Kumasi Center for Collaborative Research in Tropical Medicine

Kumasi, Ghana

Kumasi Center for Collaborative Research in Tropical Medicine

Kumasi, Ghana
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Krumkamp R.,Bernhard Nocht Institute for Tropical Medicine | Krumkamp R.,German Center for Infection Research | Sarpong N.,Kumasi Center for Collaborative Research in Tropical Medicine | Schwarz N.G.,Bernhard Nocht Institute for Tropical Medicine | And 9 more authors.
PLoS Neglected Tropical Diseases | Year: 2015

Diarrheal diseases are among the most frequent causes of morbidity and mortality in children worldwide, especially in resource-poor areas. This case-control study assessed the associations between gastrointestinal infections and diarrhea in children from rural Ghana.Stool samples were collected from 548 children with diarrhea and from 686 without gastrointestinal symptoms visiting a hospital from 2007–2008. Samples were analyzed by microscopy and molecular methods.The organisms most frequently detected in symptomatic cases were Giardia lamblia, Shigella spp./ enteroinvasive Escherichia coli (EIEC), and Campylobacter jejuni. Infections with rotavirus (adjusted odds ratio [aOR] = 8.4; 95% confidence interval [CI]: 4.3–16.6), C. parvum/hominis (aOR = 2.7; 95% CI: 1.4–5.2) and norovirus (aOR = 2.0; 95%CI: 1.3–3.0) showed the strongest association with diarrhea. The highest attributable fractions (AF) for diarrhea were estimated for rotavirus (AF = 14.3%; 95% CI: 10.9–17.5%), Shigella spp./EIEC (AF = 10.5%; 95% CI: 3.5–17.1%), and norovirus (AF = 8.2%; 95% CI 3.2–12.9%). Co-infections occurred frequently and most infections presented themselves independently of other infections. However, infections with E. dispar, C. jejuni, and norovirus were observed more often in the presence of G. lamblia.Diarrheal diseases in children from a rural area in sub-Saharan Africa are mainly due to infections with rotavirus, Shigella spp./EIEC, and norovirus. These associations are strongly age-dependent, which should be considered when diagnosing causes of diarrhea. The presented results are informative for both clinicians treating gastrointestinal infections as well as public health experts designing control programs against diarrheal diseases. © 2015 Krumkamp et al.


Nkrumah B.,Kumasi Center for Collaborative Research in Tropical Medicine | Nguah S.B.,Komfo Anokye Teaching Hospital | Sarpong N.,Kumasi Center for Collaborative Research in Tropical Medicine | Dekker D.,Bernhard Nocht Institute for Tropical Medicine | And 3 more authors.
BMC Clinical Pathology | Year: 2011

Background: In resource poor settings where automated hematology analyzers are not available, the Cyanmethemoglobin method is often used. This method though cheaper, takes more time. In blood donations, the semi-quantitative gravimetric copper sulfate method which is very easy and inexpensive may be used but does not provide an acceptable degree of accuracy. The HemoCue hemoglobin photometer has been used for these purposes. This study was conducted to generate data to support or refute its use as a point-of-care device for hemoglobin estimation in mobile blood donations and critical care areas in health facilities. Method. EDTA blood was collected from study participants drawn from five groups: pre-school children, school children, pregnant women, non-pregnant women and men. Blood collected was immediately processed to estimate the hemoglobin concentration using three different methods (HemoCue, Sysmex KX21N and Cyanmethemoglobin). Agreement between the test methods was assessed by the method of Bland and Altman. The Intraclass correlation coefficient (ICC) was used to determine the within subject variability of measured hemoglobin. Results: Of 398 subjects, 42% were males with the overall mean age being 19.4 years. The overall mean hemoglobin as estimated by each method was 10.4 g/dl for HemoCue, 10.3 g/dl for Sysmex KX21N and 10.3 g/dl for Cyanmethemoglobin. Pairwise analysis revealed that the hemoglobin determined by the HemoCue method was higher than that measured by the KX21N and Cyanmethemoglobin. Comparing the hemoglobin determined by the HemoCue to Cyanmethemoglobin, the concordance correlation coefficient was 0.995 (95% CI: 0.994-0.996, p < 0.001). The Bland and Altman's limit of agreement was -0.389 - 0.644 g/dl with the mean difference being 0.127 (95% CI: 0.102-0.153) and a non-significant difference in variability between the two measurements (p = 0.843). After adjusting to assess the effect of other possible confounders such as sex, age and category of person, there was no significant difference in the hemoglobin determined by the HemoCue compared to Cyanmethemoglobin (coef = -0.127, 95% CI: -0.379 - 0.634). Conclusion: Hemoglobin determined by the HemoCue method is comparable to that determined by the other methods. The HemoCue photometer is therefore recommended for use as on-the-spot device for determining hemoglobin in resource poor setting. © 2011 Nkrumah et al; licensee BioMed Central Ltd.


