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Background and Aims: The environment within prisons, such as overcrowding, lack of access to portable water, poor sanitation, and hygiene predisposes inmates to infections, including intestinal parasitic infections (IPIs). This study therefore determined the prevalence and associated factors of IPIs among prison inmates in Southern Ghana. Methods: A cross‐sectional study using the stratified sampling technique was employed. The study recruited 461 prison inmates across three notable prisons, with 50 inmates from Ho Central, 357 inmates from Nsawam Medium Security, and 54 inmates from Sekondi Central Prisons all in Southern Ghana. A structured closed‐ended questionnaire was administered to collect data on sociodemographics, lifestyle/behavioral characteristics, and signs and symptoms of IPIs. In addition, stool samples were collected and analyzed for the presence of various stages of intestinal parasites (trophozoites, cysts, ova, and larva) using formol‐ether concentration, and the modified Ziehl–Neelsen techniques. Results: The prevalence of IPIs among inmates of the three selected prisons was 38.2% (95% confidence interval [CI]: 33.72%–42.79%). The prevalence of IPIs among inmates of the three prisons, the Ho Central, Nsawam Medium Security, and Sekondi Central were 46% (95% CI: 31.82%–60.68%), 37.5% (95% CI: 32.49%–42.79%), and 35.2% (95% CI: 22.68%–49.38%), respectively. After adjusting for confounders, the following factors; handwashing after defecation (adjusted odds ratio [AOR]: 0.05 [0.00–0.67]; p = 0.024), trimmed fingernails (AOR: 0.32 [0.13–0.76]; p = 0.011), itchy skin (AOR [95% CI]: 5.99 [3.43–10.43]; p < 0.001), anal itching (AOR [95% CI]: 0.35 [0.19–0.62]; p < 0.001), nausea (AOR [95% CI]: 5.57 [3.22–9.65]; p < 0.001), and worm expulsion (AOR [95% CI]: 3.80 [1.42–10.18]; p = 0.008) were found to be associated with intestinal parasitic infections. Conclusion: The study revealed that the prevalence of intestinal parasitic infections among prisons in Southern Ghana is high and is therefore an important public health concern. The Public Health Department of Ghana Health Service should therefore embark on health promotion and deworming exercise in all prisons in Ghana. [ABSTRACT FROM AUTHOR]

This study examined the associations between PM (2.5 and 10) and global DNA methylation among 100 e-waste workers and 51 non-e-waste workers serving as controls. Long interspersed nucleotide repetitive elements-1 (LINE-1) was measured by pyrosequencing. Personal PM2.5 and PM10 were measured over a 4-hour work-shift using real-time particulate monitors incorporated into a backpack. Linear regression models were used to assess the association between PM and LINE-1 DNA methylation. The concentrations of PM2.5 and PM10 were significantly higher among the e-waste workers than the controls (77.32 vs 34.88, p < 0.001 and 210.21 vs 121.92, p < 0.001, respectively). PM2.5 exposure was associated with increased LINE-1 CpG2 DNA methylation (β = 0.003; 95% CI; 0.001, 0.006; p = 0.022) but not with the average of all 4 CpG sites of LINE-1. In summary, high levels of PM2.5 exposure was associated with increased levels of global DNA methylation in a site-specific manner. [ABSTRACT FROM AUTHOR]

Aberrant global DNA methylation status is a known biomarker for increased disease risk, especially cancer. There is little published data on the association between toxic and essential metal mixtures and global DNA methylation in electronic waste (e-waste) workers. We aimed to establish the association between toxic and essential metals in blood and the effect of their interactions on global DNA methylation among e-waste recyclers and a reference group in Ghana. We used ICP-MS to measure the level of five metals (Se, Zn, Mn, Cd, and Pb) in the blood of 100 e-waste workers and 51 controls. We quantified blood DNA methylation levels of LINE-1 as an indicator of global DNA methylation. Cd, Mn, and Se levels were significantly higher in the reference group than in e-waste workers. Only Pb was significantly higher in the e-waste workers compared to the controls. Our linear regression analysis results showed a significant inverse association between Zn and LINE-1 DNA methylation (βZn = − 0.912; 95% CI, − 1.512, − 0.306; p = 0.003) which corresponds to a 0.009 decrease in %LINE-1 methylation (95% CI, − 0.015, − 0.003; p = 0.003) for a 1% increase in Zn concentration. Potential interactions between Cd and Zn on global DNA methylation were observed. In summary, co-exposure to toxic and essential metals is associated with global (LINE-1) DNA methylation. [ABSTRACT FROM AUTHOR]

