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Background Sub-Saharan Africa faces a rapid spread of diabetes mellitus type 2 (DM2) but its potentially specific characteristics are inadequately defined. In this hospital-based study in Kumasi, Ghana, we aimed at characterizing clinical, anthropometric, socio-economic, nutritional and behavioural parameters of DM2 patients and at identifying associated factors. Methods Between August 2007 and June 2008, 1466 individuals were recruited from diabetes and hypertension clinics, outpatients, community, and hospital staff. Fasting plasma glucose (FPG), serum lipids and urinary albumin were measured. Physical examination, anthropometry, and interviews on medical history, socio-economic status (SES), physical activity and nutritional behaviour were performed. Results The majority of the 675 DM2 patients (mean FPG, 8.31 mmol/L) was female (75%) and aged 40-60 years (mean, 55 years). DM2 was known in 97% of patients, almost all were on medication. Many had hypertension (63%) and microalbuminuria (43%); diabetic complications occurred in 20%. Overweight (body mass index > 25 kg/m 2 ), increased body fat (> 20% (male), > 33% (female)), and central adiposity (waist-to-hip ratio > 0.90 (male), > 0.85 (female)) were frequent occurring in 53%, 56%, and 75%, respectively. Triglycerides were increased (≥ 1.695 mmol/L) in 31% and cholesterol (≥ 5.17 mmol/L) in 65%. Illiteracy (46%) was high and SES indicators generally low. Factors independently associated with DM2 included a diabetes family history (adjusted odds ratio (aOR), 3.8; 95% confidence interval (95%CI), 2.6-5.5), abdominal adiposity (aOR, 2.6; 95%CI, 1.8-3.9), increased triglycerides (aOR, 1.8; 95%CI, 1.1-3.0), and also several indicators of low SES. Conclusions In this study from urban Ghana, DM2 affects predominantly obese patients of rather low socio-economic status and frequently is accompanied by hypertension and hyperlipidaemia. Prevention and management need to account for a specific risk profile in this population.

Malaria parasites invade red blood cells (RBCs), consume copious amounts of hemoglobin, and severely disrupt iron regulation in humans. Anemia often accompanies malaria disease; however, iron supplementation therapy inexplicably exacerbates malarial infections. Here we found that the iron exporter ferroportin (FPN) was highly abundant in RBCs, and iron supplementation suppressed its activity. Conditional deletion of the gene in erythroid cells resulted in accumulation of excess intracellular iron, cellular damage, hemolysis, and increased fatality in malaria-infected mice. In humans, a prevalent mutation, Q248H (glutamine to histidine at position 248), prevented hepcidin-induced degradation of FPN and protected against severe malaria disease. Q248H appears to have been positively selected in African populations in response to the impact of malaria disease. Thus, FPN protects RBCs against oxidative stress and malaria infection.

Bates and colleagues describe the development of a tool to assess capacity-building programs in health research, which they used in Kumasi, Ghana.

Toll-like receptors (TLRs) are involved in recognition of and response to Plasmodium falciparum. In 304 primiparous Ghanaian women, we examined whether common TLR4 and TLR9 polymorphisms influence susceptibility to and manifestation of malaria during pregnancy. The TLR variants did not affect P. falciparum prevalence or parasite density. However, in P. falciparum-infected women, both the TLR4 Asp299Gly and the TLR9 T-1486C polymorphisms increased the risk of low birth weight in term infants 6-fold, and, additionally, TLR4 Asp299Gly increased the risk of maternal anemia 5-fold; preterm delivery was not associated with these TLR variants. These findings suggest that TLR4 and TLR9 play a role in the manifestation of malaria during pregnancy.

