[Show abstract][Hide abstract] ABSTRACT: Plasmodium falciparum infection can cause microvascular dysfunction, cerebral encephalopathy and death if untreated. We have previously shown that high concentrations of free heme, and C-X-C motif chemokine 10 (CXCL10) in sera of malaria patients induce apoptosis in microvascular endothelial and neuronal cells contributing to vascular dysfunction, blood-brain barrier (BBB) damage and mortality. Endothelial progenitor cells (EPC) are microvascular endothelial cell precursors partly responsible for repair and regeneration of damaged BBB endothelium. Studies have shown that EPC's are depleted in severe malaria patients, but the mechanisms mediating this phenomenon are unknown. Toll-like receptors recognize a wide variety of pathogen-associated molecular patterns generated by pathogens such as bacteria and parasites. We tested the hypothesis that EPC depletion during malaria pathogenesis is a function of heme-induced apoptosis mediated by CXCL10 induction and toll-like receptor (TLR) activation. Heme and CXCL10 concentrations in plasma obtained from malaria patients were elevated compared with non-malaria subjects. EPC numbers were significantly decreased in malaria patients (P < 0.02) and TLR4 expression was significantly elevated in vivo. These findings were confirmed in EPC precursors in vitro; where it was determined that heme-induced apoptosis and CXCL10 expression was TLR4-mediated. We conclude that increased serum heme mediates depletion of EPC during malaria pathogenesis.
PLoS ONE 11/2015; 10(11):e0142328. DOI:10.1371/journal.pone.0142328 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: There are more opportunities for research in Africa now than ever however several factors still militate against research among academics. We identified the major barriers to research and the factors that enhance research at the University of Ghana Medical School in order to identify ways to build research capacity. Methods: The study was a descriptive cross-sectional study of the views of faculty members of the University of Ghana Medical School (UGMS). A self-administered questionnaire was used to collect information. This included information on respondent characteristics, research activities, obstacles, motivations, and challenges to do research. The data was analysed using SPSS version 16. Results: Altogether 99 completed questionnaires were obtained out of which 69.7% came from the lecturer and senior lecturer grades. There were a reported 159 publications, and 94 conference presentations by respondents in the preceding year. Inability to access funding (64.6%) was identified by most as an obstacle to research followed by lack of laboratory equipment (49.5%), lack of time (48.5%), and heavy clinical workload (43.4%). The major motivating factors for research were, need for promotion (51.5%), getting a paper published (45.5%), mentorship by senior researchers (27.3%), and establishing partnerships with international organizations (25.3%). Conclusion: More investment in infrastructure, mentoring, training particularly in grantsmanship and research partnerships can provide further opportunities for capacity building in research in this African institution.
[Show abstract][Hide abstract] ABSTRACT: The study aimed to investigate the aetiological agents and clinical presentations associated with acute lower respiratory infections (ALRI) among children under five years old at the Korle-Bu Teaching Hospital in Ghana. This was a cross-sectional study carried from February to December 2001. Nasopharyngeal aspirates and venous blood specimens obtained from 108 children with features suggestive of ALRI, were cultured and the isolated bacterial organisms were identified biochemically. Nasopharyngeal aspirates were also tested for Respiratory Syncitial Virus (RSV) antigen using a commercial kit (Becton Dickinson Directigen RSV test kit). A multiplex reverse transcription-PCR (RT-PCR) was also used to detect and characterize RSV using extracted RNA. Socio-demographic and clinical data were also obtained from the study subjects. Bronchopneumonia (55.5%), bronchiolitis (25%), lobar pneumonia (10.2), non-specific ALRI (4.6%), TB, bronchitis and respiratory distress (0.67%) were diagnosed. The prevalence of septicaemia was 10% and bacteria isolated were Staphylococcus aureus, Streptococcus pneumoniae and enteric bacteria, including Salmonella spp., Enterobacter spp and Klebsiella spp, were isolated. Out of the 108 cases, 18% tested positive for RSV, with two cases having RSV as the only aetiological pathogen detected. The subtyping analysis of RSV strains by a multiplex RT-PCR showed that subgroups A and B circulated in the season of analysis.
[Show abstract][Hide abstract] ABSTRACT: Background
HIV and negative coping mechanisms have a cyclical relationship. HIV infections may lead to the adoption of coping strategies, which may have undesired, negative consequences. We present data on the various coping mechanisms that HIV-affected households in Ghana resort to.
We collected data on coping strategies, livelihood activities, food consumption, and asset wealth from a nationally representative sample of 1,745 Ghanaian HIV-affected households. We computed coping strategies index (CSI), effective dependency rate, and asset wealth using previously validated methodologies.
