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Abstract Background Viral diseases of sweet potatoes are causing severe crop losses worldwide. More than 30 viruses have been identified to infect sweet potatoes among which the sweet potato latent virus (SPLV), sweet potato mild speckling virus (SPMSV), sweet potato virus G (SPVG) and sweet potato virus 2 (SPV2) have been recognized as distinct species of the genus Potyvirus in the family Potyviridae. The sweet potato virus 2 (SPV2) is a primary pathogen affecting sweet potato crops. Methods In this study, we detected an SPV2 isolate (named SPV2-LN) in Ipomoea nil in China. The complete genomic sequence of SPV2-LN was obtained using sequencing of small RNAs, RT-PCR, and RACE amplification. The codon usage, phylogeny, recombination analysis and selective pressure analysis were assessed on the SPV2-LN genome. Results The complete genome of SPV2-LN consisted of 10,606 nt (GenBank No. OR842902), encoding 3425 amino acids. There were 28 codons in the SPV2-LN genome with a relative synonymous codon usage (RSCU) value greater than 1, of which 21 end in A/U. Among the 12 proteins of SPV2, P3 and P3N-PIPO exhibited the highest variability in their amino acid sequences, while P1 was the most conserved, with an amino acid sequence identity of 87-95.3%. The phylogenetic analysis showed that 21 SPV2 isolates were clustered into four groups, and SPV2-LN was clustered together with isolate yu-17-47 (MK778808) in group IV. Recombination analysis indicated no major recombination sites in SPV2-LN. Selective pressure analysis showed d N/d S of the 12 proteins of SPV2 were less than 1, indicating that all were undergoing negative selection, except for P1N-PISPO. Conclusion This study identified a sweet potato virus, SPV2-LN, in Ipomoea nil. Sequence identities and genome analysis showed high similarity between our isolate and a Chinese isolate, yu-17-47, isolated from sweet potato. These results will provide a theoretical basis for understanding the genetic evolution and viral spread of SPV2.

Abstract Background Within the sub-Saharan African region, there is a growing concern for sexual and reproductive health and rights communication, and more particularly, for adolescents. Given the existing barriers associated with face-to-face access, the need to use digital media to access information and services has become desirable and imperative, especially so due to the COVID-19 pandemic. However, in sub-Saharan Africa, a synthesis of evidence that informs adolescents’ digital media engagements for sexual and reproductive health and rights (SRHR) communication is limited. This systematic review therefore aims to examine and synthesize evidence on use of digital media for sexual and reproductive health and rights communication by adolescents in sub-Saharan Africa. Methods A search for peer-reviewed articles will be conducted in PubMed, ScienceDirect, Scopus, Embase, Web of Science, PsychINFO and Google Scholar with emphasis on those published between 2000 and 2023. Only observational and qualitative studies will be included. Quality assessment of included articles will be done using standardized checklists from the Joanna Briggs Institute. Both descriptive and narrative summaries will be used to appraise evidence from included studies. Discussion This review will be essential in providing information on the types of digital media adolescents use, the various SRHR issues they use this platform to address and their reasons for using it and associated challenges. It will also contribute to the advocacy for the inclusion of these technologies in the teaching and learning, provision of and access to SRHR information and services by teachers, public health providers and peer educators in the subregion. Systematic review registration PROSPERO CRD42020211491. This protocol follows the PRISMA-P guidelines for reporting systematic reviews.

Abstract Background In sub-Saharan African cities, more than half of the population lives in informal settlements. These settlements are close to smoky dumpsites, industrial plants, and polluted roads. Furthermore, polluting fuels remain their primary sources of energy for cooking and heating. Despite evidence linking smoke and its components to anaemia, none of these studies were conducted on populations living in urban informal settlements. This study investigated the risks of anemia/mean Haemoglobin (HB) levels in an informal settlement in Accra, Ghana. Exposure to smoke was examined across various sources, encompassing residences, neighborhoods, and workplaces. Methods The study was a facility-based cross-sectional design among residents at Chorkor, an informal settlement in the Greater Accra region of Ghana. A questionnaire was administered at a community hospital during an interview to gather data on sources of smoke exposure in the household, in the neighbourhood, and in the workplace. A phlebotomist collected blood samples from the participants after the interview to assess their anaemia status. Results The population (n = 320) had a high prevalence of anemia, with 49.1% of people fitting the WHO’s definition of anemia, while the average HB level was 12.6 ± 2.1 g/dL. Anemia was associated with the number of different types of waste burnt simultaneously [(1 or 2: prevalence ratio (PR): 95% confidence interval (CI), 1.14, 0.99–1.28: 3+: 1.16, 1.01–1.63, p-for-trend = 0.0082)], fuel stacking [(mixed stacking: 1.27, 1.07–1.20: dirty stacking:1.65, 1.19–2.25, p-for-trend = 0.0062)], and involvement in fish smoking (1.22, 0.99–1.06). However, the lower limit of the CIs for number of different forms of garbage burned simultaneously and engagement in fish smoking included unity. Reduced mean HB levels were associated with the number of different types of waste burnt simultaneously [(1 or 2: regression coefficient (β): 95% confidence interval (CI), -0.01, -0.97- -0.99: 3+: -0.14, -0.77- -0.05)], current smoker [(yes, almost daily: -1.40, -2.01- -0.79: yes, at least once a month: -1.14, -1.79- -0.48)], Second-Hand-Smoking (SHS) (yes, almost daily: -0.77, -1.30- -0.21), fuel stacking [(mixed stacking-0.93, -1.33–0.21: dirty stacking-1.04, -1.60- -0.48)], any smoke exposure indicator in the neighbourhood (-0.84, -1.43- -0.25), living close to a major road (-0.62, -1.09- -0.49), and fish smoking (-0.41,-0.93- -0.12). Conclusion Although the cross-sectional design precludes causality, smoke exposure was associated with mean HB levels and anaemia among populations living in informal settlements.