Boaitey Y.A.,Komfo Anokye Teaching Hospital | Nkrumah B.,Kumasi Center for Collaborative Research in Tropical Medicine | Idriss A.,Malaria Research Center | Tay S.C.K.,Kwame Nkrumah University Of Science And Technology
BMC Research Notes | Year: 2012

Background: Gastrointestinal and urinary tract pathogenic infections are aggravating the incidence and progression of the Human Immunodeficiency Virus (HIV) infection into Acquired Immune Deficiency Syndrome (AIDS) more especially in the developing countries. This study was conducted to assess the common gastrointestinal and urinary infections among HIV/AIDS patients at the Komfo Anokye Teaching Hospital (KATH) in Ghana between April and December 2008. Findings. This work reports on gastrointestinal and urinary tract pathogenic infections among 500 HIV seropositive and 300 HIV seronegative patients. There was a 35% (175/500) prevalence of intestinal parasites among HIV seropositive patients compared to 4.3% (13/300) in HIV seronegative patients. Giardia lamblia and Cryptosporidium accounted for 19% (95/500) and 14% (70/500) respectively, while Schistosoma mansoni, Strongyloides stercoralis and hookworm together accounted for 2% (10/500) of intestinal parasitic infections among the HIV seropositive patients. There was no significant difference (p > 0.05) in urinary parasitic infection between HIV seropositive 1% (2/500) and seronegative patients 0.7% (2/300). Most, 60 (86%) out of 70, of the urinary tract infection among the HIV seropositive patients was due to bacteria with E. coli being the most predominant isolate, 28 (47%) out of 60. There was no significant difference in infections based on age and gender. Conclusion: G. lamblia and Cryptosporidium were the most common gastrointestinal parasites detected while bacteria accounted for majority of the urinary tract infections among the HIV seropositive patients at the hospital. © 2012 Boaitey et al.; licensee BioMed Central Ltd.


Kang H.,University of Pennsylvania | Kreuels B.,University of Hamburg | Kreuels B.,Bernhard Nocht Institute for Tropical Medicine | Adjei O.,Kumasi Center for Collaborative Research in Tropical Medicine | And 3 more authors.
International Journal of Epidemiology | Year: 2013

Background Previous studies on the association of malaria and stunted growth delivered inconsistent results. These conflicting results may be due to different levels of confounding and to considerable difficulties in elucidating a causal relationship. Randomized experiments are impractical and previous observational studies have not fully controlled for potential confounding including nutritional deficiencies, breastfeeding habits, other infectious diseases and socioeconomic status. Methods This study aims to estimate the causal effect between malaria episodes and stunted growth by applying a combination of Mendelian randomization, using the sickle cell trait, and matching. We demonstrate the method on a cohort of children in the Ashanti Region, Ghana. Results We found that the risk of stunting increases by 0.32 (P-value: 0.004, 95% CI: 0.09, 1.0) for every malaria episode. The risk estimate based on Mendelian randomization substantially differs from the multiple regression estimate of 0.02 (P-value: 0.02, 95% CI: 0.003, 0.03). In addition, based on the sensitivity analysis, our results were reasonably insensitive to unmeasured confounders. Conclusions The method applied in this study indicates a causal relationship between malaria and stunting in young children in an area of high endemicity and demonstrates the usefulness of the sickle cell trait as an instrument for the analysis of conditions that might be causally related to malaria. © The Author 2013; all rights reserved.


Nkrumah B.,Kumasi Center for Collaborative Research in Tropical Medicine | Nguah S.,Komfo Anokye Teaching Hospital
Parasites and Vectors | Year: 2011

