The in-vitro susceptibilities of Ghanaian Plasmodium falciparum to antimalarial drugs.

In Ghana in 2004 (when choroquine was still the nationally recommended drug for the first-line treatment of malaria), the sensitivities, to chloroquine, amodiaquine, quinine, mefloquine, artesunate and halofantrine, of 60 Plasmodium falciparum isolates from two ecologically distinct areas of the country were assessed in vitro. The aim was to make available, to policy-makers, the field-based evidence needed to review the national strategy for malaria treatment. Drug susceptibilities were explored using the standardized protocol of the Antimalarial Drug Resistance Network. Although 32 of the P. falciparum isolates evaluated (56.1% of the 57 isolates successfully investigated for their susceptibility to choroquine) showed resistance to chloroquine and two showed slightly reduced sensitivity to amodiaquine, all the isolates were sensitive to mefloquine, artesunate, quinine and halofantrine. The median inhibitory concentrations (IC(50)) of chloroquine were positively correlated with those of quinine (r=0.4528; P=0.0008) but not those of any of the other drugs investigated. The IC(50) of amodiaquine and artesunate were also positively correlated (r=0.3703; P=0.0067). These results provide evidence of the presence, in Ghana, of P. falciparum isolates that are highly resistant to chloroquine but generally sensitive to most of the other antimalarial drugs commonly used in the country. Partly in consequence of these observations, the recommended first-line treatment for malaria in Ghana was changed to an amodiaquine-artesunate combination in January 2005

Bio-recovery of N and P from an anaerobic digester effluent: The potential of duckweed (Lemna minor)

The possibility of growing duckweed (Lemna minor) on anaerobic digester effluent and its nitrogen and phosphorus acquisition potential was studied. Duckweed was cultured for 21 days on an anaerobic digester effluent using two methods: static aeration (SAT) and normal batch reactor (NBR) techniques, respectively. The treatments involved pure effluent and 1/10, 1/25 and 1/50 effluent dilutions, respectively. Fifty duckweed fronds were grown in the anaerobic digester effluent for 21 days. At the end of the growth period, phosphate levels, total ammonium nitrogen (TAN) andtotal oxidized nitrogen (TON) contents of the growth media were determined. Total nitrogen concentration and orthophosphate P content in the duckweed were also determined. The results obtained indicated that duckweed was capable of growing on the anaerobic digester effluent provided its TAN content did not exceed 42 mg N l-1. Nitrogenuptake by the duckweed from the effluent ranged between 53 and 115.7 mg l-1 whereas P uptake varied from 1.40 to 8.4 mg P l-1. The relative growth rate of duckweed in the anaerobic digester effluent was observed to be comparable to literature value of 0.22 mg day -1. The results have demonstrated that duckweed has the potential to recover N and P from anaerobic digester effluent

Copy number variation of plasmepsins 2 and 3 genes in Plasmodium falciparum isolates and implication for dihydroartemisinin-piperaquine resistance in Ghana

Background: In 2008, dihydroartemisinin-piperaquine and artemether-lumefantrine were introduced to supplement artesunate-amodiaquine for the treatment of uncomplicated malaria in Ghana. Drug pressure over the years enhances the development of parasite resistance to drugs. The World Health Organization recommends the detection of copy number variations of plasmepsins 2 (PfPm2) and plasmepsins 3 (PfPm3) genes linked to dihydroartemisinin-piperaquine resistance in treatment efficacy studies.Objective: This study investigated the copy number variations of PfPm2 and PfPm3 genes in the malaria parasite population in Ghana.Methods: Overall, 313 blood samples from children ≤ 9 years presenting with uncomplicated malaria at three sentinel sites used for monitoring antimalarial drug efficacy and resistance in Ghana were used for genetic investigations. The samples were collected in the malaria transmission seasons of 2015 and 2016. Malaria parasite DNA extraction from the blood samples followed by real-time quantitative PCR was used to determine the copy number of the PfPm2 and PfPm3 genes. The gene copy number was calculated by the relative expression formula 2-ΔΔCt for quantification, where ΔΔ is the relative delta-delta, and Ct is the cycle threshold. ΔΔCt was calculated as (Ctβ-tubulin − Ctpfpm2/3) - (Ctβ-tubulin cal − Ctpfpm2/3 cal), where cal is the calibration control of genomic 3D7 DNA with one copy of both the β-tubulin endogenous control and pfpm2 and pfpm3. A change in Ct (ΔCt = Ct PfPm2/3 - Ct Pfβ-tubulin) where is the difference in Ct values for the target gene of interest PfPm2 and PfPm3 and the reference gene Pfβ-tubulin. Statistical significance was defined as p < 0.05.Results: Of the parasites analyzed, 79.2% (n = 228/288) and 80.5% (n = 227/282) had one gene copy for PfPm2 and PfPm3, respectively. For PfPm2, 14.9% (n = 43/288), 3.8% (n = 11/288), and 2.1% (n = 6/288) of the isolates had copy numbers 2, 3 and 4 respectively. For PfPm3, gene copies of 2, 3 and 4 were observed in 16.3% (n = 46/282), 2.1% (n = 6/282), and 1.1% (n = 3/282) of isolates. Analysis of the copy number variation across the three study sites in Cape-Coast, Begoro, and the Navrongo areas showed no significant difference for PfPm2 (p = 0.93) and PfPm3 (p = 0.94) genes.Conclusion: After over a decade of the use of dihydroartemisinin-piperaquine, the mutations associated with resistance to the drug have been observed in Ghanaian P. falciparum isolates. This serves as baseline data for further monitoring of this molecular marker extensively as part of ongoing surveillance of antimalarial drug efficacy studies in Ghana

