Daniel Ansong

• BSc MB ChB MSc FWACP FGCP Dip LTA (Liv)
• Dean at Kwame Nkrumah University Of Science and Technology,

Background Induced sputum (IS) is a sampling technique for obtaining lower airway samples for microbial investigations, including GeneXpert and culture for microbiological confirmation of Mycobacterium tuberculosis. Objectives To investigate the safety and yield of IS in children admitted to a tertiary hospital in Ghana with presumed pulmonary tub...

Background : Prevalence of Sickle Cell Disease (SCD) across African countries ranges between 1–3% and contributes up to 7-16% of under-five mortality. Nigeria, Ghana and Tanzania are among the top ten countries globally, with over 11,000 babies born with SCD annually. In order to bridge the gap in management and cognate research, the SickleInAfrica...

Background: Although several gene expression-based assays are validated for informing prognosis and treatment decision-making for breast cancer (BC) patients, their uptake has been hampered by technical complexities and cost, particularly in underrepresented and low-resource settings. Here, we explored whether machine learning-based features on sta...

Background Disordered amino acid metabolism is observed in cerebral malaria (CM). This study sought to determine whether abnormal amino acid concentrations were associated with level of consciousness in children recovering from coma. Twenty-one amino acids and coma scores were quantified longitudinally and the data were analysed for associations....

Background The stromal microenvironment (SME) is integral to breast cancer biology, impacting metastatic proclivity and treatment response. Emerging data indicate that host factors may impact the SME, but the relationship between prediagnostic host factors and SME phenotype remains poorly characterized, particularly among women of African ancestry....

Strain-transcending antibodies against virulence-associated subsets of P. falciparum-infected erythrocyte surface antigens could protect children from severe malaria. However, the evidence supporting the existence of such antibodies is incomplete and inconsistent. One subset of surface antigens associated with severe malaria, rosette-mediating Plas...

Our limited understanding of the pathophysiological mechanisms that operate during sepsis is an obstacle to rational treatment and clinical trial design. There is a critical lack of data from low- and middle-income countries where the sepsis burden is increased which inhibits generalized strategies for therapeutic intervention. Here we perform RNA...

Background Disordered amino acid metabolism is observed in cerebral malaria (CM). We sought to determine whether abnormal amino acid concentrations were associated with level of consciousness in children recovering from coma. We quantified 21 amino acids and coma scores longitudinally and analyzed data for associations. Methods In a prospective ob...

Background The first licensed malaria vaccine, RTS,S/AS01E, confers moderate protection against symptomatic disease. Because many malaria infections are asymptomatic, we conducted a large-scale longitudinal parasite genotyping study of samples from a clinical trial exploring how vaccine dosing regimen affects vaccine efficacy. Methods Between Sept...

Background The RTS,S/AS01 E malaria vaccine (RTS,S) was introduced by national immunisation programmes in Ghana, Kenya, and Malawi in 2019 in large-scale pilot schemes. We aimed to address questions about feasibility and impact, and to assess safety signals that had been observed in the phase 3 trial that included an excess of meningitis and cerebr...

Background The RTS,S/AS01E malaria vaccine (RTS,S) was introduced by national immunisation programmes in Ghana, Kenya, and Malawi in 2019 in large-scale pilot schemes. We aimed to address questions about feasibility and impact, and to assess safety signals that had been observed in the phase 3 trial that included an excess of meningitis and cerebra...

Background The RTS,S/AS01E (RTS,S) malaria vaccine is recommended for children in malaria endemic areas. This phase 2b trial evaluates RTS,S fractional- and full-dose regimens in Ghana and Kenya. Methods In total, 1500 children aged 5–17 months were randomized (1:1:1:1:1) to receive RTS,S or rabies control vaccine. RTS,S groups received 2 full RTS...

Background Hypertension and diabetes are leading non-communicable diseases that have driven an epidemic of cardiovascular diseases globally. Understanding the factors associated with the occurrence of hypertension and diabetes, particularly in rural settings, is crucial for designing interventions to improve awareness, detection, and control. This...