In rural tropical areas, patients frequently present with malaria and require urgent therapy. Facilities may not exist for parenteral drug administration, and oral dosing is precluded by obtundation or vomiting. In these circumstances, the rectal route of administration may allow initiation of antimalarial therapy while patients await transfer to hospital, a process that may take many hours.Artesunate (ARS) is a water-soluble hemisuccinate dihydroartemisinin (DHA) derivative being developed for the treatment of malaria and is particularly valuable against multidrugresistant infections (2, 13). ARS is currently formulated for administration by the oral and parenteral routes (3, 11). ARS suppositories (Rectocaps; 50 mg of artesunate; Mepha Pharmaceuticals Ltd.) Aesch-Basle, Switzerland) have recently undergone preliminary assessment in Gabonese children (8). However, formal bioavailability studies with this formulation are lacking. Circulating ARS is quickly converted to DHA by blood esterases and hepatic metabolism (14). As DHA is the principal antimalarial metabolite of ARS, the bioavailability of DHA was studied by comparing intrarectally (i.r.) and intravenously (i.v.) administered ARS in Ghanaian children with moderate malaria. High-performance liquid chromatography (HPLC) with electrochemical detection, currently the most precise and sensitive assay, was used to measure ARS and DHA levels. This crossover study was also designed to test the hypothesis that within the first 24 h there is no disease effect on the pharmacokinetics of ARS. These studies are critical to the design of larger (phase III-IV) studies seeking to use rectal ARS to reduce mortality from malaria. MATERIALS AND METHODS Study design description.This was an open, randomized, crossover comparison between i.v. ARS and ARS suppositories conducted on a pediatric research ward at Komfo-Anokye Teaching Hospital, Kumasi, Ghana, from August to October 1996. This study was approved by The Committee of Research, Publication and Ethics of the School of Medical Sciences, University of Science and Technology, Kumasi, Ghana, and the Review Board of the World Health Organization. A computer-generated randomization list allocating patients to one of three treatment categories was prepared (in permuted blocks of 12 patients). The treatment category for each patient was provided in an opaque sealed envelope opened only when a patient entered the study. Treatment categories were as follows: group I, i.r. ARS at 10 mg/kg of body weight, followed 12 h later by i.v. ARS at 2.4 mg/kg; group II, i.r. ARS at 20 mg/kg, followed 12 h later by i.v. ARS at 2.4 mg/kg; and group III, i.v. ARS at 2.4 mg/kg, followed 12 h later by i.r. ARS at 20 mg/kg. The doses of i.r. ARS were based on preliminary pharmacodynamic analysis of a similar study of i.r. ARS in Thai adults with moderate malaria (S. Looareesuwan, personal communication).Inclusion criteria. Patients aged 18 months to 7 years (inclusive) with a diagnosis of moderate Plasmodium falciparum malaria were eligible, pro...

There is epidemiological evidence for associations between dietary patterns and type 2 diabetes. However, for sub-Saharan Africa, information on dietary patterns and their contribution to diabetes is lacking. The aim of the present study was to identify dietary patterns and their associations with type 2 diabetes in an urban Ghanaian population. In a hospital-based case -control study on risk factors for type 2 diabetes in Kumasi, a FFQ was administered to 675 controls and 542 cases. Dietary patterns were identified by using factor analysis including thirty-three food items. Logistic regression was used to evaluate the associations of dietary patterns with type 2 diabetes. Overall, two dietary patterns were identified: (1) a 'purchase' dietary pattern which positively correlated with the consumption of sweets, rice, meat, fruits and vegetables and (2) a 'traditional' dietary pattern that correlated with the intake of fruits, plantain, green leafy vegetables, fish, fermented maize products and palm oil. In the highest quintile of the 'purchase' dietary pattern, participants were younger, leaner and of higher socio-economic status than those in the lower quintiles. In contrast, participants in the highest quintile of the 'traditional' dietary pattern were older, heavier and more deprived compared with those in the lower quintiles. In the multivariate model, the 'purchase' dietary pattern was inversely associated with type 2 diabetes (OR per 1 SD 0·41, 95 % CI 0·33, 0·50); the 'traditional' dietary pattern increased the odds of diabetes per 1 SD by 54 % (95 % CI 1·35, 1·81). In conclusion, two diverse dietary patterns were identified and associated with type 2 diabetes in urban Ghana. The determinants of pattern adherence require further investigation.

A case–control study of 1,466 urban adults in Ghana found that patients with type 2 diabetes mellitus had a 46% increased risk for infection with Plasmodium falciparum. Increase in diabetes mellitus prevalence may put more persons at risk for malaria infection.