Various dehumanizing coping strategies instituted by the HIV-affected households included skipping an entire day’s meal (13%), reducing portion sizes (61.3%), harvesting immature crops (7.6%), and begging (5.6%). Two-thirds of the households were asset poor. Asset-poor households had higher CSI than asset-rich households (p <0.001). CSI were also higher among female-headed households and lower where the education level of the household head is higher. Households caring for chronically ill members recorded higher CSI in comparison with their counterparts without the chronically ill (p < 0.05).
Institution of degrading measures by HIV-affected households in reaction to threat of food insecurity was prevalent. The three most important coping strategies used by households were limiting portion size (61.3%), reducing number of meals per day (59.5%) and relying on less expensive foods (56.2%). The least employed strategies included household member going begging (5.6%), eating elsewhere (8.7%) and harvesting immature crop (7.6%).
Given that household assets, and caring for the chronically ill were associated with high CSI, a policy focusing on helping HIV-affected households gradually build up their asset base, or targeting households caring for chronically ill member(s) with conditional household-level support may be reasonable.
BMC Public Health 02/2015; 15(166). DOI:10.1186/s12889-015-1418-x · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Diarrhoeal diseases are common among children in developing countries, and are caused by several aetiological agents including Cryptosporidium sp. Several species of this parasite exist which may belong to either anthroponotic or zoonotic forms. With recent application Original Research Article Anim-baidoo et al.; IJTDH, 10(3): 1-13, 2015; Article no.IJTDH.18532 2 of molecular tools, species involved in human transmission in any locality and sources of infection can now be determined. Aim: We screened children with acute diarrhoea at a paediatric hospital in Accra, Ghana for enteric parasites to determine frequency of cryptosporidial diarrhoea. Cryptosporidium isolates were then characterized by molecular methods to determine the genetic species in transmission. Methodology: A total of 365 diarrhoeic children of age ≤ 5 years were used in this cross-sectional study. Stool samples were collected and tested for enteric parasites by microscopy and ELISA. Cryptosporidium isolates were subsequently genotyped by PCR-RFLP and confirmed by sequencing of the 18S rRNA gene. Demographic and clinical data were obtained by a structured questionnaire and data analysed for possible association with cryptosporidial diarrhoea. Results: Enteric parasites detected were Cryptosporidium sp. (22.2%), G. lamblia (5.8%) and E. histolytica (0.8%). Neither gender nor breastfeeding habits, presence of domestic animals, source of children's food, seasons (dry or rainy) appeared to be associated with infection of Cryptosporidium sp. However, age of children, source of drinking water, and education level of mother seems to have association with infection of the parasite. Genotyping results show that C. parvum is the only species involved in transmission. Conclusion: Cryptosporidium parvum is the commonest enteric parasite causing diarrhoea among children with acute diarrhoea. Children ≤ 3 years and those who drank sachet water were most affected. A carefully planned health education among illiterate mothers and improved sanitary conditions could reduce rate of infections. Further sub-genotyping of C. parvum is needed to determine whether source of infection is zoonotic or anthroponotic.
[Show abstract][Hide abstract] ABSTRACT: IntroductionUnderstanding sex differences in willingness to test and testing experience could aid the design of focus interventions to enhance uptake and engagement with care, treatment and support services. This study determined differences in perceived risk of acquiring HIV, willingness to test and HIV testing experience in an urban fishing community.MethodsA cross-sectional community survey was conducted in 2013 among men and women in two fishing communities (Chorkor and James Town) in Accra. In all, 554 subjects (¿18 years) were involved, 264 in Chorkor and 290 in James Town. Data on demographic characteristics, perceived risk for HIV and willingness to test for HIV and testing experience were collected with a structured questionnaire. Descriptive statistics and Chi square test were used for the analysis at 95% significant level, using SPSS version 21.ResultsOf 554 subjects, 329 (59.4%) were females, and median age was 32 years. Overall, only 91(40.4%) men and 118(35.9%) women perceived themselves to be at risk of acquiring HIV. A significant proportion of women were willing to test for HIV compared to men (86.3% vs. 80.0%, P¿=¿0.048). Women were more likely to have ever tested for HIV compared to men (42.2 % vs. 28.6%, P¿=¿0.001) and more women had tested within 12 months prior to survey than men (49.6% vs. 40.6%, P¿=¿0.230). Of the number who had tested for HIV infection, a higher proportion of men tested voluntarily 42(65.6%), while a higher proportion of women tested as part of healthcare service received 96(69.1%); (P =0.001; indicating women vs. men).Conclusion
Sex differences in risk perception and willingness to test need more focused public education and behaviour change communication strategies to achieve high coverage. Community-based strategies could improve HIV testing among men whilst more access to testing in health settings should be available to women in these communities.
