Media and mass campaign on CSA/CIS and One-health concept and innovations

AICCRA Ghana is leverage the wide network of media and mass dissemination tools to scale Climate Smart Innovations and Climate Information Services to farmer

Capacitation of stakeholders on CSA, CIS and One-Health approaches

In order to establish and go on to strengthen CSA-CIS and One-Health Innovation Platforms at the AICCRA project intervention communities, there is the need to train relevant intermediary stakeholders to understand the One-Health concept and how it can be boosted with climate-smart agriculture innovations and integrated climate services for agriculture. These intermediary stakeholders comprise of municipal/district agriculture directors, crop officers, extension officers, and lead farmers. Their understanding of these concepts will contribute to mainstreaming them into their day-to day activities and sharing the knowledge beyond the AICCRA intervention communities

Clearance of viable Mycobacterium ulcerans from Buruli ulcer lesions during antibiotic treatment as determined by combined 16S rRNA reverse transcriptase /IS 2404 qPCR assay.

INTRODUCTION: Buruli ulcer (BU) caused by Mycobacterium ulcerans is effectively treated with rifampicin and streptomycin for 8 weeks but some lesions take several months to heal. We have shown previously that some slowly healing lesions contain mycolactone suggesting continuing infection after antibiotic therapy. Now we have determined how rapidly combined M. ulcerans 16S rRNA reverse transcriptase / IS2404 qPCR assay (16S rRNA) became negative during antibiotic treatment and investigated its influence on healing. METHODS: Fine needle aspirates and swab samples were obtained for culture, acid fast bacilli (AFB) and detection of M. ulcerans 16S rRNA and IS2404 by qPCR (16S rRNA) from patients with IS2404 PCR confirmed BU at baseline, during antibiotic and after treatment. Patients were followed up at 2 weekly intervals to determine the rate of healing. The Kaplan-Meier survival analysis was used to analyse the time to clearance of M. ulcerans 16S rRNA and the influence of persistent M ulcerans 16S rRNA on time to healing. The Mann Whitney test was used to compare the bacillary load at baseline in patients with or without viable organisms at week 4, and to analyse rate of healing at week 4 in relation to detection of viable organisms. RESULTS: Out of 129 patients, 16S rRNA was detected in 65% of lesions at baseline. The M. ulcerans 16S rRNA remained positive in 78% of patients with unhealed lesions at 4 weeks, 52% at 8 weeks, 23% at 12 weeks and 10% at week 16. The median time to clearance of M. ulcerans 16S rRNA was 12 weeks. BU lesions with positive 16S rRNA after antibiotic treatment had significantly higher bacterial load at baseline, longer healing time and lower healing rate at week 4 compared with those in which 16S rRNA was not detected at baseline or had become undetectable by week 4. CONCLUSIONS: Current antibiotic therapy for BU is highly successful in most patients but it may be possible to abbreviate treatment to 4 weeks in patients with a low initial bacterial load. On the other hand persistent infection contributes to slow healing in patients with a high bacterial load at baseline, some of whom may need antibiotic treatment extended beyond 8 weeks. Bacterial load was estimated from a single sample taken at baseline. A better estimate could be made by taking multiple samples or biopsies but this was not ethically acceptable

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The Prevalence, Predictors, and In-Hospital Mortality of Hepatic Encephalopathy in Patients with Liver Cirrhosis Admitted at St. Dominic Hospital in Akwatia, Ghana

Background. Hepatic encephalopathy (HE) is one of the most debilitating complications of cirrhosis leading to death. Decrease in HE mortality and recurrence has been linked with timely identification and early treatment. There is a need to document the burden, predictors, and treatment outcomes of HE in an adult population with liver cirrhosis in our setting as only reports from resource-endowed countries abound in the literature. This study aimed therefore to determine the prevalence, predictors, and treatment outcomes of patients with liver cirrhosis admitted at St. Dominic Hospital (SDH) in Akwatia, Ghana. Materials and Methods. A prospective study was conducted involving one hundred and sixty-seven (167) patients admitted at the medical wards in SDH with liver cirrhosis from January 1st, 2018, to March 24th, 2020. The demographic and clinical features of the patients were collected using a standardized questionnaire. Biochemical, haematological, and abdominal ultrasound scans were done for all patients. Patients were then followed up until discharge or death. Results. There were 109 (65.3%) males out of the 167 patients with a mean age of 45.8 and 47.5 years for those with and without HE, respectively. The prevalence of HE was 31.7% (53/167). Out of 53 participants with HE, 75.5% (40/53) died. There was a strong association between HE and death (p<0.001). The major precipitating factor of HE was infection (64.2%). Severe ascites (OR = 0.009) were clinical feature independently associated with HE, whereas high creatinine (OR = 0.987), blood urea nitrogen (BUN) (OR = 1.199), Child–Pugh score (CPS) (OR = 5.899), and low platelets (OR = 0.992) were the laboratory parameters and scores independently predictive of HE. Conclusion. HE was common among patients with liver cirrhosis admitted at SDH with high in-patient mortality. The commonest precipitating factor for HE was infection(s). Severe ascites, low platelet count, high creatinine, BUN, and CPS were independent predictors of HE

