuest, PsycNET, PubMed, and other relevant websites and reference lists. A total of 68 studies (67,665 participants) providing original data on the lifetime prevalence of skin bleaching were included. Publication bias was corrected using the trim and fill procedure. RESULTS The pooled (imputed) lifetime prevalence of skin bleaching was 27.7% (95% CI: 19.6-37.5, I2 = 99.6, P

Human pegivirus (HPgV) is a positive single-stranded RNA virus in the Flaviviridae family. Phylogenetic analysis reveals the presence of multiple HPgV genotypes with distinct geographic locations. HPgV is of interest because of its potential beneficial impact on HIV disease progression. Despite this, the effects of HPgV in the context of other viral infections, such as hepatitis B virus (HBV), are poorly understood, and data from resource-limited settings are scarce. Therefore, we conducted a cross-sectional analysis of HPgV in HIV/HBV co-infected patients in Ghana. Sera from 100 HIV/HBV co-infected individuals were evaluated for HPgV RNA, and the genotype determined by sequencing the 5′ untranslated region. HPgV RNA was detected in 27 samples (27%). Of these, 26 were genotyped successfully with 23 belonging to HPgV genotype 1 and 3 belonging to HPgV genotype 2. The presence of HPgV RNA had no statistically significant impact on CD4 cell count or HBV DNA titers in the HIV/HBV co-infected patients. However, there was a trend towards decreased HBV DNA levels in HPgV RNA-positive patients with CD4 cell count

Globally, there are approximately 240 million people chronically infected with hepatitis B virus (HBV) – a major cause of hepatocellular carcinoma. Ten different HBV genotypes (A-J) have been identified with distinct geographic distributions. Novel variants generated by recombination between different HBV genotypes have been documented worldwide and represent an important element of genetic variability with possible clinical implications. Here, the complete genome sequence of an HBV genotype D/E recombinant from Ghana is reported. The full-length sequence was obtained using rolling circle amplification followed by PCR and then sequenced using next generation sequencing (NGS). A consensus sequence was extracted from the NGS data and underwent phylogenetic analysis to determine genotype, as well as the recombination pattern. Subsequently, the sequence was compared to recombinants described previously in Africa. Based on MCMC phylogenetic analysis, SimPlot recombination analyses, and intragroup genetic distance, the isolate 007N full-length genome is unique compared to other reported D/E recombinants in Africa.

A new virus causing predominantly respiratory tract infection was described in China late 2019. The virus was subsequently named the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes as COVID-19. Subsequently the virus spread to many parts of the world. This resulted in the World Health Organisation declaring COVID-19 a global pandemic on 11th March 2020.

Background The novel Fujifilm SILVAMP TB-LAM (FujiLAM) assay detects mycobacterial lipoarabinomannan in urine and has demonstrated superior sensitivity to the Alere Determine TB-LAM Ag (AlereLAM) assay for detection of tuberculosis among hospitalized people with human immunodeficiency virus (PWH). This is the first study to evaluate the assay among a broad population referred for antiretroviral therapy including both outpatients (mainly) and inpatients. Methods We assessed diagnostic accuracy of FujiLAM and AlereLAM assays in biobanked urine samples from a cohort of adults referred for antiretroviral therapy in Ghana against a microbiological and a composite (including clinical judgement) reference standard, and we assessed the association of FujiLAM test positivity with mortality. Results We evaluated urine samples from 532 PWH (462 outpatients, 70 inpatients). Against a microbiological reference standard, the sensitivity of FujiLAM was 74.2% (95% confidence interval [CI], 62.0–84.2) compared to 53.0% (95% CI, 40.3–65.4) for AlereLAM, a difference of 21.2% (CI, 13.1–32.5). Specificity was 89.3% (95% CI, 85.8–92.2) versus 95.6% (95% CI, 93.0–97.4) for FujiLAM and AlereLAM, a difference of −6.3% (95% CI −9.6 to −3.3). Specificity estimates for FujiLAM increased markedly to 98.8% (95% CI, 96.6–99.8) in patients with CD4 >100 cells/µL and when using a composite reference standard. FujiLAM test positivity was associated with increased cumulative risk of mortality at 6 months (hazard ratio, 4.80; 95% CI, 3.01–7.64). Conclusions FujiLAM offers significantly increased diagnostic sensitivity in comparison to AlereLAM. Specificity estimates for FujiLAM were lower than for AlereLAM but were affected by the limited ability of the reference standard to correctly diagnose tuberculosis in individuals with low CD4 counts., Diagnosis of HIV-associated tuberculosis remains a major challenge. The novel rapid Fujifilm SILVAMP TB-LAM urinary assay demonstrated significantly higher sensitivity than Alere Determine TB-LAM for diagnosing tuberculosis among people with HIV among outpatients and across CD4 cell count strata.