Abstract Background Persons with albinism face challenges to their wellbeing, safety, and security, ranging from vision impairment and skin cancer to stigma and discrimination. In some regions, they also face human rights atrocities including mutilation and murder. Research on human rights and albinism is a relatively new field that has gained momentum since the United Nations appointment of an Independent Expert on the enjoyment of human rights by persons with albinism. In this paper, we present the results of a mixed methods study undertaken to identify priorities for research, advocacy, and policy on albinism and human rights. Methods The first component was a synthesis of peer-reviewed and grey literatures at the nexus of albinism, spiritual/cultural beliefs and practices, and human rights. We then conducted a priority-setting survey, informed by Delphi methods, on extant knowledge-practice gaps and research, advocacy, and policy priorities. Inclusion criteria included demonstrated expertise in the field (e.g., peer-reviewed publications, funded research), membership on national or international associations, or advocacy (civil society organizations) of more than 2 years in albinism and human rights. Thereafter, we gathered leading researchers, policy-makers, and civil society stakeholders for a Roundtable to gain consensus on these priorities. Results Access to skin and vision care, and education were not deemed high priority for research, likely because the evidence supporting the need for these is well established. However, they were priorities for advocacy and policy: what is needed is mobilization of this evidence through advocacy and implementation of such services (policy). Other social determinants of health (rurality, poverty, and gender equality) are present as subtext in the findings, more so than priorities for research, advocacy, or policy, despite their preponderance in the lives of persons with albinism. Research was prioritized on stigma and discrimination; advocacy; and witchcraft, but with some differentiation between Global North and Global South priorities. Priorities for research, advocacy, and policy vary in keeping with the explanatory frameworks at play, including how harmful practices and witchcraft are viewed. Conclusions The lived experience of albinism is profoundly shaped by the social determinants of health (SDOH). Threats to the security and well-being of persons with albinism should be viewed through a human rights lens that encompasses the explanatory frameworks at play.

Abstract Background Haemoglobin SC (HbSC) is a common form of sickle cell disease (SCD), especially among individuals of West African ancestry. Persons with HbSC disease suffer from the same clinical complications and reduced quality of life that affect those with sickle cell anaemia (HbSS/Sβ0). Retrospective anecdotal data suggest short-term safety and benefits of hydroxyurea for treating HbSC, yet rigorous prospective data are lacking regarding optimal dosing, clinical and laboratory effects, long-term safety and benefits, and appropriate endpoints to monitor. Prospective Investigation of Variables as Outcomes for Treatment (PIVOT) was designed with three aims: (1) to measure the toxicities of hydroxyurea treatment on laboratory parameters, (2) to assess the effects of hydroxyurea treatment on sickle-related clinical and laboratory parameters, and (3) to identify study endpoints suitable for a future definitive phase III trial of hydroxyurea treatment of HbSC disease. Methods PIVOT is a randomised, placebo-controlled, double blind clinical trial of hydroxyurea. Approximately 120 children and 120 adults ages 5–50 years with HbSC disease will be enrolled, screened for 2 months, and then randomised 1:1 to once-daily oral hydroxyurea or placebo. Study treatment will be prescribed initially at 20 ± 5 mg/kg/day with an opportunity to escalate the dose twice over the first 6 months. After 12 months of blinded study treatment, all participants will be offered open-label hydroxyurea for up to 4 years. Safety outcomes include treatment-related cytopenias, whole blood viscosity, and adverse events. Efficacy outcomes include a variety of laboratory and clinical parameters over the first 12 months of randomised treatment, including changes in haemoglobin and fetal haemoglobin, intracranial arterial velocities measured by transcranial Doppler ultrasound, cerebral oxygenation using near infrared spectrometry, spleen volume and kidney size by ultrasound, proteinuria, and retinal imaging. Exploratory outcomes include functional erythrocyte analyses with ektacytometry for red blood cell deformability and point-of-sickling, patient-reported outcomes using the PROMIS questionnaire, and 6-min walk test. Discussion For children and adults with HbSC disease, PIVOT will determine the safety of hydroxyurea and identify measurable changes in laboratory and clinical parameters, suitable for future prospective testing in a definitive multi-centre phase III clinical trial. Trial registration PACTR, PACTR202108893981080. Registered 24 August 2021, https://pactr.samrc.ac.za