International Journal for Equity in Health 11/2014; 13(1):109. DOI:10.1186/s12939-014-0109-z · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Poor nutrition is a determinant of death particularly among persons living with HIV (PLHIV). This paper discusses the state of food and nutrition assistance to PLHIV in Ghana. A review of published articles and program reports was done and supported by in-depth interviews with key stakeholders. Data were qualitatively analyzed. A matrix highlighting problems that need to be addressed, possible attributable factors, strengths, and opportunities of existing actions metamorphosed from the analysis. Although stakeholders agree that adequate nutrition is critically important for PLHIV, food and nutrition interventions to PLHIV are inadequate.
[Show abstract][Hide abstract] ABSTRACT: Genome-wide association studies (GWAS) have identified 76 variants associated with prostate cancer risk predominantly in populations of European ancestry. To identify additional susceptibility loci for this common cancer, we conducted a meta-analysis of >10 million SNPs in 43,303 prostate cancer cases and 43,737 controls from studies in populations of European, African, Japanese and Latino ancestry. Twenty-three new susceptibility loci were identified at association P < 5 × 10(-8); 15 variants were identified among men of European ancestry, 7 were identified in multi-ancestry analyses and 1 was associated with early-onset prostate cancer. These 23 variants, in combination with known prostate cancer risk variants, explain 33% of the familial risk for this disease in European-ancestry populations. These findings provide new regions for investigation into the pathogenesis of prostate cancer and demonstrate the usefulness of combining ancestrally diverse populations to discover risk loci for disease.
[Show abstract][Hide abstract] ABSTRACT: Background: To contribute to a fuller appreciation of Ghana’s HIV epidemic, this paper presents
various profiles of the Ghanaian HIV-affected household. To comprehensively tackle the HIV epidemic
in Ghana, the profiles would provide stakeholders with ready information for policy formulation.
Methods: We used data from a nationally representative survey that measured livelihood
activities, household asset wealth, household composition, health, and nutrition variables of
1745 HIV-affected households. From these emerged various profiles. Results: About 50% of the
households are headed by females. Households headed by men have an average size of three
members, compared to two for female-headed households. There are far more AIDS widows than
widowers. The annual death rate among the surveyed households was about 1000 per 100,000-
households. Relatively more deaths occurred in male-headed households. Two-thirds of the households
were asset poor. Various coping strategies were instituted by the households in reaction to
threat of food insecurity. The national prevalence of chronic energy deficiency is 16%. Conclusions:
Our data show that age of household head, hosting of a chronically ill member, and average size of
household differed by sex of household head. The annual death rate of 1000 per 100,000 households
is very high.
Health 08/2014; 6(15):2004-2014. DOI:10.4236/health.2014.615235 · 0.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Genome-wide association studies (GWAS) have mapped risk alleles for at least 10 distinct cancers to a small region of 63 000
bp on chromosome 5p15.33. This region harbors the TERT and CLPTM1L genes; the former encodes the catalytic subunit of telomerase reverse transcriptase and the latter may play a role in apoptosis.
To investigate further the genetic architecture of common susceptibility alleles in this region, we conducted an agnostic
subset-based meta-analysis (association analysis based on subsets) across six distinct cancers in 34 248 cases and 45 036
controls. Based on sequential conditional analysis, we identified as many as six independent risk loci marked by common single-nucleotide
polymorphisms: five in the TERT gene (Region 1: rs7726159, P = 2.10 × 10−39; Region 3: rs2853677, P = 3.30 × 10−36 and PConditional = 2.36 × 10−8; Region 4: rs2736098, P = 3.87 × 10−12 and PConditional = 5.19 × 10−6, Region 5: rs13172201, P = 0.041 and PConditional = 2.04 × 10−6; and Region 6: rs10069690, P = 7.49 × 10−15 and PConditional = 5.35 × 10−7) and one in the neighboring CLPTM1L gene (Region 2: rs451360; P = 1.90 × 10−18 and PConditional = 7.06 × 10−16). Between three and five cancers mapped to each independent locus with both risk-enhancing and protective effects. Allele-specific
effects on DNA methylation were seen for a subset of risk loci, indicating that methylation and subsequent effects on gene
expression may contribute to the biology of risk variants on 5p15.33. Our results provide strong support for extensive pleiotropy
across this region of 5p15.33, to an extent not previously observed in other cancer susceptibility loci.