Prevalence of asymptomatic malaria parasitaemia following mass testing and treatment in Pakro sub-district of Ghana.

BACKGROUND: Global efforts to scale-up malaria control interventions are gaining steam. These include the use of Long-Lasting Insecticide Nets, Indoor Residual Spraying, Intermittent Preventive Treatment and Test, Treat and Track. Despite these, the drive for malaria elimination is far from being realistic in endemic communities in Africa. This is partly due to the fact that asymptomatic parasite carriage, not specifically targeted by most interventions, remains the bedrock that fuels transmission. This has led to mass testing, treatment and tracking (MTTT) as an alternative strategy to target asymptomatic individuals. We report the impact of MTTT on the prevalence of asymptomatic malaria parasitaemia over a one-year period in Ghana, hypothesizing that implementing MTTT could reduce the rate of asymptomatic parasitaemia. METHODS: A population of about 5000 individuals in seven communities in the Pakro sub-district of Ghana participated in this study. A register was developed for each community following a census. MTTT engaged trained community-based health volunteers who conducted house-to-house testing using RDTs every 4 months and treated positive cases with Artemisinin-based Combination Therapy. Between interventions, community-based management of malaria was implemented for symptomatic cases. RESULTS: MTTT Coverage was 98.8% in July 2017 and 79.3% in July 2018. Of those tested, asymptomatic infection with malaria parasites reduced from 36.3% (1795/4941) in July 2017 to 32.9% (1303/3966) in July 2018 (p = 0.001). Prevalence of asymptomatic parasitaemia among children under 15 years declined from 52.6% (1043/1984) in July 2017 to 47.5% (820/1728) in July 2018 (p = 0.002). Implementing MTTT significantly reduced asymptomatic parasitaemia by 24% from July 2017 to July 2018 after adjusting for age, ITN use and axillary temperature (OR = 0.76, CI = 0.67, 0.85 p ≤ 0.001). CONCLUSION: This study has demonstrated that implementing MTTT is feasible and could reduce the prevalence of asymptomatic malaria parasitaemia in children under 15 years of age. Furthermore, the use of community-based health volunteers could ensure high coverage at lower cost of implementation

Predictors of Antibiotics Co-prescription with Antimalarials for Patients Presenting with Fever in Rural Tanzania.

Successful implementation of malaria treatment policy depends on the prescription practices for patients with malaria. This paper describes prescription patterns and assesses factors associated with co-prescription of antibiotics and artemether-lumefantrine (AL) for patients presenting with fever in rural Tanzania. From June 2009 to September 2011, a cohort event monitoring program was conducted among all patients treated at 8 selected health facilities in Ifakara and Rufiji Health and Demographic Surveillance System (HDSS).It included all patients presenting with fever and prescribed with AL. Logistic regression was used to model the predictors on the outcome variable which is co-prescription of AL and antibiotics on a single clinical visit. A cohort of 11,648 was recruited and followed up with 92% presenting with fever. Presumptive treatment was used in 56% of patients treated with AL. On average 2.4 (1 -- 7) drugs was prescribed per encounter, indicating co-prescription of AL with other drugs. Children under five had higher odds of AL and antibiotics co-prescription (OR = 0.63, 95% CI: 0.46 -- 0.85) than those aged more than five years. Patients testing negative had higher odds (OR = 2.22, 95%CI: 1.65 -- 2.97) of AL and antibiotics co-prescription. Patients receiving treatment from dispensaries had higher odds (OR = 1.45, 95% CI: 0.84 -- 2.30) of AL and antibiotics co-prescription than those from served in health centres even though the deference was not statistically significant. Regardless the fact that Malaria is declining but due to lack of laboratories and mRDT in most health facilities in the rural areas, clinicians are still treating malaria presumptively. This leads them to prescribe more drugs to treat all possibilities

Self-reported use of anti-malarial drugs and health facility management of malaria in Ghana