Epidemiologic data on insecticide exposures and breast cancer risk are inconclusive and mostly from high-income countries. Using data from 1071 invasive pathologically confirmed breast cancer cases and 2096 controls from the Ghana Breast Health Study conducted from 2013 to 2015, we investigated associations with mosquito control products to reduce...

Background The only licensed malaria vaccine, RTS,S/AS01E, confers moderate protection against symptomatic disease. Because many malaria infections are asymptomatic, we conducted a large-scale longitudinal parasite genotyping study of samples from a clinical trial exploring how vaccine dosing regimen affects vaccine efficacy (VE). 1,500 children ag...

Objectives Empyema and parapneumonic effusions (PPEs) are common complications of community-acquired pneumonia in children. Both contribute to prolonged hospital stay, increased morbidity, and less frequent mortality. This study aimed to describe the demographics, immunization status, clinical profile, etiology, and outcomes in children admitted wi...

Background and Aims Sickle cell disease (SCD) is the commonest monogenic haemolytic disorder in Africa. Despite strides made in its management, a significant proportion of patients are hospitalized from the various complications of the disease. This study set out to describe the main causes and outcomes of hospitalizations among pediatric patients...

Background: Malaria is still one of the main reasons for hospitalization in children living in sub-Saharan Africa. Rapid risk-stratification at admission is essential for optimal medical care and improved prognosis. Whereas coma, deep breathing, and, to a lesser degree, severe anaemia are established predictors of malaria-related death, the value...

The human fecal and oral microbiome may play a role in the etiology of breast cancer through modulation of endogenous estrogen metabolism. This study aimed to investigate associations of circulating estrogens and estrogen metabolites with the fecal and oral microbiome in postmenopausal African women. A total of 117 women with fecal (N = 110) and or...

Background Emerging data suggest that beyond the neoplastic parenchyma, the stromal microenvironment (SME) impacts tumor biology, including aggressiveness, metastatic potential, and response to treatment. However, the epidemiological determinants of SME biology remain poorly understood, more so among women of African ancestry who are disproportiona...

Objectives We evaluated the performance of commonly used sepsis screening tools across prospective sepsis cohorts in the USA, Cambodia and Ghana. Design Prospective cohort studies. Setting and participants From 2014 to 2021, participants with two or more SIRS (Systemic Inflammatory Response Syndrome) criteria and suspected infection were enrolled...

Introduction Globally, injuries account for about 5 million deaths every year out of which 90% occur in low- and middle-income countries. Injuries, particularly trauma, place a lifelong burden on affected individuals, families and society. In Ghana and most African countries particularly in sub-Saharan Africa, there is no effective surveillance sys...

Background and Aims Penicillin V prophylaxis protects children living with sickle cell disease (SCD) from bacteria infections especially Streptococcus pneumonia. However, the uptake of penicillin V prophylaxis is difficult to assess and often poor among SCD patients. Therefore, this study sought to investigate oral penicillin V prophylaxis adherenc...

Introduction Hypertension is an important public health menace globally and in sub-Saharan Africa. The prevalence of hypertension is on the rise in low- and lower-middle-income countries (LMIC) such as Ghana. This rise led to the adoption of the May Measurement Month (MMM) initiative, a global blood pressure screening campaign. We aimed to create a...

Background Direct comparisons of sepsis screening tools for prognostication have largely been limited to single-centre or high-income countries despite a disproportionately high burden of sepsis in low- and middle-income countries (LMICs). We evaluated the performance of commonly used sepsis screening tools across prospective sepsis cohorts in the...

Background The Global Point Prevalence Study (PPS) provides a platform for institutions to register and add clinical information on antimicrobial usage and determine variables related to proper antimicrobial stewardship. Objective To assess the trends in antimicrobial usage and quality indicators in antimicrobial prescriptions at our hospital. Me...

The oral microbiome, like the fecal microbiome, may be related to breast cancer risk. Therefore, we investigated whether the oral microbiome was associated with breast cancer and nonmalignant breast disease, and its relationship with the fecal microbiome in a case‐control study in Ghana. A total of 881 women were included (369 breast cancers, 93 no...