Background: Acute childhood diarrhoea remains one of the leading causes of childhood morbidity and mortality in developing countries. The WHO has accordingly underlined the need for epidemiological surveys of infantile diarrhoea in all geographical areas. This study was conducted to determine the incidence of intestinal parasites among stool samples from children examined at a secondary health care facility in a rural area of Ghana. Method. A retrospective study was conducted to investigate the incidence of intestinal parasites among children who had their stools examined at the Agogo Hospital laboratory. Stool microscopy results from January 2006 through May 2009 were obtained from archived records of the laboratory. Results for children less than 18 years were transcribed unto a standardized datasheet, entered into an electronic database designed using Microsoft access 2007 and analyzed using Stata/SE11.1 statistical software. The incidences of the parasites were determined and presented with their Poisson exact 95% confidence intervals for the various ages. Results: The median age of the 1080 children included in the study was 5 years (IQR: 2-12 years) with 51.9% being females. The overall incidence of all parasites was 114 per 1000 with Giardia lamblia being the most common (89.5%). Children aged less than a year had the lowest parasite incidence of 13 per 1000 with all being Giardia lamblia, while those aged 15-17 years had the highest of 169 per 1000. The incidence for Giardia lamblia only was lowest at 13 per 1000 for those under a year old, highest at 152 per 1000 for the 15-17 year group and 97 per 1000 for all ages combined. There was a significant rise in incidence of Giardia lamblia with age (Trend x 2 = 18.6, p < 0.001). Five (4.3%) of the 118 positive stool samples had mixed parasites infection. Enterobius vermicularis, Taenia spp and Trichuris trichiura were not seen in any of the stool samples. Conclusion: Giardia lamblia is the most prevalent intestinal parasite in examined stool samples of children within the Ashanti Akim North Municipality and its prevalence significantly increases with age. Measures must be put in place to educate the community on proper personal hygiene to reduce giardiasis. © 2011 Nkrumah and Nguah; licensee BioMed Central Ltd.


Kwofie T.B.,Kwame Nkrumah University Of Science And Technology | Anane Y.A.,Kwame Nkrumah University Of Science And Technology | Nkrumah B.,Kumasi Center for Collaborative Research in Tropical Medicine | Annan A.,Kumasi Center for Collaborative Research in Tropical Medicine | And 2 more authors.
Virology Journal | Year: 2012

Background: Acute respiratory tract infections are one of the major causes of morbidity and mortality among young children in developing countries. Information on the viral aetiology of acute respiratory infections in developing countries is very limited. The study was done to identify viruses associated with acute lower respiratory tract infection among children less than 5 years. Method. Nasopharyngeal samples and blood cultures were collected from children less than 5 years who have been hospitalized for acute lower respiratory tract infection. Viruses and bacteria were identified using Reverse Transcriptase Real-Time Polymerase Chain Reaction and conventional biochemical techniques. Results: Out of 128 patients recruited, 33(25.88%%, 95%CI: 18.5% to 34.2%) were positive for one or more viruses. Respiratory Syncytial Virus (RSV) was detected in 18(14.1%, 95%CI: 8.5% to 21.3%) patients followed by Adenoviruses (AdV) in 13(10.2%, 95%CI: 5.5% to 16.7%), Parainfluenza (PIV type: 1, 2, 3) in 4(3.1%, 95%CI: 0.9% to 7.8%) and influenza B viruses in 1(0.8%, 95%CI: 0.0 to 4.3). Concomitant viral and bacterial co-infection occurred in two patients. There were no detectable significant differences in the clinical signs, symptoms and severity for the various pathogens isolated. A total of 61.1% (22/36) of positive viruses were detected during the rainy season and Respiratory Syncytial Virus was the most predominant. Conclusion: The study has demonstrated an important burden of respiratory viruses as major causes of childhood acute respiratory infection in a tertiary health institution in Ghana. The data addresses a need for more studies on viral associated respiratory tract infection. © 2012 Kwofie et al; licensee BioMed Central Ltd.


Nkrumah B.,Kumasi Center for Collaborative Research in Tropical Medicine | Owusu M.,Komfo Anokye Teaching Hospital | Averu P.,Agogo Presbyterian Hospital
BMC Research Notes | Year: 2011

Background: Infection by Hepatitis B virus (HBV) and Hepatitis C virus (HCV) cause serious mortality, morbidity and financial burden and are thus a major global health problem. The study was conducted to investigate the prevalence of Hepatitis B and C infections and co-infections among blood donors in a rural community of Ghana. This was a retrospective study conducted at the Agogo Presbyterian Hospital in the Asanti Akim North District of Ghana to investigate the prevalence of these infections over a three year period among 2773 blood donors. Males constituted a larger proportion of the study population (92.2%). Majority of the study population (43.9%) were within 26-35 age group. The disease prevalence was calculated at a 95% confidence interval. Findings. The prevalence of Hepatitis B viral (HBV) infection was highest in females- 21.4% (95% CI: 11.6-34.4) in 2006 than males in the same year- 13.2% (95% CI: 10.8-15.9). Hepatitis C viral (HCV) infection was highest among males- 11.6% (95% CI: 9.5-13.8) in 2007. HBV and HCV co-infection was higher in males- 2.6% (95% CI: 1.6-3.8) than females- 1.3% (95% CI: 0-7.0) in 2007. The overall prevalence of HBV and HCV was 13.8% (95% CI: 11.4- 16.4) and 9.4% (95% CI: 7.4-11.6) respectively in 2006. The rate of co-infection of HBV and HCV however increased from 1.6% (95% CI: 0.8-2.7) in 2006 to 2.2% (95% CI: 1.3-3.2) in 2008 in males and from 0% (95% CI: 0-6.4) in 2006 to 1.2% (95% CI: 0-6.5) in 2008 in females. Conclusion: The single infections of HBV and HCV reduced but co-infection of these transfusion transmitted infections increased. Measures such as more sensitive techniques for effective diagnosis and sanitary education to enlighten the population must be implemented. © 2011 Nkrumah et al; licensee BioMed Central Ltd.