Abstract Background Malaria remains a public health challenge in Sub-Saharan Africa with the region contributing to more than 90% of global cases in 2020. In Ghana, the malaria vaccine was piloted to assess the feasibility, safety, and its impact in the context of routine use alongside the existing recommended malaria control measures. To obtain context-specific evidence that could inform future strategies of introducing new vaccines, a standardized post-introduction evaluation (PIE) of the successes and challenges of the malaria vaccine implementation programme (MVIP) was conducted. Methods From September to December 2021, the WHO Post-Introduction Evaluation (PIE) tool was used to conduct a mixed methods evaluation of the MVIP in Ghana. To ensure representativeness, study sites and participants from the national level, 18 vaccinating districts, and 54 facilities from six of the seven pilot regions were purposively selected. Quantitative and qualitative data were collected using data collection tools that were adapted based on the WHO PIE protocol. We performed summary descriptive statistics on quantitative data, thematic analysis on qualitative data, and triangulation of the results from both sets of analyses. Results About 90.7% (49/54) of health workers stated that the vaccine introduction process was smooth and contributed to an overall improvement of routine immunisation services. About 87.5% (47/54) of healthcare workers, and 95.8% (90/94) of caregivers accepted RTS,S malaria vaccine. Less than half [46.3%; (25/54)] of the healthcare workers participated in the pre-vaccine introduction training but almost all [94.4%; (51/54)] were able to constitute and administer the vaccine appropriately. About 92.5% (87/94) of caregivers were aware of the RTS,S introduction but only 44.0% (44/94) knew the number of doses needed for maximum protection. Health workers believed that the MVIP has had a positive impact on under five malaria morbidity. Conclusions The malaria vaccine has been piloted successfully in Ghana. Intensive advocacy; community engagement, and social mobilization; and regular onsite supportive supervision are critical enablers for successful introduction of new vaccines. Stakeholders are convinced of the feasibility of a nationwide scale up using a phased subnational approach taking into consideration malaria epidemiology and global availability of vaccines.

Abstract Tomato mottle mosaic virus (ToMMV) poses a threat to production and quality of tomato fruits. The Tm-2 2 gene confers resistance to some tobamoviruses by recognizing viral movement proteins. However, Tm-2 2 -mediated resistance against ToMMV is not well known. Here, we found that ToMMV could infect wild-type but not Tm-2 2 transgenic Nicotiana benthamiana plants and could also infect tomato cultivar Moneymaker but not resistant cultivar Jili with homozygous Tm-2 2 . Chimeric viral ToMMVToBRFV−MP with swapped ToMMV MP to MP of tomato brown rugose fruit virus could systemically infect Tm-2 2 transgenic N. benthamiana and tomato cultivars Jili plants. Further, transient expression of ToMMV MP in the leaves of Tm-2 2 transgenic N. benthamiana plants induced hypersensitive response-associated cell death, suggesting that the MP of ToMMV was the avirulent factor for the Tm-2 2 resistance gene. ToMMV could infect Tm-2 2 -containing cultivar Jinpeng 1 but not Chaobei. Sequence analysis revealed that cultivars Chaobei and Jinpeng 1 were heterozygous, where Chaobei consists of Tm-2 2 and Tm-2 genes, while Jinpeng 1 consists of Tm-2 2 and tm-2 genes. Transient co-expression assays showed that both Tm-2 2 and Tm-2 but not tm-2 could recognize ToMMV MP and induce hypersensitivity response-associated cell death in N. benthamiana leaves, suggesting that homozygous tomato harboring Tm-2 2 and heterozygous tomato containing Tm-2 2 and Tm-2 may exhibit more durable resistance to ToMMV than heterozygous tomato carrying Tm-2 2 and tm-2. Further, Tm-2 2 transgenic N. benthamiana and tomato cultivar Jili plants with silenced Tm-2 2 gene were susceptible to ToMMV. Also, silencing type-I J-domain MIP1 gene compromised Tm-2 2 -mediated resistance to ToMMV in Tm-2 2 transgenic N. benthamiana and tomato cultivar Jili. Moreover, we found that viral RNA could accumulate in the systemic leaves of Tm-2 2 transgenic N. benthamiana plants and tomato cultivar Jili at 35°C, but not at 20, 25, or 30°C. Altogether, our findings reveal that the Tm-2 2 confers resistance to ToMMV by recognizing MP, and the resistance is regulated by the allele combinations, accumulation levels of Tm-2 2 , MIP1, and the temperature.