Background: Risk estimates for women carrying germline mutations in breast cancer susceptibility genes are mainly based on studies of European ancestry women. Methods: We investigated associations between pathogenic variants (PV) in 34 genes with breast cancer risk in 871 cases (307 estrogen receptor (ER)-positive, 321 ER-negative, and 243 ER-un...

Background: Controlled infection studies in malaria-naive adults suggest increased vaccine efficacy for fractional-dose versus full-dose regimens of RTS,S/AS01. We report first results of an ongoing trial assessing different fractional-dose regimens in children, in natural exposure settings. Methods: This open-label, phase 2b, randomised control...

Sickle cell disease (SCD) is the most common clinically significant hemoglobinopathy, characterized by painful episodes, anemia, high risk of infection, and other acute and chronic complications. In Africa, where the disease is most prevalent, large longitudinal data on patients and their outcomes are lacking. This article describes the experiences...

Age-standardized incidence rates of estrogen receptor negative (ERN) breast cancers in the US are higher among Non-Hispanic Black (NHB) compared to Non-Hispanic White (NHW) women. We aimed to determine if incidence rates were similar between NHB and Ghanaians, given that a high proportion of NHB share West African genetic ancestry. We compared US r...

Objectives Hypertension is a major risk factor for cardiovascular mortality globally and in Ghana. May Measurement Month (MMM) is a global awareness and screening campaign initiated by the International Society of Hypertension. Methods Participants were recruited by opportunist sampling in the Ashanti region of Ghana. The blood pressures of partic...

Background: Several anthropometric measures have been associated with hormone-related cancers, and it has been shown that estrogen metabolism in postmenopausal women plays an important role in these relationships. However, little is known about circulating estrogen levels in African women, and the relevance to breast cancer or breast cancer risk f...

Background Childhood pneumonia is a leading cause of hospitalisation and death in Low- and Middle-Income Countries (LMIC). Despite remarkable achievements in global mortality trends in children under 5 nearly 700 000 children die annually from pneumonia. In Ghana, an estimated 4,700 children under 5 died from pneumonia in 2017. Hypoxia is a known p...

Background Sickle cell disease (SCD) is the commonest monogenic haemolytic disorder in Africa. It continues to be a major public health burden. Newborn screening of SCD has been implemented in Kumasi, Ghana, since 1995 and SCD patients identified have been enrolled into the paediatric SCD clinic. The Sickle Pan African Research Consortium (SPARCo)...

Background Childhood mortality in sub-Saharan Africa still remains high despite a reduction in global trends. Although several strategies have been instituted to help reduce this, the progress is slow which can affect the achievement of the Sustainable Development Goal 3 (SDG). Majority of these deaths occur within the first twenty-four hours of ad...

Hair relaxers and skin lighteners have been commonly used by African women, with suggestions that they may have hormonal activity. To investigate the relationship of hair relaxer and skin lightener use to serum estrogen/estrogen metabolite levels. We utilized the postmenopausal population-based controls of the Ghana Breast Health Study to estimate...

(N Engl J Med. 2021;384:2028–2038. doi: 10.1056/NEJMoa2026486. PMID: 34038632; PMCID: PMC810848) While preterm, low–birth-weight infants make up ~15% of neonates, they account for the vast majority of neonatal deaths (70%). “Kangaroo Mother Care,” where the mother or caregiver provides continuous skin-to-skin contact with the neonate, has been show...

Abstract Circulating tumor DNA (ctDNA) sequencing studies could provide novel insights into the molecular pathology of cancer in sub-Saharan Africa. In 15 patient plasma samples collected at the time of diagnosis as part of the Ghana Breast Health Study and unselected for tumor grade and subtype, ctDNA was detected in a majority of patients based o...

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30...

Despite contributing to the large disease burden in West Africa, little is known about the genomic epidemiology of Streptococcus pneumoniae which cause meningitis among children under 5 years old in the region. We analysed whole-genome sequencing data from 185 S . pneumoniae isolates recovered from suspected paediatric meningitis cases as part of t...