This study is aimed at establishing reference intervals (RIs) of 40 chemistry and immunochemistry analytes for Ghanaian adults based on internationally harmonized protocol by IFCC Committee on Reference Intervals and Decision Limits (C-RIDL). A total of 501 healthy volunteers aged ≥18 years were recruited from the northern and southern regions of Ghana. Blood samples were analyzed with Beckman-Coulter AU480 and Centaur-XP/Siemen auto-analyzers. Sources of variations of reference values (RVs) were evaluated by multiple regression analysis (MRA). The need for partitioning RVs by sex and age was guided by the SD ratio (SDR). The RI for each analyte was derived using parametric method with application of the latent abnormal values exclusion (LAVE) method. Using SDR≥0.4 as threshold, RVs were partitioned by sex for most enzymes, creatinine, uric acid (UA), bilirubin, immunoglobulin-M. MRA revealed age and body mass index (BMI) as major source of variations of many analytes. LAVE lowered the upper limits of RIs for alanine/aspartate aminotransferase, γ-glutamyl transaminase and lipids. Exclusion of individuals with BMI≥30 further lowered the RIs for lipids and CRP. After standardization based on value-assigned serum panel provided by C-RIDL, Ghanaian RIs were found higher for creatine kinase, amylase, and lower for albumin and urea compared to other collaborating countries. The LAVE effect on many clinical chemistry RIs supports the need for the secondary exclusion for reliable derivation of RIs. The differences in Ghanaian RIs compared to other countries underscore the importance of country specific-RIs for improved clinical decision making. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the associations between blood and urine levels of toxic metals; cadmium (Cd) and lead (Pb), and methylation levels of the LINE-1 gene among e-waste and control populations in Ghana. Methods: The study enrolled 100 male e-waste workers and 51 all-male non-e-waste workers or controls. The concentrations of Cd and Pb were measured in blood and urine using inductively coupled plasma mass spectrometry, while LINE1 methylation levels were assessed by pyrosequencing of bisulfite-converted DNA extracted from whole blood. Single and multiple metals linear regression models were used to determine the associations between metals and LINE1 DNA methylation. Results: Blood lead (BPb) and urine lead (UPb) showed higher median concentrations among the e-waste workers than the controls (76.82 µg/L vs 40.25 µg/L, p ≤ 0.001; and 6.89 µg/L vs 3.43 µg/L, p ≤ 0.001, respectively), whereas blood cadmium (BCd) concentration was lower in the e-waste workers compared to the controls (0.59 µg/L vs 0.81 µg/L, respectively, p = 0.003). There was no significant difference in LINE1 methylation between the e-waste and controls (85.16 ± 1.32% vs 85.17 ± 1.11%, p = 0.950). In our single metal linear regression models, BPb was significantly inversely associated with LINE1 methylation in the control group (βBPb = − 0.027, 95% CI − 0.045, − 0.010, p = 0.003). In addition, a weak association between BPb and LINE1 was observed in the multiple metals analysis in the e-waste worker group (βBPb = − 0.005, 95% CI − 0.011, 0.000, p = 0.058). Conclusion: Continuous Pb exposure may interfere with LINE1 methylation, leading to epigenetic alterations, thus serving as an early epigenetic marker for future adverse health outcomes. [ABSTRACT FROM AUTHOR]

Background: Informal sector electronic waste (e‐waste) recovery produces toxic emissions resulting from burning e‐waste to recover valuable metals. Objectives: To identify high‐risk worker groups by measuring relative levels of personal inhalation exposure to particulate matter (PM) of fine (≤2.5 µm) and coarse (2.5–10 µm) fractions (PM2.5 and PM2.5–10, respectively) across work activities among e‐waste workers, and to assess how wind conditions modify levels of PM by activity and site location. Methods: At the Agbogbloshie e‐waste site, 170 partial‐shift PM samples and time‐activity data were collected from participants (N = 105) enrolled in the GeoHealth cohort study. Personal sampling included continuous measures of size‐specific PM from the worker's breathing zone and time–activity derived from wearable cameras. Linear mixed models were used to estimate changes in personal PM2.5 and PM2.5–10 associated with activities and evaluate effect modification by wind conditions. Results: Mean (±standard deviation) personal PM2.5 and PM2.5–10 concentrations were 80 (± 81) and 123 (± 139) µg m−3, respectively. The adjusted mean PM2.5 concentration for burning e‐waste was 88 µg m−3, a 28% increase above concentrations during non‐recovery activities (such as eating). Transportation‐related and burning activities were associated with the highest PM2.5–10 concentrations. Frequent changes in wind direction were associated with higher PM2.5 concentrations when burning, and high wind speeds with higher PM2.5–10 concentrations when dismantling e‐waste downwind of the burning zone. [ABSTRACT FROM AUTHOR]

