David Adjei

Chronic kidney disease (CKD) is a major burden among sub-Saharan African (SSA) populations. However, differences in CKD prevalence between rural and urban settings in Africa, and upon migration to Europe are unknown. We therefore assessed the differences in CKD prevalence among homogenous SSA population (Ghanaians) residing in rural and urban Ghana and in three European cities, and whether conventional risk factors of CKD explained the observed differences. Furthermore, we assessed whether the prevalence of CKD varied among individuals with hypertension and diabetes compared with individuals without these conditions. For this analysis, data from Research on Obesity & Diabetes among African Migrants (RODAM), a multi-centre cross-sectional study, were used. The study included a random sample of 5607 adult Ghanaians living in Europe (1465 Amsterdam, 577 Berlin, 1041 London) and Ghana (1445 urban and 1079 rural) aged 25-70 years. CKD status was defined according to severity of kidney di...

Data on the changing levels in renal morbidity and mortality are scant globally. We sought to assess trends in renal disease mortality and attributable causes over a twenty-year period in Ghana. A retrospective analysis of 20-year autopsy records of the Pathology Departments of leading teaching hospitals in Ghana, (Korle-Bu Teaching Hospital (KBTH) in Accra and Komfo Anokye Teaching Hospital (KATH) in Kumasi) from January 1994 to December 2013. Data comprising of autopsies from in-patients, community cases and coroners' cases were used. We defined primary cause of death as death directly due to renal disease and secondary cause of death as death in which renal disease was a comorbid or contributing factor. Over the period, there were a total of 94,309 deaths of which 5608 were attributed to renal disease (5.9/100). Mortality rate remained fairly the same from 1994 to 2009 (5.0%), but doubled from 2010 to 2013 (10.8%). Similar trends were observed among males and females during t...

Uterine fibroids are the most common benign tumours affecting premenopausal women and are often associated with considerable hospitalization and morbidity. Literature shows virtually no study concerning the quantification of the main factors associated with uterine fibroids in Ghanaian women. The purpose of this study was to assess the main factors associated with uterine fibroid among Ghanaian women presenting for ultrasound. A prospective cross-sectional study design was employed in this study. A total of two hundred and forty-four (244) women were consecutively evaluated from November 2011 to February 2012 using a 2-5 MHz curvilinear probe of Philips HD3 ultrasound machines at three centres in Accra using a trans-abdominal pelvic approach. Data was analysed with (SPSS) version 20.0 for windows, 2010; Chicago. The Pearson's Chi-square test was used to determine associations between selected demographic and gynaecological characteristics and uterine fibroid appearance. All tests were two-tailed and p-value of less than 0.05 was interpreted as significant. The range, mean and standard deviation (SD) of the patients' age were 14-54 years, 31.89 years and ± 7.92 respectively. Factors that associated significantly with uterine fibroid in Ghanaian women included obesity (X(2) = 17.3, p-value = 0.001), participant's age range (X(2) = 47.4, p-value = 0.001), parity (X(2) = -10.169, p-value = 0.001), and age at last delivery (X(2) = 34.579, p-value = 0.001). Uterine fibroid was mainly associated with women of older age group of the reproductive age than the younger age categories and also associated more with women with without children compared to those with more children. Moreover, it associated more with obese patients and patient with late age at last delivery.