Introduction: we examined the epidemiology, clinical and demographic characteristics of intussusception in Ghanaian infants. Methods: active sentinel surveillance for pediatric intussusception was conducted at Komfo Anokye Teaching Hospital in Kumasi and Korle Bu Teaching Hospital in Accra. From March 2012 to December 2016, infants < 1 year of a...

Purpose: Analysis of cell free DNA could provide a rapid and non-invasive approach to detect cancer and provide new molecular insights in many African countries where expert pathology is lacking. Hence, we tested whether whole-genome sequencing of cfDNA (WGS-cfDNA) could identify somatic alterations that drive breast cancer. Methods: We conducted a...

Recently, a common genetic variant E756del in the human gene PIEZO1 was associated with protection from severe malaria. Here, we performed a genetic association study of this gain-of-function variant in a large case-control study including 4149 children from the Ashanti Region in Ghana, West Africa. The statistical analysis did not indicate an asso...

Background. There exist continuing challenges with communication medium used during health service provision. These challenges relate to clients and health institution, intra- and interhealth institution communications. This study reviewed the existing healthcare communication medium from the perspectives of clients and health professionals at a te...

The gut microbiota may play a role in breast cancer etiology by regulating hormonal, metabolic and immunologic pathways. We investigated associations of fecal bacteria with breast cancer and nonmalignant breast disease in a case‐control study conducted in Ghana, a country with rising breast cancer incidence and mortality. To do this, we sequenced t...

This viewpoint examines the impact of COVID-19 travel bans and remote education on the global health education of students from high-income countries (HIC) and low- and middle-income countries (LMIC) and explores potential opportunities for strengthening global health education based upon more dispersed and equitable practices. Global health is uni...

Cancer incidence is rising and mortality rates are high in Africa, where access to molecular pathology is limited. Analysis of cancer-related mutations in circulating tumor DNA (ctDNA) from cell-free DNA (cfDNA) that is shed into the bloodstream by tumor cells could be transformative to the African continent and provide new molecular insights. Usin...

Circulating tumor DNA (ctDNA) sequencing studies could provide novel insights into the molecular pathology of cancer in sub-Saharan Africa. ctDNA was readily detected in 15 blood samples collected in Ghana at the time of suspected breast cancer. Genomic alterations previously associated with unfavorable prognostic outcomes were observed in the majo...

Purpose: Acute Respiratory Infection (ARI) is one of the topmost childhood killers ahead of diarrhoea and malnutrition in children. This exploratory qualitative study sought to examine the influence of maternal social constructs on the recognition and care seeking for fast breathing in children to inform the development of an intervention aimed at...

Using qualitative methodology, semi-structured questionnaires were administered to participants in the Barakese subdistrict of Ghana in order to understand the extent to which men and women have knowledge of family planning services and in what ways cultural norms, practices, and attitudes toward abortion affect the decision to abort. Women in the...

Introduction: Although breast cancer incidence in sub-Saharan African countries, including Ghana, has been historically low, incidence is rising. Evaluating age-specific incidence rates by breast cancer risk factors may provide etiologic insights. Here we present age-specific incidence rates for breast cancer estimated from the Ghana Breast Health...

In the history of mankind, the black death, small pox and influenza pandemics have threatened our existence. The Spanish flu has been described as the greatest medical holocaust as it infected an estimated one third of the world’s population and caused approximately 50 million deaths globally. On the 30th November, 2017, an outbreak of an undiagnos...

Background: Non-communicable diseases (NCDs) remain a global burden and is projected to increase due to aging, rapid urbanization and unhealthy lifestyles. The study was conducted to determine the prevalence of hypertension and diabetes in rural districts in the Ashanti region of Ghana and to determine factors that influence utilization of health c...

Background Plasmodium infection among children is a serious public health problem. Asymptomatic malaria infection among humans serves as a significant reservoir for transmitting Plasmodium to uninfected Anopheles mosquitoes, fueling malaria endemicity and asymptomatic malaria may progress to clinical malaria. Therefore, prompt and accurate diagnosi...