Background: In Ghana, diagnostic laboratories rely on reference intervals (RIs) provided by manufacturers of laboratory analyzers which may not be appropriate. This study aimed to establish RIs for hematological parameters in adult Ghanaian population. Methods: This cross‐sectional study recruited 501 apparently healthy adults from two major urban areas in Ghana based on the protocol by IFCC Committee for Reference Intervals and Decision Limits. Whole blood was tested for complete blood count (CBC) by Sysmex XN‐1000 analyzer, sera were tested for iron and ferritin by Beckman‐Coulter/AU480, for transferrin, vitamin‐B12, and folate was measured by Centaur‐XP/Siemen. Partitioning of reference values by sex and age was guided by "effect size" of between‐subgroup differences defined as standard deviation ratio (SDR) based on ANOVA. RIs were derived using parametric method with application of latent abnormal values exclusion method (LAVE), a multifaceted method of detecting subjects with abnormal results in related parameters. Results: Using SDR ≥ 0.4 as a threshold, RIs were partitioned by sex for platelet, erythrocyte parameters except mean corpuscular constants, and iron markers. Application of LAVE had prominent effect on RIs for majority of erythrocyte and iron parameters. Global comparison of Ghanaian RIs revealed lower‐side shift of RIs for leukocyte and neutrophil counts, female hemoglobin and male platelet count, especially compared to non‐African countries. Conclusion: The LAVE effect on many hematological RIs indicates the need for deliberate secondary exclusion for proper derivation of RIs. Obvious differences in Ghanaian RIs compared to other countries underscore the importance of country‐specific RIs for improved clinical decision‐making. [ABSTRACT FROM AUTHOR]

Background: Intestinal parasitic infections affect pregnant women worldwide. The infection has been implicated in causing life-threatening conditions in both gravid women and their developing foetus. Sub-Saharan Africa is known to harbor the greatest proportion of intestinal parasitic infections largely due to socioeconomic and environmental factors. In Kasoa, Southern Ghana, there is paucity of data on the prevalence and associated factors of intestinal parasitic infections among pregnant women.Objective: The aim of the study was to determine the prevalence of intestinal parasitic infections and associated factors among pregnant women attending antenatal care in Kasoa Polyclinic.Methods: A hospital based analytical cross-sectional study was carried out among three hundred (300) conveniently sampled pregnant women receiving antenatal care services at the Kasoa Polyclinic. Structured questionnaires were administered to the study participants to assess sociodemographic and other possible factors. Stool samples were collected from each pregnant woman and examined for the presence of intestinal parasites by microscopy using direct wet mount as well as formol-ether sedimentation techniques.Results: Overall prevalence of intestinal parasites was 14.3% (95% CI 11-19%). Entamoeba histolytica (5.0%) was the most predominant parasite species identified followed by Ascaris lumbricoides (4.3%), Giardia lamblia (2.3%), Trichuris trichiura (1.3%), Schistosoma mansoni (0.3%), Hookworm (0.3%), Hymenolepis nana (0.3%), and Isospora belli (0.3%). Age > 30 years (AOR = 0.17, 95% CI = 0.06-0.48; p=0.001), multigravidity (AOR = 0.43, 95% CI = 0.19-0.97; p=0.043), and 2nd and 3rd trimesters (AOR = 4.73, 95% CI = 1.36-16.49; p=0.015) were independently associated with intestinal parasitic infections among pregnant women.Conclusions: A prevalence of 14.3% pregnant women compared to previous studies in Ghana is relatively low. It however suggests that intestinal parasitic infection is still a problem. The major factors noted were age, gravidity, and gestational age. Routine stool examination and provision of public health education are recommended to prevent infection of pregnant mothers and their unborn babies. [ABSTRACT FROM AUTHOR]