Evidence suggesting important ethnic differences in chronic kidney disease (CKD) prevalence comes mainly from the United States, and data among various ethnic groups in Europe are lacking. We therefore assessed differences in CKD in 6 ethnic groups living in the Netherlands and explored to what extent the observed differences could be accounted for by differences in conventional cardiovascular risk factors (smoking, physical activity, obesity, hypertension, diabetes, and hypercholesterolemia). Cross-sectional analysis of baseline data from the Healthy Life in an Urban Setting (HELIUS) cohort study. A random sample of 12,888 adults (2,129 Dutch, 2,273 South Asian Surinamese, 2,159 African Surinamese, 1,853 Ghanaians, 2,255 Turks, and 2,219 Moroccans) aged 18 to 70 years living in Amsterdam, the Netherlands. Ethnicity. CKD status was defined using the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) severity of CKD classification. CKD was defined as albumin-creatinine ratio ≥ 3mg/mmol (category ≥ A2) or glomerular filtration rate < 60mL/min/1.73m(2) (category ≥ G3). Comparisons among groups were made using prevalence ratios (PRs). The age-standardized prevalence of CKD was higher in all ethnic minority groups, ranging from 4.6% (95% CI, 3.8%-5.5%) in African Surinamese to 8.0% (95% CI, 6.7%-9.4%) in Turks, compared with 3.0% (95% CI, 2.3%-3.7%) in Dutch. Adjustment for conventional risk factors reduced the PR substantially, but ethnic differences remained for all ethnic minority groups except African Surinamese, with the PR ranging from 1.48 (95% CI, 1.12-1.97) in Ghanaians to 1.75 (95% CI, 1.33-2.30) in Turks compared with Dutch. Similar findings were found when CKD was stratified into a moderately increased and a combined high/very high risk group. Among the combined high/very high CKD risk group, conventional risk factors accounted for most of the ethnic differences in CKD except for South Asian Surinamese (PR, 2.60; 95% CI, 1.26-5.34) and Moroccans (PR, 2.33; 95% CI, 1.05-5.18). Cross-sectional design. These findings suggest ethnic inequalities in CKD for most groups even after adjustment for conventional risk factors. These findings highlight the need for further research to identify other potential factors contributing to the ethnic inequalities in CKD.

Helicobacter pylori infection is prevalent in Ghana. The development of gastro-duodenal disease is dependent on virulence of the infecting strain, host susceptibility and environmental factors. Helicobacter pylori cagA and vacA strains induce more inflammation, ulceration and oncogenesis. Here, for the first time we present data on H. pylori cagA and vacA genes and their association with gastro-duodenal disease in Ghana. A total of 159 patients with dyspepsia at Korle-Bu Teaching Hospital, Accra, were investigated for H. pylori with urease-CLO, of which 113 (71.1%) were positive. Genomic DNA was extracted from antral biopsies using QIAGEN DNeasy kit. Detection of H. pylori vacA and cagA genes were determined by PCR as previously described. In total, 110 (69.2%) vacAs1, 71 (44.7%) vacAm1, 35 (22.0%) vacAm2, 77 (48.4%) cagA-(hydrophilic region) and 109 (68.6%) cagA-(internal duplication region) were detected. In multivariate analysis, duodenal ulcer was more likely than other diagnose...

Knowledge of hepatitis B virus (HBV) genotype is an important predictive variable which might have an impact in management and treatment of patients with chronic hepatitis B infection. In Ghana very little information is available on hepatitis B genotypes. This study was conducted to determine the distribution of HBV genotypes circulating among chronic hepatitis B patients reporting at the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana. Blood samples (10 ml) were collected from 250 consenting patients. DNA was extracted and amplified using polymerase chain reaction technique. Restriction fragment length polymorphism (RFLP) was used for the detection of genotypes. Out of the 250 chronic hepatitis B patients who were HBsAg positive, 91 (36.4%) were males aged 29.8 ± 9.1 and 159 (63.6%) females aged 33± 12.1 years. HBV DNA was detected in 111 (44.4%) but only 58 (52%) of these were typeable. These were classified as genotype A, 8 (7.2%); genotype D, 3 (2.7%) and genotype E, 47 (42.3%). Our results did not show any association between the infecting genotype and age (X(2)= 0.923; p-value=0.623) or gender (X(2)= 0.283, p= 0.579). Consistent with similar studies worldwide, the results suggest that genotypes A, D and E were the genotypes circulating among chronic hepatitis B patients who reported to the Korle-Bu Teaching Hospital with genotype E being the most predominant and therefore constitutes an important public health concern. We recommend further epidemiological studies to understand the implication of genotype E in terms of disease progression and treatment.