Infants born to HIV-infected mothers are more likely to be low birthweight (LBW) than other infants, a condition that is stigmatized in many settings worldwide, including sub-Saharan Africa. Few studies have characterized the social-cultural context and response to LBW stigma among mothers in sub-Saharan Africa or explored the views of women living with HIV (WLHIV) on the causes of LBW. We purposively sampled thirty postpartum WLHIV, who had given birth to either LBW or normal birthweight infants, from two tertiary hospitals in Accra, Ghana. Using semi-structured interviews, we explored women's understanding of the etiology of LBW, and their experiences of caring for a LBW infant. Interviews were analyzed using interpretive phenomenology. Mothers assessed their babies' smallness based on the baby's size, not hospital-recorded birthweight. Several participants explained that severe depression and a loss of appetite, linked to stigma following an HIV diagnosis during pregnancy, contributed to infants being born LBW. Women with small babies also experienced stigma due to the newborns' "undesirable" physical features and other people's unfamiliarity with their size. Consequently, mothers experienced blame, reluctance showing the baby to others, and social gossip. As a result of this stigma, women reported self-isolation and depressive symptoms. These experiences were layered on the burden of healthcare and infant feeding costs for LBW infants. LBW stigma appeared to attenuate with increased infant weight gain. A few of the women also did not breastfeed because they thought their baby's small size indicated pediatric HIV infection. Among WLHIV in urban areas in Ghana, mother and LBW infants may experience LBW-related stigma. A multi-component intervention that includes reducing LBW incidence, treating antenatal depression, providing psychosocial support after a LBW birth, and increasing LBW infants' weight gain are critically needed.

Background: Graduating student nurses as the future workforce are expected to possess the requisite skill-competence to care for TB/HIV coinfected patients. However, few studies have investigated the self-assessed TB/HIV coinfection care skill-competence of graduating student nurses and its determinants in Accra, Ghana. Purpose: This study investigated final year student nurses’ self-assessed TB/HIV coinfection care skill-competence and its determinants. Methods: This was a descriptive cross-sectional survey among Bachelor of Science in nursing (n = 112) and Diploma in nursing (n = 236) students in their final year of training in four (4) nursing training institutions using convenience sampling technique. Descriptive, independent t and Kruskal Wallis mean rank statistical tests were conducted to identify determinants. Results: TB/HIV coinfection care skill-competencies were low. Determinants of TB/HIV coinfection care skill-competence were age (r = 0.110, p = .048), duration of managing patients (r = 0.219, p = .005) and ownership of nursing training institution (p = .005). Other factors included student nurses’ previous experience working in a TB health facility (p

BACKGROUND: Incomplete hepatitis B virus (HBV) suppression during antiretroviral therapy (ART) in human immunodeficiency virus (HIV) and HBV co-infected patients is common, but underlying factors are not fully elucidated. We hypothesize that genetic factors that influence nucleoside analog pharmacokinetics will affect HBV treatment response. METHODS: HIV/HBV co-infected patients on tenofovir disoproxil fumarate/lamivudine ((TDF/3TC)-containing ART were enrolled. Selected ABCC4 single nucleotide polymorphisms (SNPs) with known effects on nucleoside pharmacokinetics were genotyped using TaqMan(®) assays. Relationship between ABCC4 SNPs and unsuppressed HBV DNA (HBV DNA ≥ 20 IU/mL) were examined. RESULTS: Of the 50 participants on TDF/3TC-containing ART for a median (range) of 1.5 (1 to 7.4) years, 20 (40%) had unsuppressed HBV DNA. Participants with unsuppressed compared to those with suppressed HBV DNA were more likely to have negative HBe antibody, lower body mass index (BMI) and lower CD4 count at enrolment. Carriers of ABCC4 rs11568695 (G3724A) variant allele were more likely than non-carriers to have unsuppressed HBV (61.1% vs. 29.0%, P = 0.038). Among 36 patients with suppressed HIV RNA (presumed good ART adherence), ABCC4 rs11568695 variant carriers were more likely than non-carriers to have unsuppressed HBV (58.8% vs. 20.0% P=0.021). Logistic regression analysis that included genetic and non-genetic factors identified ABCC4 rs11568695 variant allele, BMI and male sex as predictors of unsuppressed HBV DNA. CONCLUSION: We identified a novel association between ABCC4 rs11568695 SNP and poor HBV treatment response. If confirmed in further studies, ABCC4 genotyping could be used to identify individuals who may need intensified HBV therapy.