Air quality information is scarce in low‐ and middle‐income countries. This study describes the application of moderate cost approaches that can provide spatial and temporal information on concentrations of particulate matter (PM) needed to assess community and occupational exposures. We evaluated PM levels at the Agbogbloshie e‐waste and scrap yard site in Accra, Ghana, and at upwind and downwind locations, obtaining both optical and gravimetric measurements, local meteorological data and satellite aerosol optical depth. Due to overload issues, the gravimetric 24‐hr samplers were modified for periodic sampling and some optical data were screened for quality assurance. Exceptionally high concentrations (e.g., 1‐hr average PM10 exceeding 2000 μg/m3) were sometimes encountered near combustion sources, including open fires at the e‐waste site and spoil piles. 24‐hr PM2.5 levels averaged 31, 88 and 57 μg/m3 at upwind, e‐waste and downwind sites, respectively, and PM10 averaged 145, 214 and 190 μg/m3, considerably exceeding air quality standards. Upwind levels likely reflected biomass burning that is prevalent in the surrounding informal settlements; levels at the e‐waste and downwind sites also reflected contributions from biomass combustion and traffic. The highest PM levels occurred in evenings, influenced by diurnal changes in emission rates, atmospheric dispersion and wind direction shifts. We demonstrate that moderate cost instrumentation, with some modifications, appropriate data cleaning protocols, and attention to understanding local sources and background levels, can be used to characterize spatial and temporal variation in PM levels in urban and industrial areas. Key Points: Ambient particulate matter was monitored onsite, upwind and downwind of an e‐waste site in Ghana using gravimetric and optical measurementsE‐waste site emissions increased 24‐hr PM2.5 levels by 57 μg/m3 over upwind levels of 31 μg/m3, and some exceptionally high levels were measuredModerate cost methods can measure air quality and source impacts given attention to study design, sampler performance and local influences [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

Malaria pathogenesis may be influenced by IgE responses and cytokine cross-regulation. Several mutations in the IL-4/STAT6 signaling pathway can alter cytokine cross-regulation and IgE responses during a Plasmodium falciparum malarial infection. This study investigated the relationship between a STAT6 intronic single-nucleotide polymorphism (rs3024974), total IgE, cytokines, and malaria severity in 238 Ghanaian children aged between 0.5 and 13 years. Total IgE and cytokine levels were measured by ELISA, while genotyping was done by polymerase chain reaction-restriction fragment length polymorphism (RFLP). Compared with healthy controls, heterozygosity protected against clinical malaria: uncomplicated malaria (odds ratios [OR] = 0.13, P, 0.001), severe malarial anemia (OR = 0.18, P, 0.001), and cerebral malaria (OR = 0.39, P = 0.022). Levels of total IgE significantly differed among malaria phenotypes (P = 0.044) and rs3024974 genotypes (P = 0.037). Neither cytokine levels nor IL-6/IL-10 ratios were associated with malaria phenotypes or rs3024974 genotypes. This study suggests a role for rs3024974 in malaria pathogenesis and offers further insights into an IL-4/STAT6 pathway mutation in malaria pathogenesis. [ABSTRACT FROM AUTHOR]

There is growing evidence that e-waste recyclers may be exposed to potentially high levels of metals though associations between such exposures and specific work activities is not well established. In addition, studies have focused on metals traditionally biomonitored and there is no data on the exposure of recyclers to elements increasingly being used in new technologies. In the current study, levels of metals were measured in blood and urine of e-waste recyclers at Agbogbloshie (Ghana) and a control group. Blood and urine samples (from 100 e-waste recyclers and 51 controls) were analyzed for 17 elements (Ag, As, Ba, Cd, Ce, Cr, Eu, La, Mn, Nd, Ni, Pb, Rb, Sr, Tb, Tl, Y) using the ICP-MS. Most e-waste recyclers reported performing at least 4 different tasks in decreasing order as e-waste dismantling (54%), trading/selling of e-waste (45%), burning wires only (40%), and collecting wires after burning (34%). Mean levels of blood Pb, Sr, Tl, and urinary Pb, Eu, La, Tb, and Tl were significantly higher in recyclers versus controls. In general, the collectors and sorters tended to have higher elemental levels than other work groups. Blood Pb levels (mean 92.4 μg/L) exceeded the U.S. CDC reference level in 84% of the e-waste recyclers. Likewise, blood Cd, Mn, and urinary As levels in recyclers and controls were higher than in reference populations elsewhere. E-waste recyclers are exposed to metals traditionally studied (e.g., Pb, Cd, As) and several other technology-critical and rare earth elements which previously have not been characterized through human biomonitoring. • e-waste workers are exposed to potentially high levels of diverse metals. • Biomonitoring of technology critical and rare earth elements seldom done. • Blood Pb, Sr, Tl and urinary Pb, Eu, La, Tb, and Tl higher in workers vs. controls. • Exposures linked to different e-waste work practices. [ABSTRACT FROM AUTHOR]

