Musings on malaria morbidity and mortality after the new Mosquirix® vaccine

There are some facts relating to the new malaria vaccine (Mosquirix® or RTS,S/AS01) recently introduced in Ghana, which need to be more widely known. Contrary to expectations based on mathematical modelling and on the vaccine’s effect on clinical malaria and severe malaria, mortality was not reduced in children receiving the Mosquirix® vaccine in the phase 3 trial.1 This (surprising) result has been attributed to the fact that mortality was reduced in both the vaccinated and unvaccinated children due to better implementation of malaria control measures such as use of bed nets and prompt treatment of malaria.2 The startling implication of thisfinding is that when the existing malaria control measures are implemented more effectively, the vaccine in its current form does not offer any measurable mortality advantages.This means that if there were a willingness to implement malaria control measures intensively, there would be no need to expose our children to the unknown effects of a new vaccine

Admissions and mortality over a 5-year period in a limited-resource neonatal unit in Ghana

Objective: To review admissions and deaths at the neonatal intensive care unit (NICU) of the Korle Bu Teaching Hospital (KBTH), Ghana from 2011 to 2015, for the purposes of documentation of outcomes and identification of areas for improvement.Design: A retrospective descriptive study of NICU Admissions & Discharges from 2011 to 2015. All data in the NICU Admissions & Discharge books were transferred into a spreadsheet and analysed.Setting – The NICU of KBTH provides secondary and tertiary care for premature and critically ill term babies in the southern half of Ghana.Results: Over the 5-year period, 9213 babies were admitted to the NICU. Admission weights ranged from 300 to 6700g with median of 2400g. Overall mortality rate was 19.2%. Mortality rates were progressively and significantly higher in babies with lower admission weights and earlier gestations.Conclusions: We report a high NICU mortality rate of 19.2%, compared to the worldwide range of 3.1% to 29%. This wide range of outcomes is attributable to differences in the severity of illness of patients and to the organisation of resources devoted to obstetric and neonatal care. To substantially improve perinatal and neonatal outcomes, there is a need for wider coverage and better quality of health care; and to consider rationing of care. Complex interventions are necessary to improve outcomes, not just an increase in the allocation of particular resources.Keywords: Intensive Care, Neonatal; developing countries; mortality rateFunding: None declare

Audit of antenatal steroid use in mothers of preterms admitted to a neonatal intensive care unit in Ghana.

Background: Antenatal corticosteroids (ACS) are established as an effective method of reducing preterm morbidity and mortality. At the Korle Bu Teaching Hospital (KBTH), a tertiary referral centre in Ghana, it is recommended that a course of ACS should be given to mothers before delivery between 24 weeks to 34 weeks gestation.Objectives: The study was performed primarily to determine the level of adherence to guidelines on administration of ACS.Methods: All babies with gestational ages up to 34 weeks admitted to the neonatal unit (NICU) during the period of the study were eligible for inclusion.Results: There were 214 eligible admissions during the study period, of which 93 babies (43%) were studied due to poor access to medical records. Dexamethasone was the only steroid used, and mothers of 65 (70%) of the 93 babies received at least one dose; 17 (18%) received only one dose, 35 (38%) - 2 doses, 9 (10%) – 3 doses, and 4 (4%) - 4doses.Conclusions: This study has shown a low uptake of antenatal corticosteroids, similar to other low-income and middle-income countries. To improve preterm survival and morbidity, there is an urgent need to increase the use of corticosteroids before preterm deliveries in Ghana and other low-income and middle-income countries.Funding: Not indicatedKeywords: Antenatal corticosteroids, prematurity, neonatal intensive care, audit, low-income countries

ENERGETIC COST OF RUNNNING STABILITY EVALUATED WITH WIRELESS TRUNK ACCELEROMETRY

The purpose of this study was to determine inter-individual variance in the energetic cost of running (Ec) using dynamic stability measures derived from a single tri-axial trunk accelerometer. These measures were extracted from fifteen male recreational runners at their fastest steady-state treadmill running speed. A select group of dynamic stability measures were entered in a hierarchical regression to explain Ec (kcal.km-1) after reducing dimensionality with factor analysis. Two dynamic stability parameters could explain an additional 9.9% of inter-individual variance in Ec over and above body mass, attributed to anteroposterior (AP) stride regularity (6.5%) and mediolateral (ML) sample entropy (3.4%). Our results suggest that recreational male runners with better stability in terms of greater AP stride consistency and greater ML trunk movement complexity have an energetic advantage at running speeds approximating race pace

Preliminary Study on the Effects of Two Different Sources of Organic Manure on the Growth Performance of Moringa oleifera Seedlings

The study was designed to investigate the effects of application of two sources of organic manure, namely poultry droppings and cow dung manure on the vegetative growth and photosynthetic pigments of Moringa oleifera seedlings. The experimental design was completely randomized design, consisting of 540 seedlings in black polythene bags fertilized with 15 g of organic manure per plant by point application of poultry dropping and cow dung. Thus, each seedling in the treatments received 15 g of either partly decomposed poultry droppings or 15 g of partly decomposed cow dung or none of the manure (ie controls). Seedling height, stem girth, root length and root girth were measured with a metre rule and the aid of a thread. Seedling dry weight and leaf relative water contents were also determined. Photosynthetic pigments were determined by the spectrophotometer technique. The results indicated that both sources of organic manure significantly (p < 0.01) increased growth performance of Moringa oleifera seedlings but the photosynthetic pigments in the leaves were not significantly affected by the effects of both sources of organic manure. The results thus showed that both poultry manure and cow dung are valuable sources of fertilizer for Moringa oleifera seedlings but poultry manure out-performed cow dung in all growth attributes assessed because it produced higher values for all the attributes. However, the values for chlorophyll and carotenoid content did not show clear-cut differences between the two sources of organic manure. It is therefore, recommended that in the event of a choice between the two for crop production in general and Moringa in particular, poultry manure would be a better option. Keywords: Cow dung, Moringa oleifera, Organic manure, Poultry manure, Seedling

Prevalence of red blood cell antibodies among transfused patients at Komfo Anokye teaching (Kath) hospital, Ghana

Red blood cell (RBC) alloimmunisation is a common problem in transfused patients because of the possibility of haemolytic reaction and limited availability of compatible blood. In highincome countries, pre-transfusion antibody screening is performed routinely. In Ghana, patients are transfused with ABO Rh ‘D’ compatible blood without screening for immune antibodies. We therefore studied the prevalence and specificities of RBC antibodies in transfused patients at Komfo Anokye Teaching hospital, Ghana. The study was cross-sectional, involving previously transfused patients who required another transfusion. Participants’ basic data on demography and transfusion history were recorded. Blood samples were screened and subsequently typed for RBC antibodies using a column gel agglutination test. A total of 106 transfused patients, 52 male and 54 females were enrolled. The patients had previously received a median of 4 RBC units (range 1-14). Of these, ten patients (9.4%) had 11 RBC alloantibodies, whose specificities were 2 anti-K; 2 anti-C; one each of anti-D, -E, -M, and -S; and 3 were pan-reactive. The number of transfusion episodes was significantly associated with the rate of alloimmunisation (p=0.000). In conclusion the overall alloimmunisation rate in the study was 9.4% and this was significantly associated with increasing number of transfusion episodes. Antibodies were mainly directed against antigens in the Rhesus system and K antigen. We recommend that antibody screening be incorporated into routine pre-transfusion testing procedures in Ghana. Keywords: Alloimmunisation, multi transfusion, Alloantibod