Background: Antimicrobial resistance (AMR) in Gram-negative bacteria-causing bloodstream infections (BSIs), such as Klebsiella pneumoniae and non-typhoidal Salmonella (NTS), is a major public health concern. Nonetheless, AMR surveillance remains scarce in sub-Saharan Africa, where BSI treatment is largely empirical. The aim of the study was to determine the distribution and AMR patterns of BSI-causing NTS, K. pneumoniae, and other Gram-negative bacteria in Ghana. Methods: A cross-sectional study was conducted between April and December 2021 at eleven sentinel health facilities across Ghana as part of a pilot study on the feasibility and implementation of the human sector AMR surveillance harmonized protocol in sub-Saharan Africa. Gram-negative bacteria recovered from blood specimens of febrile patients were identified using MALDI-TOF and evaluated for antimicrobial resistance using the BD Phoenix M50 analyzer and Kirby-Bauer disc diffusion. The Department of Medical Microbiology at the University of Ghana served as the reference laboratory. Results: Out of 334 Gram-negative blood isolates, there were 18 (5.4%) NTS, 85 (25.5%) K. pneumoniae, 88 (26.4%) Escherichia coli, 40 (12.0%) Acinetobacter baumannii, 25 (7.5%) Pseudomonas aeruginosa, and 77 (23.1%) other Gram-negative bacteria. As a composite, the isolates displayed high resistance to the antibiotics tested—amoxicillin (89.3%), tetracycline (76.1%), trimethoprim-sulfamethoxazole (71.5%), and chloramphenicol (59.7%). Resistance to third-generation cephalosporins [ceftriaxone (73.7%), cefotaxime (77.8%), and ceftazidime (56.3%)] and fluoroquinolones [ciprofloxacin (55.3%)] was also high; 88% of the isolates were multidrug resistant, and the rate of extended-spectrum beta-lactamase (ESBL) production was 44.6%. Antibiotic resistance in K. pneumoniae followed the pattern of all Gram-negative isolates. Antibiotic resistance was lower in NTS blood isolates, ranging between 16.7–38.9% resistance to the tested antibiotics. Resistance rates of 38.9%, 22.2%, and 27.8% were found for cefotaxime, ceftriaxone, and ceftazidime, respectively, and 27.8% and 23.8% for ciprofloxacin and azithromycin, respectively, which are used in the treatment of invasive NTS. The prevalence of multidrug resistance in NTS isolates was 38.9%. Conclusions: Multicenter AMR surveillance of Gram-negative blood isolates from febrile patients was well-received in Ghana, and the implementation of a harmonized protocol was feasible. High resistance and multidrug resistance to first- or second-choice antibiotics, including penicillins, third-generation cephalosporins, and fluoroquinolones, were found, implying that these antibiotics might have limited effectiveness in BSI treatment in the country. Continuation of AMR surveillance in Gram-negative blood isolates is essential for a better understanding of the extent of AMR in these pathogens and to guide clinical practice and policymaking.

Rabies is a highly fatal, viral, zoonotic disease caused by a Lyssa virus. It is acquired through the bite of an infected animal, mostly dogs. Estimated annual global human mortalities from rabies is 61,000, over 99% of which are from developing countries where about US$583.5 million is spent on its control. Rabies is enzootic in Ghana. Vaccinating about 70% of the dog population leads to a reduction in rabies transmission to humans; however, percentage dog anti-rabies vaccination coverage in Ghana is unknown. This study therefore investigated the magnitude of rabies in dogs and humans in the Greater-Accra region, and assessed annual percentage dog anti-rabies vaccination coverage from 2007-2011. Secondary data on rabies vaccination, post mortem and dog quarantine records for all ten districts in the region, and human rabies records were analysed. Means and percentages were calculated, graphs drawn and trends analysed. The number of animal samples which tested positive out of 309, was 283. Predictive value positive was 91.6%. Of the positive cases, 97.5% (276/283) had no previous vaccination history, and 96.1% (272/283) were from dogs. Fifty-five out of 174 (31.6%) samples were from dogs which bit more than one person. Human exposures to dog and other animal bites are not differentiated. Average annual number of outbreaks was 31, whereas percentage dog vaccination ranged from 10.26-17.56. Current annual percentage dog anti-rabies vaccination coverage is very low, whereas the incidence of dog rabies in the region is high. The number of humans affected may be underestimated. Government should immediately facilitate annual mass vaccination of pets.