Abstract Objective To determine the diagnostic accuracy and safety of trans-thoracic echocardiography alone for indicating surgery by correlating preoperative trans-thoracic echocardiography with intra-operative findings in patients with congenital heart disease (CHD) in a low resource, low volume center. Methodology The pre-operative trans-thoracic echocardiography and intra-operative findings of two hundred and fifty patients with CHD, undergoing surgery at the National Cardiothoracic Centre (NCTC), Korle Bu Teaching Hospital, from 2012 to 2017 were prospectively compared. Included in this prospective study, were all patients with CHD who had trans-thoracic echocardiography alone at the NCTC. Excluded were patients who were operated at the NCTC based on echocardiography done elsewhere, those who had echocardiography at the NCTC but were operated elsewhere, as well as those whose operative decision were based on cardiac catheterization or CT angiography and patients with acquired heart defects. The analysis included profiling of patients on different demographic and clinical parameters. SPSS software was used for analysis. Results Of the 250 patients ages ranged from 2 months to 60 years. The mean was 4 years 95 days, median 1 year 180 days. The female sex accounted for 152 (60.6%). The preoperative trans-thoracic echocardiography correlated with intra-operative findings completely in 228 (91.2%) of patients, affirming the accuracy of this imaging modality. There were however, 19 (7.6%) false negatives and 3 (1.2%) false positive. Neither the false positive nor false negative errors resulted in complications or adversely affected the surgical outcome. Conclusion Based on the results of this study, preoperative transthoracic echocardiography done by cardiologists at the National Cardiothoracic Center, Korle Bu Teaching Hospital Accra, demonstrated a high correlation with intraoperative findings. Echocardiography also proved to be sensitive, accurate and safe for indicating surgery in patients with congenital heart disease.

Abstract Background In Ghana, Balantidium coli (B. coli) has been identified in vegetables and in pigs, although there is a paucity of data regarding human balantidiosis. This study sought to assess human B. coli infection in Ghana, factors associated with the infection as well as its association with haematological and biochemical parameters. Methods Two pig rearing communities in the Ga West Municipality, Ghana, were involved in this study. Stool and blood samples were collected from pig farmers and their exposed household members as well as relevant information on potential associated factors. Eosin-saline wet preparation was done on the same day of stool samples were collected while formol ether concentration technique was performed later. Haematological, biochemical parameters and serum electrolytes were determined using Celltac MEK-6500 K, PKL-125 biochemical analyser, and FT-320 electrolyte analyser, respectively. Results The overall prevalence of balantidiosis was 10.4 %, significantly higher among farmers (21.7 %) than in exposed household members (5.8 %) (x 2 = 17.8, p = 0.000025). Of the 43 infected individuals, 20.9 % were co-infected with either Entamoeba histolytica, Giardia lamblia, or Schistosoma mansoni. In B. coli infection, mild to moderate anaemia together with a reduction in levels of platelet, albumin and, sodium, chloride, and bicarbonate ions were observed. However, white blood cells were significantly elevated in infected states. Poor farming practices such as free-range systems, improper disposal of pig faeces, lack of use of protective farming clothing, and unavailability of dedicated farming clothing were found to be associated with B. coli infection status. Finally, frequent diarrhea (OR = 12.30, p = 0.006) with occult blood (OR = 25.94, p

Abstract Background Healthcare is amongst the most complex of human systems. Coordinating activities and integrating newer with older ways of treating patients while delivering high-quality, safe care, is challenging. Three landmark reports in 2018 led by (1) the Lancet Global Health Commission, (2) a coalition of the World Health Organization, the Organisation for Economic Co-operation and Development and the World Bank, and (3) the National Academies of Sciences, Engineering and Medicine of the United States propose that health systems need to tackle care quality, create less harm and provide universal health coverage in all nations, but especially low- and middle-income countries. The objective of this study is to review these reports with the aim of advancing the discussion beyond a conceptual diagnosis of quality gaps into identification of practical opportunities for transforming health systems by 2030. Main body We analysed the reports via text-mining techniques and content analyses to derive their key themes and concepts. Initiatives to make progress include better measurement, using the capacities of information and communications technologies, taking a systems view of change, supporting systems to be constantly improving, creating learning health systems and undergirding progress with effective research and evaluation. Our analysis suggests that the world needs to move from 2018, the year of reports, to the 2020s, the decade of action. We propose three initiatives to support this move: first, developing a blueprint for change, modifiable to each country’s circumstances, to give effect to the reports’ recommendations; second, to make tangible steps to reduce inequities within and across health systems, including redistributing resources to areas of greatest need; and third, learning from what goes right to complement current efforts focused on reducing things going wrong. We provide examples of targeted funding which would have major benefits, reduce inequalities, promote universality and be better at learning from successes as well as failures. Conclusion The reports contain many recommendations, but lack an integrated, implementable, 10-year action plan for the next decade to give effect to their aims to improve care to the most vulnerable, save lives by providing high-quality healthcare and shift to measuring and ensuring better systems- and patient-level outcomes. This article signals what needs to be done to achieve these aims.