<p>Abstract</p> <p>Objective</p> <p>To assess the appropriateness of self-reported use of anti-malarial drugs prior to health facility attendance, and the management of malaria in two health facilities in Ghana.</p> <p>Method</p> <p>A structured questionnaire was used to collect data from 500 respondents who were diagnosed clinically and/or parasitologically for malaria at Agogo Presbyterian Hospital and Suntreso Polyclinic, both in the Ashanti Region of Ghana. Collected information included previous use of anti-malarial drugs prior to attending the health facilities, types of drugs used, how the drugs were used, and the sources of the drugs. In addition, the anti-malarial therapy given and outcomes at the two health facilities were assessed.</p> <p>Results</p> <p>Of the 500 patients interviewed, 17% had severe malaria, 8% had moderate to severe malaria and 75% had uncomplicated malaria. Forty three percent of the respondents had taken anti-malarial drugs within two weeks prior to hospital attendance. The most commonly used anti-malarials were chloroquine (76%), sulphadoxine-pyrimethamine (9%), herbal preparations (9%) and amodiaquine (6%). The sources of these medicines were licensed chemical sellers (50%), pharmacies (21%), neighbouring clinics (9%) or "other" sources (20%) including left-over medicines at home. One hundred and sixty three (77%) of the 213 patients who had used anti-malarial drugs prior to attending the health facilities, used the drugs inappropriately. At the health facilities, the anti-malarials were prescribed and used according to the national standard treatment guidelines with good outcomes.</p> <p>Conclusion</p> <p>Prevalence of inappropriate use of anti-malarials in the community in Ghana is high. There is need for enhanced public health education on home-based management of malaria and training for workers in medicine supply outlets to ensure effective use of anti-malaria drugs in the country.</p

Therapeutic efficacy of dihydroartemisinin-piperaquine combination for the treatment of uncomplicated malaria in Ghana

In 2020, Dihydroartemisinin-Piperaquine (DHAP) was adopted as a second-line antimalarial for treatment of uncomplicated malaria in Ghana following a review of the country’s antimalarial medicines policy. Available data obtained in 2007 had shown PCR-uncorrected therapeutic efficacy of 93.3% using a 28-day follow-up schedule. In 2020, the standard 42-day follow-up schedule for DHAP was used to estimate efficacy levels among febrile children aged 6 months to 9 years in three malaria sentinel sites representing the three main ecological zones of the country- savannah, forest, and coastal. PCR genotyping distinguished between recrudescence and re-infection using merozoite surface protein 2 (MSP2)-specific primers for FC27 and 3D7 strains. Per protocol analyses showed day 28 efficacy of 100% in all three sentinel sites with day 42 PCR-corrected efficacy ranging between 90.3% (95% CI: 80.1 – 96.4%) in the savannah zone and 100% in the forest and coastal zones, yielding a national average of 97.0% (95% CI: 93.4 – 98.8). No day 3 parasitemia was observed in all three sites. Prevalence of measured fever (axillary temperature ≥ 37.5°C) declined from 50.0 - 98.8% on day 0 to 7.1-11.5% on day 1 whilst parasitemia declined from 100% on day 0 to 1.2 - 2.3% on day 1. Mean haemoglobin levels on days 28 and 42 were significantly higher than pre-treatment levels in all three sites. We conclude that DHAP is highly efficacious in the treatment of uncomplicated malaria in Ghana. This data will serve as baseline for subsequent DHAP efficacy studies in the country

Who sleeps under bednets in Ghana? A doer/non-doer analysis of malaria prevention behaviours

BACKGROUND: Malaria prevention programmes should be based in part on knowledge of why some individuals use bednets while others do not. This paper identifies factors and characteristics of women that affect bednet use among their children less than five years of age in Ghana. METHODS: Data come from the baseline component of an evaluation of Freedom from Hunger's malaria curriculum. A quasi-experimental design was used to select clients (n = 516) of Credit with Education (an integrated package of microfinance and health education) and non-clients (n = 535). Chi-squares, Fisher's Exact tests and logistic regression were used to compare the characteristics of mothers whose children use bednets (doers) with those whose children do not (non-doers) and to identify factors associated with bednet use among children less than five years of age. RESULTS: The following factors were most closely associated with bednet use: region of residence; greater food security; and caregivers' beliefs about symptoms, causation and groups most vulnerable to malaria. Most respondents knew mosquitoes caused malaria; however, 20.6% of doers and 12.3% of non-doers (p = .0228) thought overworking oneself caused malaria. Ninety percent of doers and 77.0% of non-doers felt that sleeping under a net was protective against malaria (p = .0040). In addition, 16.5% of doers and 7.5% of non-doers (p = .0025) identified adult males as most vulnerable to malaria. CONCLUSION: Greater knowledge about malaria does not always translate into improved bednet use. Though culturally-based ideas about malaria may vary between communities, integrating them into traditional health education messages may enhance the effectiveness of public health efforts