Hepatitis B virus (HBV) exhibits a high degree of heterogeneity with at least 10 genotypes (A-J) identified to date. Intergenotypic recombination is relatively common. Previously, we investigated HBV drug resistance in HIV/HBV co-infected individuals in Ghana. After identifying multiple circulating genotypes and a novel D/E recombinant, we sought to determine if additional individuals were also infected with recombinant HBV. Partial genome sequences from three individuals were initially identified as genotype A4. Full-length HBV genomes were obtained using rolling circle amplification followed by PCR and shown to cluster with known A/E recombinant viruses. Similar recombination breakpoints were observed in these three individuals suggesting local spread of this novel recombinant HBV in Ghana.

Background Injuries directly lead to 5 million deaths every year, accounting for 9% of all deaths worldwide. While knowledge of the pattern of injuries is essential to plan health interventions to reduce the incidence of injuries, these are not thoroughly described in Ghana. The aim of this study was to describe the epidemiology of injuries seen at the Accident centre of the Korle-Bu Teaching Hospital, Ghana’s main referral hospital. Method A retrospective review of two-year records of all patients who attended the Accident centre of the Korle-Bu Teaching Hospital from January 2016 to December 2017 was done. Data on the cause of injuries was the main focus of this review. Results A total of 17,860 patients’ records were included in the study. There were 12,116 (67.8%) males and 5,744 (32.2%) females. The ages of the patients seen during the period ranged from three (3) days to 101 years. The overall mean age was 27.9 (±18.2). Majority of the injuries resulted from road traffic accidents and falls, accounting for 39.1 and 19.7% respectively. Conclusion Road Traffic accidents (RTA), especially motorcycle related, are a significant cause of injuries in Ghana. Future studies should focus on interventions that can reduce the incidence of RTA’s to reduce the number of injuries that present to the Korle-Bu Teaching Hospital.

Introduction Tuberculosis (TB) is currently causing more deaths than Human Immunodeficiency Virus (HIV) globally. Ghana as one of the 30 high burden TB/HIV countries has a high annual TB case-fatality rate of 10%. The study sought to assess the effect of HIV infection on TB treatment outcomes and assess the time to mortality after treatment onset. Methods We conducted a review of treatment files of TB patients who were treated from January 2013 to December 2015 in two urban hospitals in the Accra Metropolis. Modified Poisson regression analysis was used to measure the association between HIV infection and TB treatment outcomes. Kaplan-Meier survival estimates were used to plot survival curves. Results Seventy-seven percent (83/107) of HIV infected individuals had successful treatment, compared to 91.2% (382/419) treatment success among HIV non-infected individuals. The proportion of HIV-positive individuals who died was 21.5% (23/107) whilst that of HIV-negative individuals was 5.5% (23/419). Being HIV-positive increased the risk of adverse outcome relative to successful outcome by a factor of 2.89(95% CI 1.76-4.74). The total number of deaths recorded within the treatment period was 46; of which 29(63%) occurred within the first two months of TB treatment. The highest mortality rate observed was among HIV infected persons (38.6/1000 person months). Of the 107 TB/HIV co-infected patients, 4(3.7%) initiated ART during TB treatment. Conclusion The uptake of ART in co-infected individuals in this study was very low. Measures should be put in place to improve ART coverage among persons with TB/HIV co-infection to help reduce mortality.