Abstract Background Informal recycling of electronic waste (e-waste) releases particulate matter (PM) into the ambient air. Human exposure to PM has been reported to induce adverse effects on cardiovascular health. However, the impact of PM on the cardiovascular health of e-waste recyclers in Ghana has not been studied. Although intake of micronutrient-rich diet is known to modify these PM-induced adverse health effects, no data are available on the relationship between micronutrient status of e-waste recyclers and the reported high-level exposure to PM. We therefore investigated whether the intake of micronutrient-rich diets ameliorates the adverse effects of ambient exposure to PM2.5 on blood pressure (BP). Methods This study was conducted among e-waste and non-e-waste recyclers from March 2017 to October 2018. Dietary micronutrient (Fe, Ca, Mg, Se, Zn, and Cu) intake was assessed using a 2-day 24-h recall. Breathing zone PM2.5 was measured with a real-time monitor. Cardiovascular indices such as systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were measured using a sphygmomanometer. Ordinary least-squares regression models were used to estimate the joint effects of ambient exposure to PM2.5 and dietary micronutrient intake on cardiovascular health outcomes. Results Fe was consumed in adequate quantities, while Ca, Se, Zn, Mg, and Cu were inadequately consumed among e-waste and non-e-waste recyclers. Dietary Ca, and Fe intake was associated with reduced SBP and PP of e-waste recyclers. Although PM2.5 levels were higher in e-waste recyclers, exposures in the control group also exceeded the WHO 24-h guideline value (25 μg/m3). Exposure to 1 μg/m3 of PM2.5 was associated with an increased heart rate (HR) among e-waste recyclers. Dietary Fe intake was associated with a reduction in systolic blood pressure levels of e-waste recyclers after PM exposure. Conclusions Consistent adequate dietary Fe intake was associated with reduced effects of PM2.5 on SBP of e-waste recyclers overtime. Nonetheless, given that all other micronutrients are necessary in ameliorating the adverse effects of PM on cardiovascular health, nutrition-related policy dialogues are required. Such initiatives would help educate informal e-waste recyclers and the general population on specific nutrients of concern and their impact on the exposure to ambient air pollutants.

Abstract Introduction Geophagia although pleasurable and somewhat a necessity among pregnant women, also comes along with its own attendant problems such as exposure to potentially hazardous substances like bacteria, fungi, helminthes and ova, radioactive materials, and toxic elemental minerals in the soil depending on the geographical location. Methodology This study evaluated the potential health risk involved during the exposure of pregnant women to toxic elemental minerals via the consumption of clay as pica (geophagia). Elemental mineral analysis was carried out using Buck Scientific 210VGP Flame Atomic Absorption Spectrophotometer (Buck Scientific, Inc. East Norwalk, USA). Risk assessment methods were also used to ascertain the various risks factors and the overall risk level. Results Concentrations of the macro elements investigated were 1.38 ± 1.5, 2.40 ± 1.5, 7.74 ± 1.5, 4.01 ± 1.0, 13.24 ± 2.2 and 13.76 ± 2.1 mg/Kg for iron (Fe), copper (Cu), zinc (Zn), potassium (K), magnesium (Mg) and sodium (Na) respectively. While that for the micro elements were 1.63 ± 0.03 μg/Kg, 4.72 ± 0.8, 0.53 ± 0.02 and 1.85 ± 0.3 mg/kg respectively for arsenic (As), manganese (Mn), lead (Pb) and nickel (Ni). Estimated Daily Intake (EDI), Hazard Quotient (HQ), Target Hazard Quotient (THQ) and Total Target Hazard Quotient (TTHQ) values ranged 0.611–5.44 (mg/kg Bw/day), 6.26 × 10− 4 – 106.5, 0.067–10.34 and 15 respectively. Conclusion There is the likelihood of posing adverse health problems when clay samples obtained from Anfoega which is sited in the Volta region of Ghana is consumed due to the fact that the HQ’s of these elemental minerals were > 1 which points to high content of Manganese (Mn) and Nickel (Ni). It is also likely to cause adverse health problems in an individual’s life time since THQ for Arsenic, Lead and Nickel were above 1. Ultimately, the cumulative effect of these toxicants were exceedingly great (≤ 15) which implied a high level of unsafety associated with this clay. Per the results from this study, it is not safe for pregnant women to consume clay as pica since these toxic elements may cause detrimental effects on the foetus of the unborn child.