[Display omitted] • PM 2.5 and polycyclic aromatic hydrocarbons (PAHs) were monitored at an e-waste site. • PM and PAH concentrations in personal air were nearly double levels at fixed sites. • Workers performing burning and dismantling tasks had the highest exposures. • Both PM and PAH levels exceeded standards or risk-based guidelines. • Pollutant emissions at informal e-waste sites affects nearby communities. Electronic waste (e-waste) disposal and recycling activities such as burning and smelting can emit particulate matter (PM), polycyclic aromatic hydrocarbons (PAHs), and other pollutants that expose workers and nearby communities. At informal e-waste recycling facilities, both emission controls and protective measures for workers are absent. This study characterizes personal exposures (breathing zone) of PM and PAHs of e-waste workers at the large Agbogbloshie e-waste site in Accra, Ghana. We collected gravimetric and optical measurements of PM 2.5 and PM 10 using shift samples for workers and for an age- and gender-matched reference population. PM 2.5 filters were analyzed for 26 PAHs using gas chromatography/mass spectroscopy. Among e-waste workers, PM 2.5 and PM 10 concentrations were 99 ± 56 and 218 ± 158 µg/m3 (median ± interquartile range, optical measurements), respectively; these levels were 78 and 57% higher, respectively, than levels measured at a fixed site that was centrally located at the waste site. In the reference community, breathing zone PM 2.5 and PM 10 levels were lower, 49 ± 20 and 131 ± 108 µg/m3, respectively, and the fraction of coarse PM was larger. We detected all 26 target PAHs, of which naphthalene and phenanthrene were the most abundant. PAH concentrations were weakly correlated to PM levels, but PAH abundances, representing the fraction of PAH mass to the total PM 2.5 mass collected, were strongly and inversely correlated to PM levels, suggesting multiple and different sources of PAHs and PM that affected exposures. Both PM and PAH levels were elevated for workers performing burning and dismantling, and both exceeded standards or risk-based guidelines, e.g., lifetime excess cancer risks for several PAHs were in the 10−4 to 10−6 range, indicating the need to reduce emissions as well as provide respiratory protection. The study emphasizes the importance of using personal and shift samples to accurately characterize worker exposure. [ABSTRACT FROM AUTHOR]

Informal e-waste recycling processes emit various air pollutants. While there are a number of pollutants of concern, little information exists on volatile organic compounds (VOCs) releases at e-waste sites. To assess occupational exposures and estimate health risks, we measured VOC levels at the Agbogbloshie e-waste site in Ghana, the largest e-waste site in Africa, by collecting both fixed-site and personal samples for analyzing a wide range of VOCs. A total of 54 VOCs were detected, dominated by aliphatic and aromatic compounds. Mean and median concentrations of the total target VOCs were 46 and 37 μg/m3 at the fixed sites, and 485 and 162 μg/m3 for the personal samples. Mean and median hazard ratios were 2.1 and 1.4, respectively, and cancer risks were 4.6 × 10-4 and 1.5 × 10-4. These risks were predominantly driven by naphthalene and benzene; chloroform and formaldehyde were also high in some samples. Based on the VOC composition, the major sources were industry, fuel evaporation and combustion. The concentration gradient across sites and the similarity of VOC profiles indicated that the e-waste site emissions reached neighboring communities. Our results suggest the need to protect e-waste workers from VOC exposure, and to limit emissions that can expose nearby populations. [Display omitted] • This is the first study to assess both personal and ambient VOCs in e-waste site. • VOC levels in personal samples were much higher than that in fixed-site samples. • Local industrial use, fuel evaporation and combustion were the main sources. • VOC emissions from the e-waste site polluted the neighboring environment. • Health risks exceeded guideline levels and were mainly due to naphthalene and benzene. [ABSTRACT FROM AUTHOR]