IntroductionBovine tuberculosis (bTB) is a chronic, zoonotic, multi-species disease of cattle caused by Mycobacterium bovis. In developed countries, effective surveillance and enforcement of regulations on bTB control resulted in significant reduction of infections in cattle and hence, humans. However, in developing countries, weak surveillance systems affect accurate and timely reporting of bTB in humans and cattle. In Ghana, transhumance movement of cattle increases the risk of bTB importation and spread, however, the extent to which surveillance detects bTB is unknown. We therefore evaluated the bTB surveillance system in the Greater-Accra Region to determine its performance and assessed its attributes.MethodsWe interviewed stakeholders, and reviewed bTB surveillance data for all ten districts in the region from 2006-2011 using the CDC Guidelines for Evaluation of public health surveillance systems.ResultsFrom 2006-2011, bTB was suspected in 284/244,576 (0.12%) cattle slaughtered, of which 7/284 (2.5%) were submitted for laboratory confirmation and all tested positive. Predictive value positive was 100%. There is no standard case definition which guides bTB detection. Fifty percent of carcasses slip through inspection, and confirmed cases are not traced back. There were 99/284 (34.9%) condemnations from suspected carcasses and 57/97 (58.8%) from positive reactors from screening. Ninety percent (9/10) of districts submitted reports late to the region whereas representativeness was 30%. Regional and district data were manually stored with no electronic backups. The region's cattle population is unknown.ConclusionAlthough the bTB surveillance system is sensitive, it is under performing, and the possibility of bTB transmission from cattle to humans is high.

Background: Bovine tuberculosis (BTB) is caused by Mycobacterium bovis. Developed countries have succeeded to control BTB infections and reduced its transmission to humans through the enforcement of meat inspection laws, test and slaughter/segregation of positive reactors, and milk pasteurisation. This was paralleled by a concomitant decrease in human tuberculosis infections (HTBI) from 5%-20% to 0.5%-1% in the past five decades. In developing countries, an estimated 10-15% of HTBI are attributed to M. bovis, however, weak control measures and under reporting of BTB may grossly underestimate this. Surveillance by the Veterinary Services Directorate (VSD) through meat inspection, voluntary reporting and periodic cattle screening with the objective to early detect and monitor trend for rapid intervention are the mainstay of control. Controlling BTB in cattle results in its reduction in humans; hence, we evaluated the BTB surveillance system in the Greater-Accra Region of Ghana to determine its performance and assessed the system's attributes.Methods & Materials: We interviewed stakeholders, reviewed veterinary monthly reports of all ten districts in the region, laboratory and screening records, and extracted surveillance data from national electronic database for the period 2006-2011 using the CDC Guidelines for Evaluation of Public Health Surveillance Systems.Results: From 2006-2011, 284/244,576 (0.12%) cattle slaughtered were suspected to have BTB; of which 7/284 (2.5%) were submitted and all laboratory-confirmed positive by Ziehl-Neelsen acid-fast stain test; predictive value positive (PVP) being 100%. From the suspected carcasses, there were 91 partial and 8 total condemnations. BTB detected at slaughter rose from 13 in 2006 to 78 in 2010, then dropped to 48 in 2011. Interviews suggest that about 50% of carcasses slip through inspection. Out of 3,367 cattle screened with tuberculin from eight farms, 97 (2.9%), tested positive and were culled. Ninety percent (9/10) of districts consistently submitted reports late to the region whereas 70% (7/10) made no reference to BTB. Regional and district data were manually stored with no electronic backups. Conclusion:The BTB surveillance system is sensitive, useful and monitors trend, however, timeliness, representativeness, completeness of reporting, and data quality need improvement. Non-reporting districts are now reporting following training.

Background: Fruit and vegetable consumption (F&VC) provide important nutrients and greatly reduces the risk of non-communicable diseases, especially when started from childhood. F&VC among adults in Ghana is one of the lowest worldwide, and this may also pertain to children. Since school children spend considerable time in school, what they eat during school hours is important for their development. The objective of this study was to assess F&VC and the proportion of sugarsweetened beverage consumption (SSBC) among two socio-economic classes. Methods: A cross-sectional study of kindergartners in the Accra Metropolitan Area was carried out. Fruits, vegetables, sugar-sweetened beverages and two socioeconomic classes were defined prior to the study. Six schools were randomly selected; two each from three sub-metros from the Accra-Metropolitan Area. Data on meals eaten by 422 kindergartners were collected through observation and interview, guided by a checklist. Means and percentages were calculated. F&VC and SSBC was assessed along the two socio-economic classes. Results: Feeding options at school were home-packed, school-provided, and meals sold by vendors. The mean age of the respondents was 4.1 years, with 49.1% (207/422) being male. The proportion of kindergartners who consumed schoolprovided and home-packed meals was 70.1% (296/422) and 64.5% (272/422) respectively. Only 2.2% (9/422) of kindergartners consumed fruits, whereas total vegetable consumption was 34.1% (144/422). SSBC was associated with socioeconomic class (95% CI 0.28-0.62). Conclusions: F&VC was generally low in the study population. SSBC was high, especially, in kindergartners from the higher socio-economic class schools. The Ghana Education Service should promote their consumption, by making fruits and vegetables available in schools.

No abstract