Background The practice of skin lightening has been reported from North America, Europe, Asia, and Africa. In literature, some prevalence rates exceed 50%, and both sexes are involved. Common agents used include hydroquinone, mercury, corticosteroids, and caustic agents. The agents are easily accessible and affordable with very little regulation. Cutaneous and systemic side effects occur but do not appear to be a deterrent, as the notion of light skin as a surrogate for beauty is strong. In Ghana, anecdotal reports of high bleaching rates among certain urban communities resulted in a study supported by the Food and Drugs Authority to determine various facets of this practice. Methods A cross-sectional study among adults in selected urban fishing communities of Accra was undertaken. Consecutive cases were enrolled after written informed consent. A questionnaire was administered, followed by physical examination and clinical photographs. Descriptive statistics were used to analyze the data. Results Of the 555 participants from the three communities, prevalence was 279 (50.3%). Duration of use ranged from 2 months to 17 years. Approximately 212 (76%) used more than one product, and 231 (82%) used agents on their face and body. Dermatological features were hypopigmentation 270 (96.8%), other color changes including ochronosis 241 (86.4%), changes in consistency 141 (50.3%), striae 157 (56.3%), and infections 42 (15.1%). Conclusions The prevalence of skin bleaching was 50.3% in these communities, which is high considering the adverse effects from the practice. We recommend regulation of products by enforcing the law, more education, and a population prevalence study.

OBJECTIVES: To assess the prevalence and clinical importance of previously unrecognised tuberculosis (TB) and isolation of non-tuberculous mycobacteria (NTM) among HIV-infected individuals in a teaching hospital in Ghana.METHODS: Intensified mycobacterial case finding was conducted among HIV-positive individuals before initiation of antiretroviral therapy (ART). Data were collected on socio-demographic characteristics, medical history and TB-related signs and symptoms, and participants were followed for six months to determine treatment and vital status. Two sputum samples were obtained and examined for mycobacteria with smear microscopy, culture and Xpert MTB/RIF assay. NTM species were identified with the GenoType Mycobacterium CM/AS or sequence analysis of 16S rRNA gene.RESULTS: Of 473 participants, 60 (12.7%) had confirmed pulmonary TB, and 38 (8.0%) had positive cultures for NTM. Mycobacterium avium complex was identified in 9/38 (23.7%) of NTM isolates. Participants with NTM isolated were more likely to have CD4 cell count< 100 cells/μL (aOR 2.37; 95% CI: 1.10-5.14), BMICONCLUSIONS: Intensified mycobacterial screening of HIV-infected individuals revealed a high burden of unrecognised pulmonary TB before ART initiation, which increased risk of death within six months. NTM were frequently isolated and associated with signs of poor clinical status but not with increased mortality.

There are three major clonal lineages, types I, II, and III, of Toxoplasma gondii known to cause human toxoplasmosis worldwide. Toxoplasma gondii infections have, however, not been genotyped in Ghana. This study detected the clonal types infecting immune compromised and immune competent individuals in Accra, Ghana. Blood samples were obtained from 148 HIV seropositive pre-antiretroviral therapy individuals (0 ≤ CD4(+) T-cell count/μl blood ≤ 200) at the Fevers Unit and 149 HIV seronegative apparently healthy blood donors at the blood bank, all of the Korle-Bu Teaching Hospital. Genomic DNA was extracted and multilocus genotyping conducted by nested PCR-RFLP analysis using GRA6, SAG3, and BTUB gene markers. Among the HIV seropositive participants, 54.7% (81/148) were T. gondii DNA positive for any of the markers. Out of the 81, 42.0% (34) were positive for SAG3 only, 30.9% (25) for GRA6 only, 24.7% (20) for both SAG3 and GRA6, and 2.5% (2) for SAG3, GRA6, and BTUB. Overall, 93.8% of the positives were of clonal type II, 1.2% type I, while 4.9% (4) were atypical or mixed types (I and II). In the healthy blood donors, prevalence of T. gondii DNA positivity was 3.4% (5/149) by SAG3 and/or GRA6; among them, 60.0% (3/5) were type I, and the remaining 40.0%, type II. This study showed a relatively high prevalence of active T. gondii infections in immune compromised patients and low prevalence in immune competent individuals in Accra. Type II was highly prevalent. Detection of T. gondii in blood donors raises public health concerns and screening for T. gondii should be considered.