Wastewater discharge into the environment in resource-poor countries poses a threat to public health. Studies in this area within these countries are limited, and the use of high-throughput whole-genome sequencing technologies is lacking. Therefore, understanding of environmental impacts is inadequate. The present study investigated the antibiotic resistance profiles and diversity of beta-lactamases in Escherichia coli strains isolated from environmental water sources in Accra, Ghana. Microbiological analyses were conducted on wastewater samples from three hospitals, a sewage and wastewater treatment plant, and water samples from two urban surface water bodies. Confirmed isolates (N = 57) were selected for phenotypic antibiotic resistance profiles. Multi-drug-resistant isolates (n = 25) were genome sequenced using Illumina MiSeq sequencing technology and screened for sequence types, antibiotic resistance, virulence and beta-lactamase genes, and mobile genetic elements. Isolates were frequently resistant to ampicillin (63%), meropenem (47%), azithromycin (46%), and sulfamethoxazole-trimethoprim (42%). Twenty different sequence types (STs) were identified, including clinically relevant ones such as ST167 and ST21. Five isolates were assigned to novel STs: ST14531 (n = 2), ST14536, ST14537, and ST14538. The isolates belonged to phylogroups A (52%), B1 (44%), and B2 (4%) and carried β-lactamase (TEM-1B, TEM-1C, CTX-M-15, and blaDHA-1) and carbapenemase (OXA-1, OXA-181) resistance genes. Dominant plasmid replicons included Col440I (10.2%) and IncFIB (AP001918) (6.8%). Polluted urban environments in Accra are reservoirs for antibiotic-resistant bacteria, posing a substantial public health risk. The findings underscore the need for targeted public health interventions to mitigate the spread of antibiotic-resistant bacteria and protect public health., Competing Interests: I have read the journal’s policy and the authors of this manuscript have no competing interests., (Copyright: © 2024 Tettey et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Vaccine-preventable diseases (VPDs) persist globally with a disproportionately high burden in Low and Middle-Income Countries (LMICs). Although this might be partly due to the failure to sustain vaccination coverage above 90% in some WHO regions, a more nuanced understanding of VPD transmission beyond vaccination coverage may unveil other important factors in VPD transmission and control. This study identified VPDs hotspots and explored their relationships with ecology, urbanicity and land-use variations (Artisanal and Small-scale Gold Mining (ASGM) activities) in Ghana., Methods: District-level disease count data from 2010 to 2014 from the Ghana Health Service (GHS) and population data from the Ghana Population and Housing Census (PHC) were used to determine clustering patterns of six VPDs (Measles, Meningitis, Mumps, Otitis media, Pneumonia and Tetanus). Spatial and space-time cluster analyses were implemented in SaTScan using the discrete Poisson model. P-values were estimated using a combination of sequential Monte Carlo, standard Monte Carlo, and Gumbel approximations., Results: The study found a preponderance for VPD hotspots in the northern parts of Ghana and northernmost ecological zones (Sudan Savannah and Guinea Savannah). Incidence of meningitis was higher in the Sudan Savannah ecological zone relative to: Tropical Rain Forest (p = 0.001); Semi Deciduous Forest (p < 0.0001); Transitional Zone (p < 0.0001); Coastal Savannah (p < 0.0001) and Guinea Savannah (p = 0.033). Except for mumps, which recorded a higher incidence in urban districts (p = 0.045), incidence of the other five VPDs did not differ across the urban-rural divide. Whereas spatial analysis suggested that some VPD hotspots (tetanus and otitis media) occur more frequently in mining districts in the southern part of the country, a Mann-Whitney U test revealed a higher incidence of meningitis in non-mining districts (p = 0.019). Pneumonia and meningitis recorded the highest (722.8 per 100,000) and least (0.8 per 100,000) incidence rates respectively during the study period., Conclusion: This study shows a preponderance of VPD hotspots in the northern parts of Ghana and in semi-arid ecoclimates. The relationship between ASGM activities and VPD transmission in Ghana remains blurred and requires further studies with better spatial resolution to clarify., (© 2022. The Author(s).)