Human Molecular Genetics 07/2014; DOI:10.1093/hmg/ddu363 · 6.39 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Genome-wide association studies (GWAS) have identified that a ∼1 M region centromeric to the MYC oncogene on chromosome 8q24.21 harbors at least five independent loci associated with prostate cancer risk and additional loci associated with cancers of breast, colon, bladder, and chronic lymphocytic leukemia (CLL). Because GWAS identify genetic markers that may be indirectly associated with disease, fine-mapping based on sequence analysis provides important insights into patterns of linkage disequilibrium (LD) and is critical in defining the optimal variants to nominate for biological follow-up.
To catalog variation in individuals of African ancestry, we resequenced a region (250 kb; chr8:128,050, 768–128, 300,801, hg19) containing several prostate cancer susceptibility loci as well as a locus associated with CLL. Our samples included 78 individuals from Ghana and 47 of African-Americans from Johns Hopkins University.
After quality control metrics were applied to next-generation sequence data, 1,838 SNPs were identified. Of these, 285 were novel and not yet reported in any public database. Using genotypes derived from sequencing, we refined the LD and recombination hotspots within the region and determined a set of tag SNPs to be used in future fine-mapping studies. Based on LD, we annotated putative risk loci and their surrogates using ENCODE data, which should help guide laboratory studies.
In comparison to the 1000 Genome Project data, we have identified additional variants that could be important in establishing priorities for future functional work designed to explain the biological basis of associations between SNPs and both prostate cancer and CLL.
The Prostate 05/2014; 74(6):579-89. DOI:10.1002/pros.22726 · 3.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Reasons for the high rates of prostate cancer in African Americans are unknown; both genetic and lifestyle factors have been implicated. A better understanding of prostate cancer rates in West Africans would help clarify why African Americans have such high rates, since African Americans share genetic ancestry with West Africans yet have very different lifestyles and screening practices. To estimate prostate cancer burden in West Africans, we conducted a population-based screening study with biopsy confirmation in Ghana.
We randomly selected 1,037 healthy men aged 50-74 from Accra, Ghana for prostate cancer screening with prostate specific antigen (PSA) testing and digital rectal examination (DRE). Men who had a positive screen (DRE+ or PSA>2.5 ng/ml) underwent transrectal ultrasound (TRUS)-guided biopsies.
Of the 1,037 men, 154 (14.9%) had a positive DRE and 272 (26.2%) had a PSA>2.5 ng/ml (166 had a PSA>4.0 ng/ml). In total, 352 (33.9%) men had a positive screen by PSA or DRE, and 307 (87%) had a biopsy. Of these, 73 were confirmed to have prostate cancer, yielding a 7.0% screen-detected prevalence of prostate cancer (65 cases, 5.8% with a PSA>4.0 ng/ml).
In this relatively unscreened population in Africa, the screen-detected prostate cancer prevalence is high, suggesting a possible role of genetics in both prostate cancer etiology and the disparity in prostate cancer risk between African Americans and Caucasian Americans. Further studies are needed to confirm the high prostate cancer burden in Africans and the role of genetics in prostate cancer etiology.
The Journal of urology 04/2014; 192(3). DOI:10.1016/j.juro.2014.04.017 · 4.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Age-adjusted mortality rates for prostate cancer are higher for African-American men compared with those of European ancestry. Recent data suggest that West African men also have elevated risk for prostate cancer relative to European men. Genetic susceptibility to prostate cancer could account for part of this difference. We conducted a genome-wide association study (GWAS) of prostate cancer in West African men in the Ghana Prostate Study. Association testing was performed using multivariable logistic regression adjusted for age and genetic ancestry for 474 prostate cancer cases and 458 population-based controls on the Illumina HumanOmni-5 Quad BeadChip. The most promising association was at 10p14 within an intron of a long non-coding RNA (lncRNA RP11-543F8.2) 360 kb centromeric of GATA3 (p = 1.29E-7). In sub-analyses, SNPs at 5q31.3 were associated with high Gleason score (≥7) cancers, the strongest of which was a missense SNP in PCDHA1 (rs34575154, p = 3.66E-8), and SNPs at Xq28 (rs985081, p = 8.66E-9) and 6q21 (rs2185710, p = 5.95E-8) were associated with low Gleason score (<7) cancers. We sought to validate our findings in silico in the African Ancestry Prostate Cancer GWAS Consortium, but only one SNP, at 10p14, replicated at p < 0.05. Of the 90 prostate cancer loci reported from studies of men of European, Asian or African-American ancestry, we were able to test 81 in the Ghana Prostate Study, and 10 of these replicated at p < 0.05. Further genetic studies of prostate cancer in West African men are needed to confirm our promising susceptibility loci.