Abstract Background The study objective was to determine the carriage and serotype distribution of Streptococcus pneumoniae among children in Accra, Ghana, five years after the introduction of the pneumococcal conjugate vaccine (PCV-13) in 2012. Methods Nasopharyngeal swab samples were collected from 410 children below 5 years of age in Accra, Ghana, from September to December, 2016. Pneumococcal isolates were identified by optochin sensitivity and bile solubility. Serotyping was performed using the latex agglutination kit and Quellung reaction. The isolates were furthermore tested for antimicrobial susceptibility for different antimicrobials, including penicillin (PEN). Twelve isolates including seven non-typeable (NT) isolates were characterized using whole-genome sequencing analysis (WGS). Results The overall carriage prevalence was found to be 54% (95% CI, 49–59%), and 20% (95% CI, 49–59%) of the children were carrying PCV-13 included serotypes, while 37% (95% CI, 33–42%) of the children were carrying non-PCV-13 serotypes. Based on the serotype distribution, 33% of all observed serotypes were included in PCV-13 while 66% were non-PCV-13 serotypes. The dominating non-PCV-13 serotypes were 23B, 16F, and 11A followed by PCV-13 serotypes 23F and 19F. The PCV-13 covers the majority of resistant isolates in Accra. A proportion of 22.3% of the isolates showed intermediate resistance to penicillin G, while only one isolate showed full resistance. Forty-five isolates (20.5%) were defined as multidrug-resistant (MDR) as they were intermediate/resistant to three or more classes of antimicrobials. Of the seven NT isolates characterized by WGS, four showed highest match to genotype 38, while the remaining three showed highest match to genotype 14. Four MDR serotype 19A isolates were found to be MLST 320. Conclusion PCV-13 introduced in Ghana did not eliminate PCV-13 covered serotypes, and the carriage rate of 54% in this study is similar to carriage studies from pre PCV-13 period. However, the penicillin non-susceptible isolates have been reduced from 45% of carriage isolates before PCV-13 introduction to 22.3% of the isolates in this study. Continuous monitoring of serotype distribution is important, and in addition, an evaluation of an alternative vaccination schedule from 3 + 0 to 2 + 1 will be important to consider.

Abstract Background Health facility births contribute to the prevention of maternal deaths. Although theoretical and empirical evidence suggest that social network characteristics influence facility delivery, examination of this relationship in sub-Saharan Africa is limited. We determined whether network structural and functional characteristics were associated with, or had an interactive effect on health facility delivery in rural Ghana. Methods Data on mothers (n = 783) aged 15–49 years came from a Maternal and Newborn Health Referral (MNHR) project in Ghana, and included egocentric network data on women’s social network characteristics. Using multivariate logistic regression we examined the relationship between facility delivery and women’s network structure and functions, as well as the interaction between network characteristics and facility delivery. Results Higher levels of instrumental support (e.g. help with daily chores or seeking health care [OR: 1.60, CI: 1.10–2.34]) and informational support (OR: 1.66, CI: 1.08–2.54) were significantly associated with higher odds of facility delivery. Social norms, such as knowing more women who had received pregnancy-related care in a facility, were significantly associated with higher odds of facility delivery (OR: 2.20, CI: 1.21–4.00). The number of network members that respondents lived nearby moderated the positive relationship between informational support and facility delivery. Additionally, informational support moderated the positive relationship between facility delivery and the number of women the respondents knew who had utilized a facility for pregnancy-related care. Conclusions Social support from network members was critical to facilitating health facility delivery, and support was further enhanced by women’s network structure and norms favoring facility delivery. Maternal health interventions to increase facility delivery uptake should target women’s social networks.

Abstract Background Influenza A viruses that cause highly pathogenic avian influenza (HPAI) also infect humans. In many developing countries such as Ghana, poultry and humans live in close proximity in both the general and military populations, increasing risk for the spread of HPAI from birds to humans. Respiratory infections such as influenza are especially prone to rapid spread among military populations living in close quarters such as barracks making this a key population for targeted avian influenza surveillance and public health education. Method Twelve military barracks situated in the coastal, tropical rain forest and northern savannah belts of the country were visited and the troops and their families educated on pandemic avian influenza. Attendants at each site was obtained from the attendance sheet provided for registration. The seminars focused on zoonotic diseases, influenza surveillance, pathogenesis of avian influenza, prevention of emerging infections and biosecurity. To help direct public health policies, a questionnaire was used to collect information on animal populations and handling practices from 102 households in the military barracks. Cloacal and tracheal samples were taken from 680 domestic and domesticated wild birds and analysed for influenza A using molecular methods for virus detection. Results Of the 1028 participants that took part in the seminars, 668 (65%) showed good knowledge of pandemic avian influenza and the risks associated with its infection. Even though no evidence of the presence of avian influenza (AI) infection was found in the 680 domestic and wild birds sampled, biosecurity in the households surveyed was very poor. Conclusion Active surveillance revealed that there was no AI circulation in the military barracks in April 2011. Though participants demonstrated good knowledge of pandemic avian influenza, biosecurity practices were minimal. Sustained educational programs are needed to further strengthen avian influenza surveillance and prevention in military barracks.