While metal exposures are generally high among informal electronic waste (e-waste) recyclers, the joint effect of metals and dietary macronutrients on their metabolic health is unknown. Therefore, we investigated the relationship between metal exposures, dietary macronutrients intake, and blood glucose levels of e-waste recyclers at Agbogbloshie using dietary information (48-h recall survey), blood metals (Pb & Cd), and HbA1C levels of 151 participants (100 e-waste recyclers and 51 controls from the Accra, Ghana) in March 2017. A linear regression model was used to estimate the joint relationship between metal exposures, dietary macronutrient intake, and blood glucose levels. Except for dietary proteins, both groups had macronutrient deficiencies. Diabetes prevalence was significantly higher among controls. Saturated fat, OMEGA-3, and cholesterol intake were associated with significant increases in blood glucose levels of recyclers. In a joint model, while 1 mg of cholesterol consumed was associated with a 0.7% increase in blood glucose, 1 g/L of Pb was found to significantly increase blood glucose levels by 0.9% among recyclers. Although the dietary consumption of cholesterol and fat was not high, it is still possible that exposure to Pb and Cd may still increase the risk of diabetes among both e-waste recyclers and the general population.

Informal recycling of electrical and electronic waste (e-waste) has myriad environmental and occupational health consequences, though information about the chronic musculoskeletal health effects on workers is limited. The aim of this study was to examine the prevalence and intensity of self-reported musculoskeletal disorder (MSD) symptoms among e-waste workers at Agbogbloshie in Ghana-the largest informal e-waste dumpsite in West Africa-relative to workers not engaged in e-waste recycling. A standardized musculoskeletal discomfort questionnaire was administered to 176 e-waste workers (73 collectors, 82 dismantlers, and 21 burners) and 41 workers in a reference group. The number of body parts with musculoskeletal discomfort were 1.62 and 1.39 times higher for collectors and dismantlers than burners, respectively. A 1-week discomfort prevalence was highest for collectors (91.8%) followed by dismantlers (89%), burners (81%), and the reference group (70.7%). The discomfort prevalence for e-waste workers was highest in the lower back (65.9%), shoulders (37.5%), and knees (37.5%). Whole-body pain scores (mean ± SE) were higher for collectors (83.7 ± 10.6) than dismantlers (45.5 ± 7.6), burners (34.0 ± 9.1), and the reference group (26.4 ± 5.9). Differences in prevalence, location, and intensity of MSD symptoms by the e-waste job category suggest specific work-related morbidity. Symptom prevalence and intensity call attention to the high risk for MSDs and work disability among informal e-waste workers, particularly collectors and dismantlers.

Growing evidence suggests that micronutrient status is adversely impacted by toxic metals (e.g., cadmium, lead, and arsenic) exposures; however, the micronutrient status of e-waste recyclers who are amongst the highest metal-exposed groups is not known. This study, therefore, assessed the micronutrient status of e-waste recyclers using dietary information (2-day 24-h recall survey) and biomarker data (whole blood and urine) among 151 participants (100 e-waste recyclers at Agbogbloshie and 51 controls at Madina Zongo from the Accra region, Ghana) in March 2017. Biomarker levels of iron (Fe), calcium (Ca), magnesium (Mg), selenium (Se), zinc (Zn) and copper (Cu) were analyzed by the ICP-MS. Linear regression models were used to assess associations ofwork-related factors and sociodemographic characteristics with micronutrient intake, blood, and urine micronutrient levels. The results showed that apart from Fe and Zn, e-waste recyclers at Agbogbloshie did not meet the day-to-day dietary requirements for Ca, Cu, Se, and Mg intake. Except for the low levels of Mg and Fe detected in blood of e-waste recyclers, all other micronutrients measured in both blood and urine of both groups fell within their reference range. Exposure to biomass burning was associated with lower blood levels of Fe, Mg, and Zn among the e-waste recyclers. Further, among e-waste recyclers, significant relationships were found between the number of years spent recycling e-waste and urinary Ca and Cu excretion. Given that, some dietary and blood levels of micronutrients were below their reference ranges, the implementation of evidence-based nutrition strategies remains necessary among e-waste recyclers to reduce their risk of becoming malnourished.