Human Genetics 11/2013; 133(5). DOI:10.1007/s00439-013-1400-6 · 4.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pregnancy in sickle cell disease (SCD) patients is associated with increased risk of maternal and fetal mortality. This study determines pregnancy outcomes among women with SCD delivering at Korle-Bu Teaching Hospital, Accra, Ghana. Nine hundred sixty (960) medical records of pregnant women (131 HbSS, 112 HbSC, and 717 comparison group) from 2007 to 2008 were reviewed. The HbSS women were at increased risk of eclampsia (adjusted odds ratio [AOR] = 10.56, 95% confidence interval [CI] = 3.60-30.96, P < 0.001), intrauterine growth restriction (AOR = 4.00, 95% CI = 1.38-11.64, P = 0.011), and placenta previa (AOR = 22.03, 95% CI = 9.87-49.14, P < 0.001) compared with the comparison group. The HbSC women had increased risk for intrauterine fetal death (AOR = 3.38, 95% CI = 1.15-9.96, P = 0.027) and decreased risk of delivering low birth weight babies (AOR = 0.21, 95% CI = 0.06-0.73, P = 0.014). Women with SCD in Ghana are at a greater risk of morbidity and mortality in pregnancy compared with women without hemoglobinopathies. Improved maternal and fetal outcomes in Ghanaian women with SCD can be achieved through effective intervention by health care providers with thorough knowledge about predisposing factors toward adverse outcomes.
The American journal of tropical medicine and hygiene 06/2012; 86(6):936-42. DOI:10.4269/ajtmh.2012.11-0625 · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chronic antigenic stimulation is associated with hypergamma-globulinemia. Higher rates of hypergamma-globulinemia in tropical populations are maintained even with migration to temperate regions. We conducted a population-based screening study to assess the prevalence and risk factors for hypergamma-globulinemia in Ghana, Africa. 917 Ghanaian males (50-74 years) underwent in-person interviews and health examinations. Serum from all persons was analyzed by electrophoresis performed on agarose gel; serum with a discrete/localized band was subjected to immunofixation. 54 persons with monoclonal proteins were excluded and 17 samples were insufficient for analysis. Using logistic regression and Chi-square statistics we analyzed patterns of hypergamma-globulinemia. Among 846 study subjects, the median γ-globulin level was 1.86 g/dL. On the basis of a U.S. reference, 616 (73%) had hypergamma-globulinemia (>1.6 g/dL) and 178 (21%) had γ-globulin levels >2.17 gm/dl. On multivariate analyses, lower education status (P = 0.0013) and never smoking (P = 0.038) were associated with increased γ-globulin levels. Self-reported history of syphilis was associated with hypergamma-globulinemia. We conclude that three quarters of this population-based adult Ghanaian male sample had hypergamma-globulinemia with γ-globulin levels >1.6 g/dL. Future studies are needed to uncover genetic and environmental underpinnings of our finding, and to define the relationship between hypergamma-globulinemia, monoclonal gammopathy of undetermined significance (MGUS), and multiple myeloma.
American Journal of Hematology 07/2011; 86(7):554-8. DOI:10.1002/ajh.22040 · 3.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The effectiveness of intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) against malaria and anemia is unclear because of the spread of SP-resistant Plasmodium falciparum. This study evaluates the effectiveness of IPTp-SP among pregnant women attending the antenatal clinic at Korle-Bu Teaching Hospital in Accra, Ghana. A cross-sectional study comparing malaria and anemia prevalence among pregnant women using IPTp-SP with non-IPTp-SP users was conducted during June-August 2009. A total of 363 pregnant women (202 of IPTp users and 161 non-IPTp users) were recruited. A total of 15.3% of IPTp users had malaria compared with 44.7% of non-IPTp users (P < 0.001). A total of 58.4% of non-IPTp users were anemic compared with 22.8% of IPTp users (P < 0.001). When we controlled for other variables, the difference in the prevalence of malaria (odds ratio = 0.18, 95% confidence interval = 0.08-0.37) and anemia (odds ratio = 0.20, 95% confidence interval = 0.12-0.34) remained significant. The recommended IPTp-SP regimen is useful in preventing malaria and anemia among pregnant women in Ghana.
The American journal of tropical medicine and hygiene 07/2011; 85(1):12-21. DOI:10.4269/ajtmh.2011.10-0512 · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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.
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).
Consistent with similar studies worldwide, the results of our studies revealed a high prevalence of HEV infection, ALT and AST values in pig handlers.