Kreuels B.,Bernhard Nocht Institute for Tropical Medicine | Kreuzberg C.,Bernhard Nocht Institute for Tropical Medicine | Kobbe R.,Bernhard Nocht Institute for Tropical Medicine | Kobbe R.,University of Hamburg | And 9 more authors.
Blood | Year: 2010

The high prevalence of hemoglobin S (HbS) in Africa and hemoglobin C (HbC) in parts of West Africa is caused by the strong protection against severe falciparum malaria during childhood. Much less is known about the effect of HbS and especially HbC on Plasmodium falciparum infection, uncomplicated malaria, and anemia. A total of 1070 children from the Ashanti Region, Ghana, were enrolled at the age of 3 months and visited monthly until 2 years of age. The effects of the β-globin genotype on the age-dependent incidence of malaria, levels of parasitemia, and hemoglobin as well as physical development were analyzed by population-averaged models. Infants with HbAS were protected from uncomplicated malaria (P < .005) and anemia (P < .001), had lower age-adjusted parasite densities (P < .001), and higher age-adjusted hemoglobin levels compared with children with the HbAA genotype (P = .004). In contrast, HbAC carriers had lower hemoglobin levels (P < .033) and were not protected against malaria or anemia. Notably, infants with HbAS were also significantly protected against stunting compared with carriers of HbAA or HbAC. This indicates differing mechanisms of protection against malaria of HbAS and HbAC and might help to understand why HbC is restricted to distinct areas of West Africa. © 2010 by The American Society of Hematology.


Hoerauf A.,University of Bonn | Pfarr K.,University of Bonn | Mand S.,University of Bonn | Debrah A.Y.,Kwame Nkrumah University Of Science And Technology | And 2 more authors.
Clinical Microbiology and Infection | Year: 2011

Lymphatic filariasis (LF) and onchocerciasis are parasitic nematode infections that are responsible for a major disease burden in the African continent. Disease symptoms are induced by the immune reactions of the host, with lymphoedema and hydrocoele in LF, and dermatitis and ocular inflammation in onchocerciasis. Wuchereria bancrofti and Onchocerca volvulus, the species causing LF and onchocerciasis in Africa, live in mutual symbiosis with Wolbachia endobacteria, which cause a major part of the inflammation leading to symptoms and are antibiotic targets for treatment. The standard microfilaricidal drugs ivermectin and albendazole are used in mass drug administration programmes, with the aim of interrupting transmission, with a consequent reduction in the burden of infection and, in some situations, leading to regional elimination of LF and onchocerciasis. Co-endemicity of Loa loa with W. bancrofti or O. volvulus is an impediment to mass drug administration with ivermectin and albendazole, owing to the risk of encephalopathy being encountered upon administration of ivermectin. Research into new treatment options is exploring several improved delivery strategies for the classic drugs or new antibiotic treatment regimens for anti-wolbachial chemotherapy. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.


Nkrumah B.,Kumasi Center for Collaborative Research in Tropical Medicine
Ghana medical journal | Year: 2011

To investigate the prevalence of Hepatitis B and C infections and co-infections among blood donors in a rural community of Ghana. A retrospective study. Samples of blood donated between January 2007 and December 2008 were screen for Hepatitis B and C viruses at the Agogo Presbyterian Hospital. The prevalence of Hepatitis B viral (HBV) infection was highest in females 21.4% (95% CI: 11.6-34.4) in 2006 than males in the same year 13.2% (95% CI: 10.8-15.9). Hepatitis C viral (HCV) infection was highest among males at 11.6% (95% CI: 9.5-13.8) in 2007. HBV and HCV co-infection was higher in males 2.6% (95% CI: 1.6-3.8) than females 1.3% (95% CI: 0-7.0) in 2007. The overall prevalence of HBV and HCV was 13.8% (95% CI: 11.4-16.4) and 9.4% (95% CI: 7.4-11.6) respectively in 2006. The rate of co-infection of HBV and HCV however increased from 1.6% (95% CI: 0.8-2.7) in 2006 to 2.2% (95% CI: 1.3-3.2) in 2008 in males and from 0% (95% CI: 0-6.4) in 2006 to 1.2% (95% CI: 0-6.5) in 2008 in females. The single infections of HBV and HCV reduced but co-infection of these transfusion transmitted infections (TTI) increased. Measures such as more sensitive techniques and education must be employed in these areas.

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