Background : Direct and continuous exposure to particulate matter (PM), especially in occupational settings is known to impact negatively on respiratory health and lung function. Objective : To determine the association between concentrations of PM (2.5, 2.5-10 and 10 µm) in breathing zone and lung function of informal e-waste workers at Agbogbloshie. Methods : To evaluate lung function responses to PM (2.5, 2.5-10 and 10 µm), we conducted a longitudinal cohort study with three repeated measures among 207 participants comprising 142 healthy e-waste workers from Agbogbloshie scrapyard and 65 control participants from Madina-Zongo in Accra, Ghana from 2017-2018. Lung function parameters (FVC, FEV1, FEV1/FVC, PEF, and FEF 25-75) and PM (2.5, 2.5-10 and 10 µm) concentrations were measured, corresponding to prevailing seasonal variations. Socio-demographic data, respiratory exposures and lifestyle habits were determined using questionnaires. Random effects models were then used to examine the effects of PM (2.5, 2.5-10 and 10 µm) on lung function. Results : The median concentrations of PM (2.5, 2.5-10 and 10 µm) were all consistently above the WHO ambient air standards across the study waves. Small effect estimates per IQR of PM (2.5, 2.5-10 and 10 µm) on lung function parameters were observed even after adjustment for potential confounders. However, a 10 µg increase in PM (2.5, 2.5-10 and 10 µm) was associated with decreases in PEF and FEF 25-75 by 13.3% % [β = -3.133; 95% CI: -0.243, -0.022) and 26.6% [β = -0.266; 95% CI: -0.437, 0.094]. E-waste burning and a history of asthma significantly predicted a decrease in PEF by 14.2% [β = -0.142; 95% CI: -0.278, -0.008) and FEV1 by 35.8% [β = -0.358; 95% CI: -0.590, 0.125] among e-waste burners. Conclusions : Direct exposure of e-waste workers to PM predisposes to decline in lung function and risk for small airway diseases such as asthma and COPD.

Background: A walk through the Agbogbloshie e-waste recycling site shows a marked heterogeneity in the spatial distribution of the different e-waste processing activities, which are likely to drive clustering of health conditions associated with the different activity type in each space., Objective of Study: To conduct a spatial assessment and analysis of health conditions associated with different e-waste activities at different activity spaces at Agbogbloshie., Methods: A choropleth showing the various activity spaces at the Agbogbloshie e-waste site was produced by mapping boundaries of these spaces using Etrex GPS device and individuals working in each activity spaces were recruited and studied. Upon obtaining consent and agreeing to participate in the study, each subject was physically examined and assessed various health outcomes of interest via direct physical examination while characterizing and enumerating the scars, lacerations, abrasions, skin condition and cuts after which both systolic and diastolic blood pressure values were recorded alongside the administration of open and close ended questionnaires. All individuals working within each activity space and consented to participate were recruited; giving a total of one hundred and twelve (112) subjects in all., Results: A study of the choropleth showed that health conditions associated e-waste processing activities were clustered in a fashion similar to the corresponding distribution of each activity. While a total of 96.2% of all the study subjects had cuts, the dismantlers had higher mix of scars, lacerations and abrasions. Abrasions were observed in 16.3% of the dismantlers. Scars were the most common skin condition and were observed on the skins of 93.6% of the subjects. Prevalence of burns among the study subjects was 23.1%. Developing hypertension was not associated with activity type and while a total of 90.2% of subjects had normal blood pressure and 9.8% of them were hypertensives. Finally, 98.2% of respondents felt the need to have a first aid clinic at the site with 96.4% and 97.3% willing to visit the clinic and pay for services respectively., Conclusion: We conclude that while the observed injuries were random and were due purely to accidents without any role of spatial determinants such as the configuration, slope, topography and other subterranean features of the activity spaces, a strong association between the injuries and activity type was observed., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2020 The Author(s).)

The influence of area-based socioeconomic (SE) conditions on environmental quality conditions has recently been reported showing the precise spatial relationship between area-based SE conditions and neighborhood environmental quality in an urban area in a low-income setting. Nonetheless, there is still a lack of understanding of the nature of the relationship on a temporal scale. This study aimed to investigate the dynamic temporal relationship between area-based SE conditions and urban environmental quality conditions over a decadal period in Accra, Ghana. The results showed that there were differences in environmental quality across the SE quintiles in space (with regard to per capita waste generation (p < 0.012), waste collection/clearing (p < 0.01), and waste deposition (p < 0.001) and that the urban environmental quality conditions had changed dramatically over the decade for most of the environmental variables (p < 0.001). Despite the enormous urban development initiatives, some of the environmental quality indicators (e.g., proportion of households without flush toilet/Water Closet, connection to central sewer p < 0.001) appeared to have worsened in the high class quintile, suggesting that a high proportion of households were without acceptable sanitation facilities. The study concludes that urban development in low-income countries will need to follow strictly international best practice by observing standardized building codes and guidelines, if progress should be made in meeting the Millennium Development Goals targets.