Bacterial Infections in Patients with Liver Cirrhosis: Prevalence, Predictors, and in-Hospital Mortality at a District Hospital in Ghana

BackgroundIn-patients with liver cirrhosis, bacterial infections are common with high in-hospital mortality. In Ghana, bacterial infections in liver cirrhosis patients and their impact on in-patient mortality are generally unknown. This study was conducted to define the prevalence, predictors, and treatment outcomes of cirrhotic patients with bacterial infections admitted to a district hospital in Ghana. MethodsPatients with liver cirrhosis hospitalized from 1st January, 2018 to 24th April, 2020 were consecutively recruited. The demographic data and clinical presentations of the patients were collected using standardized questionnaire. Full blood count, liver function test, renal function test, ascitic fluid analysis and culture, urinalysis and culture, hepatitis B surface antigen, anti-hepatitis C antibodies and abdominal ultrasound scans of the abdomen were conducted for all patients. ResultsThere were 110 (65.09%) males out of the 169 patients with a mean age of 47.10±12.88 years. The prevalence of infections was 42.01% (71/169). Out of 71 participants with infections, 59.15% (42/72) died. Fever, encephalopathy, high white cell count, Child-Pugh Class C and Blood urea nitrogen were independent predictors of bacterial infections ConclusionBacterial infection among the participants admitted to district hospital with liver cirrhosis was common with high in-hospital mortality. Rwanda J Med Health Sci 2022;5(1):46-5

Climate Smart Agriculture (CSA)-Climate Smart Infirmation Services (CIS) Prioritization in Ghana: Smart Assessments and Outcomes

Climate change continoulsy affects efficient farm productivity among smallholder famrers in Ghana and other parts of West Africa. Efforts have been made by farmers and policy makers in mitigating the effects of climate change on livelihhods. Hitherto, these efforts lacked complementarity and adhoc in adaptation among worst affected areas. Advancement in CSA practices therefore called for prioritization based on identified enablers in commodity value chains and within geographical areas. These enablers under the AICCRA-Ghana project consist of climate smartness (mitigation, adaptation and productivity), gender and social inclusion (labour requirements, youth involvement and women friendliness), achieving one-health (pest load reduction, soil nutrient improvement, reducing soil-water pollution, promoting crop-livestock integration, lowers GHG emissions, contributes to lowering incidences of disease to humans, and preserves biodiversity), and addressing end-user friendliness (technical feasibility, and cost effectiveness among male and female end-users). On-farm composting, organic amendment to improving soil fertility, enhanced biopesticide use in potato system, promotion of disease and pest tolerant varieties and vine technology were the top 5 prioritized CSA practices for AICCRA intervention for the Central region. Promotion of disease and pest tolerant maize, cowpea and yam varities, minimum tillage, seedbed options with ridging as an alternative to mounding, water management (mulching), and promotion of drought, early maturing, and striga resistant seed varieties were CSAs prioritized in the Bonno East region. Northern, North-East and Savanna regions of Ghana identified minimum tillage, mucuna pruriens or cowpea/maize intercropping-yam rotation to build soil Carbon stocks, leguminous crops as previous crop to yam and maize, organic amendment for improving soil health, and promotion of stress (drought, early maturing, striga and low N ) tolerant improved maize, cowpea, yam and potato varieties were prioritized. Specifically to the Climate Smart Villages (CSVs), leguminous crops as previous crop to cereals and promotion of disease and pest tolerant seed varieties were simultaneously given high priority. Enhanced biopesticide use in maize, cowpea, potato and vegetable systems, mucuna pruriens or cowpea /maize intercropping to build soil C stocks, minimum tillage for maize and cowpea and vegetable production, water management (mulching) and promotion of stress (drought, early maturing, striga and low N) tolerant improved varieties were prioritized in the Upper West and Upper East regions along maize, cowpea and tomato value chains. Due to the complementary nature of CSA-CIS practices, 5 bundles were created and common products for sustainable financing included improved and drought tolerant seeds, water management (small scale irrigation), seasonal calenders and soil fertility improvement products

Demographic data and diagnostic test results for Buruli ulcer patients.

<p>Demographic data and diagnostic test results for Buruli ulcer patients.</p

Kaplan-Meier analysis of <i>M</i>. <i>ulcerans</i> 16S rRNA in Buruli patients on antibiotic treatment.

<p>Blue line: Median time (weeks) for detection of <i>M</i>. <i>ulcerans</i> 16S rRNA. Red line: Proportion of patients with positive <i>M</i>. <i>ulcerans</i> 16S rRNA at week 4.</p

Comparison of baseline <i>M</i>. <i>ulcerans</i> IS<i>2404</i> in Buruli ulcer patients with a positive or negative 16S rRNA result at week 4.

<p>Comparison of baseline <i>M</i>. <i>ulcerans</i> IS<i>2404</i> in Buruli ulcer patients with a positive or negative 16S rRNA result at week 4.</p