Though giardiasis is an important public health problem in Ghana, several aspects of its epidemiology, particularly the molecular epidemiology has not been investigated adequately. This could be a major hindrance to effective surveillance and control of giardiasis in the country. The study was carried out to determine the prevalence, risk factors and genotypes of Giardia lamblia infecting children at a paediatric hospital in Ghana. A total of 485 patients including 365 diarrhoea and 120 non-diarrhoea children were enrolled into the study. Stool samples were collected and analysed for parasite presence using microscopy, ELISA and PCR. Positive samples were subsequently characterized into assemblages by PCR-RFLP, and further confirmed with sequencing of the glutamate dehydrogenase (gdh) gene. Epidemiological data on demographic, clinical and behavioral features of the study subjects were also collected. Prevalence of G. lamblia infections in diarrhoea and non-diarrhoea children were 5.8% and 5% respectively (P>0.5). Sequence data confirmed Giardia lamblia assemblage B as the predominant genotype in both diarrhoea and non-diarrhoea cases. There was no significant association of G. lamblia infection with any of the epidemiological variables investigated. Our findings suggest that assemblage B could be the predominant genotype causing giardiasis in children. Increased public health education focusing on good sanitary practices, particularly among mothers and children, could decrease the risk of G. lamblia infection.

Pregnancy during the adolescent period is challenging mainly because of the nutritional demands of both the adolescent and pregnancy period. The risk for anaemia increases especially in developing countries such as Ghana where malaria is endemic and the practice of pica is common. In this study, we sought to determine the prevalence of anaemia, pica practice and malaria infection among pregnant adolescent girls and assess the extent to which these factors are associated. Two hundred and sixty five (265) pregnant adolescent girls were recruited from three hospitals in Accra. Haemoglobin levels, malaria infection and the practice of pica were assessed. Pearson's Chi squared tests were used to determine associations and logistic regression analysis was used to determine the odds of being anaemic. Significance was set at p≤0.05. Anaemia prevalence was 76% with severity ranging from mild (47.8%) to severe (0.8%). About 27.5% were moderately anaemic. Pica was practiced in only 9.1% of the girls. Malaria infection was prevalent in 17.7% of the girls. The logistic regression analysis indicated that pregnant girls with malaria infection were 3.56 times more likely to be anaemic when compared to those without malaria. Also, those who practiced pica were 1.23 times more likely to be anaemic when compared to those who did not practice pica. Anaemia is very prevalent in pregnant adolescent girls and is a public health problem. Drastic measures should be taken to reduce the high prevalence.

Bacterial and other microbial contamination of fresh vegetables from the farm or garden to the market and to the final consumer remain a problem worldwide. This study was designed to evaluate the various possible bacterial species responsible for the contamination of Brassica oleracea var. capitata (cabbage) grown in the Korle-Bu vegetable garden and sold at the Agbogbloshie market in the Accra Metropolis, Ghana. Sixty (60) cabbage samples were collected and investigated bacteriologically using standard Food and Agriculture Organization (FAO) of the United Nations (UN) total aerobic plate count methods.Cabbage samples from the vegetable garden were found to be more contaminated than the market with a total mean colony count of 2.43×10 6 CFU/g and 1.53×10 6 CFU/g respectively. Staphylococcus aureus was the most predominant bacteria isolated with a high percentage occurrence of 51% followed by Escherichia coli (28%), Bacillus sp. (12%), Streptococcus sp. (5%), and Pseudomonas aerugino...