Abstract Background There is limited data on adolescent mortality particularly from developing countries with unreliable death registration systems. This calls for the use of other sources of data to ascertain cause of adolescent mortality. The objective of this study was to describe the causes of death among Ghanaian adolescents 10 to 19 years in Accra, Ghana utilizing data from autopsies conducted in Korle Bu Teaching Hospital (KBTH). Findings Out of the 14,034 autopsies carried out from 2001 to 2003 in KBTH, 7% were among adolescents. Of the 882 deaths among adolescents analyzed, 402 (45.6%) were females. There were 365 (41.4%) deaths from communicable disease, pregnancy related conditions and nutritional disorders. Non-communicable diseases accounted for 362 (41%) cases and the rest were attributable to injuries and external causes of morbidity and mortality. Intestinal infectious diseases and lower respiratory tract infections were the most common communicable causes of death collectively accounting for 20.5% of total deaths. Death from blood diseases was the largest (8.5%) among the non-communicable conditions followed by neoplasms (7%). Males were more susceptible to injuries than females (χ2 = 13.45, p = .000). At least five out of ten specific causes of death were as a result of infections with pneumonia and typhoid being the most common. Sickle cell disease was among the top three specific causes of death. Among the females, 27 deaths (6.7%) were pregnancy related with most of them being as a result of abortion. Conclusions The autopsy data from the Korle-Bu Teaching Hospital can serve as a useful source of information on adolescent mortality. Both communicable and non-communicable diseases accounted for most deaths highlighting the need for health care providers to avoid complacency in their management of adolescents presenting with these diseases.

Abstract Background The West African sub-region has poor health infrastructure. Mechanical valve replacement in children from such regions raises important postoperative concerns; among these, valve-related morbidity and complications of lifelong anticoagulation are foremost. Little is known about the long-term outcome of mechanical valve replacement in West Africa. We sought to determine the outcome of mechanical valve replacement of the left heart in children from this sub-region. Method We conducted a retrospective review of all consecutive left heart valve replacements in children (< 18 years old) from January 1993 - December 2008. The study end-points were mortality, valve-related morbidity, and reoperation. Results One hundred and fourteen patients underwent mitral valve replacement (MVR), aortic valve replacement (AVR) or mitral and aortic valve replacements (MAVR). Their ages ranged from 6-18 years (13.3 ± 3.1 years). All patients were in NYHA class III or IV. Median follow up was 9.1 years. MVR was performed in 91 (79.8%) patients, AVR in 13 (11.4%) and MAVR in 10 (8.8%) patients. Tricuspid valve repair was performed concomitantly in 45 (39.5%) patients. There were 6 (5.3%) early deaths and 6 (5.3%) late deaths. Preoperative left ventricular dysfunction (ejection fraction < 45%) was the most important factor contributing to both early and late mortality. Actuarial survival at 1 and 15 years were 98.1% and 94.0% respectively. Prosthetic valve thrombosis occurred in 5 patients at 0.56% per patient-year. There was 1(0.9%) each of major bleeding event and prosthetic valve endocarditis. Two reoperations were performed at 0.22% per patient-year. Actuarial freedom from reoperation was 99.1% at 1 and 10 years, and 85.1% at 15 years. Conclusion Mechanical valve replacement in West African children has excellent outcomes in terms of mortality, valve-related events, and reoperation rate. Preoperative left ventricular dysfunction is the primary determinant of mortality within the first 2 years of valve replacement. The risk of valve-related complications is acceptably low. Anticoagulation is well tolerated with a very low risk of bleeding even in this socioeconomic setting.

Abstract Background Several studies have suggested that elevated serum alanine aminotransferase (ALT) and asparte aminotransferase (AST) may be markers of hepatitis E virus (HEV) infection. Thus, individuals with elevated ALT and AST may have ongoing subclinical infection of HEV. We estimated the prevalence of anti-HEV antibodies and serum ALT and AST levels among persons who work with pigs in Accra, Ghana. Results Three hundred and fifty- persons who work with pigs provided blood samples for unlinked anonymous testing for the presence of antibodies to HEV, ALT and AST levels. The median age of participants was 32.85 ± 11.38 years (range 15-70 years). HEV seroprevelance was 34.84%. Anti-HEV IgG was detected in 19.26% while anti-HEV IgM was detected in 15.58% of the persons who tested positive. On multivariate analysis, the independent determinants of HEV infection were, being employed on the farm for less than six months [odds ratio (OR) 8.96; 95% confidence interval (95% CI) 5.43-14.80], having piped water in the household and/or on the farm (OR 13.33; 95% CI 5.23-33.93) and consumption of alcohol (OR 4.91: 95% CI 2.65-9.10). Levels >3× the expected maximum were found for both ALT and AST among individuals who tested positive for anti-HEV IgG (ALT, 210.17 ± 11.64 U/L; AST, 127.18 ± 11.12 U/L) and anti-HEV IgM (ALT, 200.97 ± 10.76 U/L; AST, 120.00 ± 15.96 U/L). Conclusion Consistent with similar studies worldwide, the results of our studies revealed a high prevalence of HEV infection, ALT and AST values in pig handlers.