BACKGROUND. Pneumonia remains the foremost cause of death in young children in sub-Saharan Africa. This phenomenon is largely driven by poor access to healthcare and delay in seeking medical care for childhood pneumonia. OBJECTIVE. To assess the effectiveness of training caregivers to recognise the early clinical signs of pneumonia. METHODS. The st...

Despite the implementation of effective conjugate vaccines against the three main bacterial pathogens that cause meningitis, Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis serogroup A, the burden of meningitis in West Africa remains high. The relative importance of other bacterial, viral, and parasitic pat...

Objective: Light microscopy which is a blood-based test is the Gold standard for malaria diagnosis in the clinical settings. The low sensitivity of Microscopy coupled with the challenges associated with blood sampling necessitates exploring alternative methods of identifying malaria cases. The aim of this study was to detect the presence of Plasmod...

We aimed to identify the contribution of central nervous system (CNS) viral coinfection to illness in African children with retinopathy-negative or retinopathy-positive cerebral malaria (CM). We collected cerebrospinal fluid (CSF) from 272 children with retinopathy-negative or retinopathy-positive CM and selected CSF from 111 of these children (38...

There are limited data on factors associated with longitudinal control of blood pressure (BP) among Ghanaians on antihypertensive treatment. We sought to evaluate associations between prospective BP control and 24 putative factors within socio‐demographic, biological, and organizational domains. This is a cohort study involving 1867 (65%) adults wi...

Background: Globally, about 15% of newborns are born with a low birth weight (LBW) as a result of preterm birth or intrauterine growth restriction or both. Up to 70% of neonatal deaths occur in this group within the first 3 days after birth. Kangaroo Mother Care (KMC) applied after stabilization of the infant has been shown to reduce mortality by...

Higher proportions of early‐onset and estrogen receptor (ER) negative cancers are observed in women of African ancestry than in women of European ancestry. Differences in risk factor distributions and associations by age at diagnosis and ER status may explain this disparity. We analyzed data from 1,126 cases (aged 18–74 years) with invasive breast...

Background To optimize vaccine implementation visits for young children, it could be efficient to administer the first RTS,S/AS01 malaria vaccine dose during the Expanded Programme on Immunization (EPI) visit at 6 months of age together with Vitamin A supplementation and the third RTS,S/AS01 dose on the same day as yellow fever (YF), measles and ru...

Background: The issue with communication mediums during service provision and for making enquiries to a hospital on the type of services available, availability of physicians and beds at the receiving hospitals, and a reminder system remains a challenge for patients and providers of the health service in sub-Sharan Africa. This present study sought...

Background Malaria remains an important public health threat claiming many lives particularly in Sub-Saharan Africa. Light microscopy which is a blood-based test is the Gold standard for laboratory diagnosis of malaria in the clinical settings. The lack of sensitivity of Microscopy coupled with the challenges associated with blood sampling necessit...

RTS,S/AS01E malaria vaccine contains the hepatitis B virus surface antigen and may thus serve as a potential hepatitis B vaccine. To evaluate the impact of RTS,S/AS01E when implemented in the Expanded Program of Immunization, infants 8–12 weeks old were randomized to receive either RTS,S/AS01E or a licensed hepatitis B control vaccine (HepB), both...

The manifestations of malaria infection and malaria illness vary according to the epidemiology of malaria transmission: in settings of stable transmission, anti-disease immunity develops and asymptomatic infections are common, but when non-immune individuals are infected, life-threatening disease can develop rapidly. On an individual level, chemopr...

The global burden of non-communicable diseases (NCDs) is growing, and access to prevention and treatment strategies remain limited, especially for those in low- and middle-income countries (LMICs). Novel approaches are needed to improve access and affordability of medicines that can treat NCDs in LMICs. The Access and Affordability Initiative (AAI)...

The human genetic factors that affect resistance to infectious disease are poorly understood. Here we report a genome-wide association study in 17,000 severe malaria cases and population controls from 11 countries, informed by sequencing of family trios and by direct typing of candidate loci in an additional 15,000 samples. We identify five replica...

Background: The issue with communication mediums during service provision and for making enquiries to a hospital on the type of services available, availability of physicians and beds at the receiving hospitals, and a reminder system remains a challenge for patients and providers of the health service in sub-Sharan Africa. This present study sought...