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the important causal agents of nosocomial infections worldwide. The prevalence and susceptibility profiles of MRSA in the University of Ghana Hospital, Legon, Accra were investigated from 65 swab samples. Samples were inoculated onto blood agar plates and incubated at 37degree aerobically for 24 h. After overnight incubation, isolates were tested biochemically and a total of 11 (16.9%) isolates of Staphylococcus aureus were identified from the swab samples. The S. aureus isolates were later confirmed as MRSA by growth on Oxacillin-Resistant Screening Agar Base (ORSAB) and detection of the mecA gene using polymerase chain reaction (PCR) technique. Kirby-Baeur disc diffusion method was also used to determine the susceptibility of the isolates. There was only 1 (9.1%) MRSA isolate detected from the samples. The MRSA isolate was susceptible to cotrimoxazole, tetracycline, and gentamicin but resistant to ampicillin, cephalexin,...

Background: Chronic Myeloid leukaemia (CML) is a clonal disease that results from an acquired genetic change in a pluripotential haemopoietic stem cell. Hearing loss is a rare complication of CML. The most probable cause of the hearing loss in CML has been attributed to hyperleukostasis rather than leukaemic infiltration as seen in other leukaemias. This supported by the fact that hearing loss can be reversed in some patients if leukapheresis is done early. Patients and Methods: This retrospective study was conducted at the Korle-Bu Teaching Hospital, Accra, Ghana. Study included adult patients diagnosed with (CML) over a five year period from January 2007 to December 2011 who presented with hearing loss. Seven of them presented with hearing loss. Diagnosis of CML was made by a bone marrow aspirate and confirmed with Fluorescence in situ hybridization (FISH) analysis for Philadelphia chromosome. Medical records of cases were analyzed for their demographic characteristics and clinica...

Background: Occupational exposure to lead has been reported to have a toxic effect on multiple body systems, including haematological and gastrointestinal systems. Those who work directly in petroleum industries (such as fuel station attendants) are likely to be affected. Aim: The aim of this study was to investigate for haematological alterations that may be due to lead exposure in apparently healthy fuel station attendants. Methodology: This cross-sectional study employed convenience sampling method to select subjects. A total of One hundred (100) subjects comprising 84 males and 16 females were used as cases and controls in this study. Approximately 4 ml of venous blood was collected into EDTA tubes for blood lead level and haematological analysis. Results: The mean blood lead level of the fuel station attendants was 3.44µg/dl as compared to 3.12µg/dl for the controls. The means of lymphocyte counts and red blood cell counts were significantly decreased in cases (33.70 ± 12.80 an...

Introduction Chronic kidney disease (CKD) affects over 35 million adults in sub-Saharan Africa. The health care burden due to CKD is a major continent-wide challenge in Africa where access to necessary health care facilities is grossly inadequate and hence for many CKD patients the diagnosis is practically a death sentence. As part of the effort to address this challenge, the H3Africa Kidney Disease Research Network (H3A-KDRN), which is funded by the NIH, is conducting a genetic study of CKD in multiple populations in sub-Saharan Africa to identify variants involved in the etiology of CKD in African populations. Objectives The aim of the present analysis was to explore and compare the genetic diversity at select known CKD loci among populations being studied by H3A-KDRN so as to gain some insight to what to expect as the project moves towards the stage of sequencing and association mapping for susceptibility loci in these populations. Methods Genotype data were obtained from The 100...

Hepatitis D virus (HDV), a defective RNA virus which depends on hepatitis B virus (HBV) for its replication and expression, appears to be highly pathogenic and modifies the natural history of HBV infection. Two types of infection, co-infection and super-infection are recognised. During infection, anti-delta antibodies appear in serum and can be detected by Enzyme linked Immunosorbent Assay (ELISA).