Abstract Background Injuries are noted to be an important cause of death among adolescents. There is however limited data on the injury related deaths among adolescents in Ghana. Findings Using data from post-mortem records derived from the Department of Pathology of the Korle-Bu Teaching Hospital (KBTH), Accra Ghana from 2001 to 2003, the causes of injury related deaths among adolescents 10 to 19 years were analyzed by gender and age groups 10 to 14 and 15 to 19 years. There were 151 injury-related deaths constituting 17% of the autopsies performed among adolescents in the study period. The male-to-female ratio was 2.1:1. Drowning was the most common cause of death (37%) in the study population. This was followed by road traffic accidents (RTA) (33%). Over 70% of the RTA victims were pedestrians knocked downed by a vehicle. Deaths from electrocution, poisoning, burns, stab/gunshot, hanging and other miscellaneous causes (example blast injury, traumatic injury from falling debris, fall from height) made up the remaining 30% of the injury related mortality. Among males and in both age categories, drowning was the leading cause of death. In females, the highest mortality was from road traffic accidents accounting for almost half (49%) of the deaths; significantly more than that occurring in males (25%, p = .004). Conclusions Findings from Korle-Bu Teaching Hospital post-mortem data on adolescents show that drowning and road traffic accidents are the leading causes of injury-related mortality. Appropriate injury reducing interventions are needed to facilitate a decrease in these preventable deaths.

Abstract Background Hepatitis E virus (HEV) is highly endemic in several African countries with high mortality rate among pregnant women. The prevalence of antibodies to HEV in Ghana is not known. Therefore we evaluated the prevalence of anti-HEV IgG and anti-HEV IgM among pregnant women seen between the months of January and May, 2008 at the Obstetrics and Gynaecology Department, Korle-Bu Teaching Hospital, Accra, Ghana. Results One hundred and fifty-seven women provided blood samples for unlinked anonymous testing for the presence of antibodies to HEV. The median age of participants was 28.89 ± 5.76 years (range 13–42 years). Of the 157 women tested, HEV seroprevelance was 28.66% (45/157). Among the seropositive women, 64.40% (29/45) tested positive for anti-HEV IgM while 35.60% (16/45) tested positive to HEV IgG antibodies. HEV seroprevalence was highest (46.15%) among women 21–25 years of age, followed by 42.82% in = 20 year group, then 36.84% in = 36 year group. Of the 157 women, 75.79% and 22.92% were in their third and second trimesters of pregnancy, respectively. Anti-HEV antibodies detected in women in their third trimester of pregnancy (30.25%) was significantly higher, P < 0.05, than in women in their second trimester of pregnancy (25.0%). Conclusion Consistent with similar studies worldwide, the results of our studies revealed a high prevalence of HEV infection in pregnant women.

Abstract Background Plasmodium falciparum can cause a diffuse encephalopathy known as cerebral malaria (CM), a major contributor to malaria associated mortality. Despite treatment, mortality due to CM can be as high as 30% while 10% of survivors of the disease may experience short- and long-term neurological complications. The pathogenesis of CM and other forms of severe malaria is multi-factorial and appear to involve cytokine and chemokine homeostasis, inflammation and vascular injury/repair. Identification of prognostic markers that can predict CM severity will enable development of better intervention. Methods Postmortem serum and cerebrospinal fluid (CSF) samples were obtained within 2–4 hours of death in Ghanaian children dying of CM, severe malarial anemia (SMA), and non-malarial (NM) causes. Serum and CSF levels of 36 different biomarkers (IL-1β, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12 (p70), IL-13, IL-15, IL-17, Eotaxin, FGF basic protein, CRP, G-CSF, GM-CSF, IFN-γ, TNF-α, IP-10, MCP-1 (MCAF), MIP-1α, MIP-1β, RANTES, SDF-1α, CXCL11 (I-TAC), Fas-ligand [Fas-L], soluble Fas [sFas], sTNF-R1 (p55), sTNF-R2 (p75), MMP-9, TGF-β1, PDGF bb and VEGF) were measured and the results compared between the 3 groups. Results After Bonferroni adjustment for other biomarkers, IP-10 was the only serum biomarker independently associated with CM mortality when compared to SMA and NM deaths. Eight CSF biomarkers (IL-1ra, IL-8, IP-10, PDGFbb, MIP-1β, Fas-L, sTNF-R1, and sTNF-R2) were significantly elevated in CM mortality group when compared to SMA and NM deaths. Additionally, CSF IP-10/PDGFbb median ratio was statistically significantly higher in the CM group compared to SMA and NM groups. Conclusion The parasite-induced local cerebral dysregulation in the production of IP-10, 1L-8, MIP-1β, PDGFbb, IL-1ra, Fas-L, sTNF-R1, and sTNF-R2 may be involved in CM neuropathology, and their immunoassay may have potential utility in predicting mortality in CM.