The pathophysiology of malarial anemia is multifactorial and incompletely understood. We assessed mechanistic and risk factors for post-malarial anemia in Ghanaian and Gabonese children with severe P. falciparum malaria treated with parenteral artesunate followed by an oral artemisinin-combination therapy. We analyzed data from two independent stud...

There is a global demand for physicians; this demand is even higher in Sub-Saharan Africa (SSA) where individuals suffer significantly more from the global burden of disease but have a significantly higher healthcare workforce shortage. Since the introduction of the traditional medical education curricula by Abraham Flexner over 100 years ago, ther...

Background: Malaria remains a major public health threat claiming many lives particularly in Sub-Saharan Africa. Light microscopy and RDT are the mainstay tests in the clinical settings for malaria diagnosis. Many studies report varying levels of validity of these tests compared to molecular methods like PCR. Documentation on such comparative study...

Background Higher proportions of early onset and estrogen receptor (ER) negative cancers are observed in women of African ancestry than in women of European ancestry. Differences in risk factor distributions and associations by age at diagnosis and ER status may explain this disparity. Methods We analyzed data from 1,126 women (aged 18 to 74 years)...

Background: We assessed the safety and immunogenicity of the RTS,S/AS01 malaria vaccine in a subset of children identified as HIV-infected during a large phase III randomized controlled trial conducted in seven sub-Saharan African countries. Methods: Infants 6-12 weeks and children 5-17 months old were randomized to receive 4 RTS,S/AS01 doses (R...

Pneumonia is the highest cause of death in children under five (5) especially in sub-Saharan Africa. It accounts for 16 % of all deaths in Africa, deadlier than Malaria. Sub-Saharan Africa carries about half of the burden of the world’s under-five deaths. Progress in the fight against pneumonia has slacked behind that of the others. Pneumonia morta...

Introduction Preterm infants make up the majority of the 9 million babies born in Africa and South Asia requiring supplemental feedings as they transition to exclusive breastfeeding. The World Health Organization recommends the use of a cup to feed newborns with breastfeeding difficulties in low-resource settings. We set out to evaluate the Nifty c...

Background: The issue of mediums to communicate to make enquiries to a hospital in finding out the type of services available, availability of physicians and beds at the receiving hospitals, and a reminder system remains a challenge for patients and providers of the health service in the Sub-Sharan Africa. This present study sought to review the ex...

Background: There exist continuing challenges with communication media used during health service provision. These challenges relate to clients and health institution, intra and inter-health institution communications. This study reviewed the existing healthcare communication media from the perspectives of clients and health professionals at a tert...

Background: Global surveillance for vaccine preventable invasive bacterial diseases has been set up by the World Health Organization to provide disease burden data to support decisions on introducing pneumococcal conjugate vaccine (PCV). We present data from 2010 to 2016 collected at the 2 sentinel sites in Ghana. Methods: Data were collected fr...

Background: Access to medicines for hypertension and diabetes mellitus (DM) management is challenging in resource-limited countries. We sought to assess whether differential pricing of medicines based on socio-economic status would improve affordability of antihypertensive and anti-diabetic medications. A quasi-experimental, prospective cohort stud...

Emergently ill infants and children are often inadequately recognized and stabilized by health care facilities in low- and middle-income countries. Limited reports have shown that process improvements and prioritization of emergency care for children presenting to the hospital can improve pediatric hospital mortality. A dedicated pediatric emergenc...

A phase III, double-blind, randomized, controlled trial (NCT00866619) in sub-Saharan Africa showed RTS,S/AS01 vaccine efficacy against malaria. We now present in-depth safety results from this study. 8922 children (enrolled at 5–17 months) and 6537 infants (enrolled at 6–12 weeks) were 1:1:1-randomized to receive 4 doses of RTS,S/AS01 (R3R) or non-...

Background In case-control studies, population controls can help ensure generalizability; however, the selection of population controls can be challenging in environments that lack population registries. We developed a population enumeration and sampling strategy to facilitate use of population controls in a breast cancer case-control study conduct...