Water is essential for life and in most parts of the world including Ghana it is used for various activities such as drinking, bathing and recreational purposes. The objective of this study was to assess the bacteriological quality of swimming pools' water in the Accra Metropolis. Five swimming pools were selected randomly and a research team visited the pools to collect water samples and at the same time administer short questionnaires about the characteristics of the pools. The average number of swimmers, swimming bathing loads, average age group of pool users, methods of disinfection, type of chlorine used, recycling, and treatment of the water before and after use were investigated. During the visit, water samples were collected for total coliform, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus counts using the Membrane Filtration (MF) method and cultured on chromogenic media. Most (60%) of the selected swimming pools had a bathing load≤20 per day. The op...

Stroke is often characterized by disturbance in balance and mobility among the survivors with its attendant rehabilitation potentials. Static balance serves as a foundation for attainment of functions in patients with stroke, yet its determinants are usually under-estimated. This study was therefore designed to determine the influence of some clinical and demographic factors on static balance in stroke survivors. Eighty (80) hemiparetic stroke survivors participated in this cross-sectional survey. Demographic variables include age, height, weight and body mass index (BMI) whilst knee range of motion, (ROM) duration of stroke, levels of disability and spasticity of the paretic lower limbs of the participants were the clinical variables. Universal Goniometer, Barthel Index, and Modified Ashworth Scale were used to assess ROM, disability and spasticity levels respectively. The outcome measure for static balance was Functional Reach Test. Pearson's correlation coefficient analysis w...

Assessment of impairment and disability measures on dynamic balance status of elderly patients is well documented in the rehabilitation of neuromuscular disorders. Few studies however considered similar evaluation in musculoskeletal disorders. To determine the influence of pain, hip range of motion and level of activity on dynamic balance among elderly people with hip osteoarthritis (OA). Elderly patients with hip OA participated in the cross-sectional survey. The impairment measures were assessed using the visual analogue scale and double-arm universal goniometer whilst their levels of activity were assessed with the Barthel Index. Participants performed Turn-180 on two trials by taking steps clockwise and anti-clockwise round a sturdy arm chair. The total number of steps taken to complete each Turn- 180 was determined. Descriptive statistics were used to summarize data whilst Pearson moment correlation coefficient determined the correlations of the variables at 95% confidence interval. The study involved 87 participants comprising 40(46%) males and 47(54%) females. The age of the participants ranged from 60 to 74years with a mean of 65.8±4.5years. There was a positive and significant correlation (r=0.596; p<0.001) between the participants' pain and steps taken to complete Turn-180. The participants' hip flexibility and the level of activity were also significantly and inversely correlated with the performance of Turn-180. The dynamic balance of the sampled elderly patients was considerably influenced by pain, hip flexibility and level of activity, thereby putting premium on the assessment of the variables during musculoskeletal rehabilitation of elderly patients.

ABSTRACT Malaria is hyper-endemic in Ghana. Haematological alterations in the disease pathology may offer complimentary criteria to improve clinical and microscopy diagnosis. Our primary outcome was to evaluate haematological parameters in children with Plasmodium falciparum infections and report their predictive risk and diagnostic performance for malaria infections in Ghana. Haematological data, including thin and thick blood films were examined for children less than 12 years of age in a multicenter-based active case finding approach. Haematological changes were common in P. falciparum infected children and more pronounced in severe malaria cases. More so, a unit increase in parasiteamia increased the odds for severe malaria infection by 93 % [OR, 95 % CI: 1.93 (1.28–2.91); P value = 0.02]. In multivariate regression, low haemoglobin was a significant haematological change in predicting P. falciparum infections [OR, 95 % CI: 3.20 (1.26–7.09); P value = 0.001]. Low haemoglobin levels <11 g/dl was the most reliable indicator for P. falciparum infections [with a sensitivity of (64 %), specificity (71 %), positive predictive value (83 %) and likelihood ratio (2.2)]—even when evaluated in combination with leucocytosis, lymphocytopaenia and high neutrophil counts >7,500 µL. In malaria endemic settings, low haemoglobin concentration (<11 g/dl) in children with febrile illness should prompt a more diligent search for the malarial parasite to limit the misuse and abuse of anti-malarial drugs.