No abstract

No abstract

Two adjacent communities of differing socio-economic levels were selected, in Accra, Ghana, for the study of the home management of malaria. The youngest child in each selected household, each of which had a child aged < 5 years, was recruited for weekly follow-up, following informed consent. Malaria was the most common condition reported by the 'caregivers' (mothers of the subjects and others caring for the subjects) in each community, with 2.0 episodes of clinical malaria/child during the 9-month study. Most (89%) of the caregivers in the better-off community had been educated beyond primary-school level, but 55% of the caregivers in the poorer community had either received no formal education or only primary-school education. This difference was also reflected by the educational facilities provided to the children studied: 52% of the those in the better-off community attended nurseries, kindergartens or creches, compared with 8% of the children investigated in the poorer community. The proportion of caregivers who purchased drugs without prescription or used left-over drugs to treat clinical malaria in the children was higher in the poorer community (82% v. 53%), and a child from the poorer community was less likely to have been taken to a clinic or hospital to be treated for malaria than a child from the better-off community (27% v. 42%). During the follow-up period two children died, one from each community. Treatment of malaria in young children is likely to be less effective in the poorer community, where a lack of economic access to health services was demonstrated.

Background Early diagnosis of sickle cell disease (SCD) through newborn screening (NBS) is a cost‐effective intervention, which reduces morbidity and mortality. In sub‐Saharan Africa (SSA) where disease burden is greatest, there are no universal NBS programs and few institutions have the capacity to conduct NBS. We determined the feasibility and challenges of implementing NBS for SCD in Ghana's largest public hospital. Procedure The SCD NBS program at Korle Bu Teaching Hospital (KBTH) is a multiyear partnership between the hospital and the SickKids Center for Global Child Health, Toronto, being implemented in phases. The 13‐month demonstration phase (June 2017–July 2018) and phase one (November 2018–December 2019) focused on staff training and the feasibility of universal screening of babies born in KBTH. Results During the demonstration phase, 115 public health nurses and midwives acquired competency in heel stick for dried blood spot sampling. Out of 9990 newborns, 4427 babies (44.3%) were screened, of which 79 (1.8%) were identified with presumptive SCD (P‐SCD). Major challenges identified included inadequate nursing staff to perform screening, shortage of screening supplies, and delays in receiving screening results. Strategies to overcome some of the challenges were incorporated into phase one, resulting in increased screening coverage to 83.7%. Conclusions Implementing NBS for SCD in KBTH presented challenges with implications on achieving and sustaining universal NBS in KBTH and other settings in SSA. Specific steps addressing these challenges comprehensively will help build on the modest initial gains, moving closer toward a sustainable national NBS program.

Background: The interplay between Epstein-Barr virus infection, malaria, and endemic Burkitt’s Lymphoma is not well understood. Reports show diminished EBV-specific Th1 responses in children living in malaria endemic areas and deficiency of EBNA1-specific IFN-γ T cell responses in children with endemic Burkitt’s Lymphoma (eBL). This study, therefore, examined some factors involved in the loss of EBNA-1-specific T cell responses in eBL. Methods: T-cell subset frequencies, activation, and IFN-γ- or IL-4-specific responses were analyzed by flow-cytometry. Plasma cytokine levels were measured by ELISA. Results: CD4+ and CD8+ cells in age- and sex-matched healthy controls (n = 3) expressed more IFN-γ in response to all immunostimulants than in pediatric endemic BL (eBL) patients (n = 4). In healthy controls, IFN-γ expression was higher than IL-4 expression, whereas in eBL patients the expression of IL-4 by CD4+ cells to EBNA-1 was slightly higher than IFN-γ. Moreover, the blood levels of TNF-α was significantly lower (p = 0.004) while IL-10 was significantly higher (p = 0.038), in eBL patients (n = 21) compared to controls (n = 16). Additionally, the frequency of CD4+CD25hi+ T cells was higher in both age-matched acute uncomplicated malaria (n = 26) and eBL (n = 14) patients compared to healthy controls (n = 19; p = 0.000 and p = 0.027, respectively). Conclusion: The data suggest that reduced Th1 response in eBL might be due to increased levels of IL-10 and T reg cells.

Policy makers in Ghana need to consider implementing education programmes in paediatric resuscitation for nurses as part of a comprehensive strategy to improve emergency systems and address preventable and avoidable infant and child mortality.

Background :The global older adult population is increasing, however the health and care of this segment of the population has not been accorded optimal attention in Ghana and other low-income countries. This paper describes socio-demographic and socioeconomic correlates of alcohol use as major health risk factors among older adult Ghanaians. Methods: This work was based on the World Health Organization's multi-country Study on global Ageing and adult health (SAGE), conducted in six countries including Ghana. Wave one of SAGE in Ghana was conducted in 2007-2008 as collaboration among WHO, National Health Research Unit and the University of Ghana Medical School through the Department of Community Health. A sample of 3109 older adults, ≥ 50 years were involved in this analysis. Data was obtained on the patterns and intensity of alcohol use among older adults in Ghana.Results: Heavy drinking (Excessive alcohol use) was more prevalent among the 50-59 year group (3.4%), males (4.2%), rural residents (2.9%), the separated/divorced (4.0%), those with secondary education (or equivalent) completed (8.4%) and higher incomes (3.8%). Regional differences existed in heavy drinking; was most prevalent in the three northern regions, Upper West (97.1%); Upper East (70.1%) and Northern (62.5%). The two most developed and populous regions (Greater Accra and Ashanti) had relatively lower prevalence of heavy drinking (43.4% and 39.9% respectively). Significant socio-demographic correlates of alcohol use were male sex (OR=1.4, CI=1.37-1.52), rural resident (OR=1.3, CI=1.08-1.44), higher education (OR=2.4, CI=1.65-3.61) and lower income (OR=1.6, CI=1.44-1.70). Conclusions:Risk reduction measures including improvement in access to health and social services, implementing the national aging policy with due consideration to demographic, socio-economic, religion, culture and regional disparities will engender health and social benefits to the older adult population in Ghana.

No abstract