Water Handling And Hygiene Practices On The Transmission Of Diarrhoeal Diseases And Soil Transmitted Helminthic Infections In Communities In Rural Ghana

In Ghana, diarrhoeal diseases have been identified as the second commonest health problem treated in outpatient clinics. In this study, the relevance of water handling and hygienic practices on the transmission of diarrhoeal diseases and soil-transmitted helminthic infections in three communities in Ghana was evaluated. Specifically, the research looked at physico-chemical qualities of household water, the incidence of diarrhoeal diseases and soil-transmitted helminthic infections. Thirty households were selected by the systematic random sampling technique from the three communities namely Mayera, Ashongman village and Tetegu. Within each household, domestic water was collected and transported to the laboratory for physico-chemical testing. Standardized questionnaires were also administered. The questionnaires addressed issues such as water storage, treatment and hygienic practices among households. The incidence of diarrhoeal diseases and soil transmitted helminthic (STH) infections among households were also assessed. The commonest water sources included pipe-borne water, borehole, rainwater and water from rivers. Most households in the three communities did not treat their water before use. The commonest water storage containers included barrels without lids, pots and plastic containers. There was no significant correlation between STH and diarrhoeal diseases at both Mayera and the Ashongman communities (R=0.279, p=0.136 for Mayera; R=0.311, p=0.094 for Ashongman). However, there existed a weak significantly positive correlation between the incidences of diarrhoeal diseases and the incidence of STH at the Tetegu community (R=0.384, p=0.036). Health education in the aspect of proper hand washing with soap under running water should be intensified in the three communities. Keywords: diarrhoeal disease, water handling, hygiene, soil transmitted helminth, water qualit

Cytokine response to selected MTB antigens in Ghanaian TB patients, before and at 2 weeks of anti-TB therapy is characterized by high expression of IFN-gamma and Granzyme B and inter- individual variation

Background: There has been a long held belief that patients with drug-susceptible TB are non-infectious after two weeks of therapy. Recent microbiological and epidemiological evidence has challenged this dogma, however, the nature of the Mtb-specific cellular immune response during this period has not been adequately investigated. This knowledge could be exploited in the development of immunological biomarkers of early treatment response. Methods: Cellular response to four Mtb infection phase-dependent antigens, ESAT-6/CFP-10 fusion protein and three DosR encoded proteins (Rv1733c, Rv2029c, Rv2628) were evaluated in a Ghanaian TB cohort (n=20) before and after 2 weeks of anti TB therapy. After 6-days in vitro stimulation, Peripheral blood mononuclear cell (PBMC) culture supernatant was harvested and the concentration of IFN-gamma, Granzyme B, IL-10, IL-17, sIL2R alpha and TNF-alpha were determined in a 6-plex Luminex assay. Frequencies of IFN-gamma + CD4 and CD8 T cells were also determined in an intracellular cytokine assay. Results: All antigens induced higher levels of IFN-gamma, followed by Granzyme B, TNF-alpha and IL-17 and low levels of IL-10 and sIL-2R-alpha in PBMC before treatment and after 2 weeks of treatment. Median cytokine levels of IFN-gamma, Granzyme B, IL-17 and sIL-2R-alpha increased during week two, but it was significant for only Rv1733-specific production of Granzyme B (P = 0.013). The median frequency of antigen specific IFN-gamma + CD4 T cells increased at week two; however, only the increase in the ESAT-6/CFP-10-specific response was significant (P = 0.0008). In contrast, the median frequency of ESAT-6/CFP-10-specific IFN-gamma + CD8 T cell responses declined during week two (P = 0.0024). Additionally, wide inter-individual variation with three distinct patterns were observed; increase in all cytokine levels, decrease in all cytokine levels and fluctuating cytokine levels after 2 weeks of treatment. Conclusion: The second week of effective chemotherapy was characterized by a general increase in cytokine response to Mtb-specific antigens suggestive of an improvement in cellular response with therapy. However, the wide inter-individual variation observed would limit the utility of cytokine biomarkers during this period

Farm-related determinants of food insecurity among livestock dependent households in two agrarian districts with varying rainfall patterns in Ghana

Background: Despite availability of sufficient arable land, many African countries continue to dawdle in agricultural productivity due to over-reliance on rainfall patterns. Thus, undernourishment levels are disproportionately high in Africa. Even though they play key roles in agricultural production, the food security (FS) levels of livestock dependent households are understudied. Our study assessed the FS level and its determinants in livestock farming households in Ghana. Methods: We compared the FS levels of 287 cattle producing households in two representative agrarian districts with varying rainfall patterns in Ghana (dry vs. wet), using a cross-sectional survey. We assessed household's FS using the Food Insecurity Experience Scale. FS scores and categories were computed, and using generalized linear models, we assessed factors that explained variations in the FS levels among households. Results: The median herd size of households was 31 cattle (lower quartile = 24, upper quartile = 60 cattle), with a majority (91%) engaged in crop cultivation. Households reported experiencing an average of eight adverse events over a five-year recall period (2014–2018) mainly from animal diseases, cattle theft, and pasture shortages. Most households (81%) were food insecure (moderate = 40%, severe = 41%). In an adjusted model, households raising cattle in the dry district [adjusted Odds Ratio (aOR) = 5.43, 95% CI: 1.94, 15.2] and being married (aOR = 9.48, 95% CI: 2.35, 38.3) were associated with moderate food insecurity. While households raising cattle in the dry district [adjusted Odds Ratio (aOR) = 4.17, 95% CI: 1.44, 12.0], being married (aOR = 3.55, 95% CI: 1.03, 12.2), and increase in number of adverse events experienced (aOR = 1.53, 95% CI: 1.20, 1.96), were associated with increased odds of severe food insecurity. Household's odds of severe food insecurity decreased with each additional head of cattle in their herds (aOR = 0.97, 95% CI: 0.96, 0.99). We find no evidence of effect modification by farming district on other predictor's effect on food insecurity. Conclusion: Most of the livestock dependent households are food insecure. The food insecurity levels are worse for households farming in dry areas, those married and who experience increased frequency of adverse events. Government policy interventions focusing on maintaining healthy, secure, and productive animal herds would contribute to improving the productivity of household herds, food safety and food security

Poor mental health of livestock farmers in Africa: a mixed methods case study from Ghana.

BACKGROUND: Agriculture represents the mainstay of African economies and livestock products are essential to the human population's nutritional needs. However, in many developing countries, including Ghana, livestock production fails to meet demand due to population growth and negative effects of climate change. One of the challenges to production is livestock loss affecting farmers. However, despite stressful events experienced, livestock farmers' mental health is poorly documented. This study aims to identify the root causes of livestock losses and their influence on pastoralists' mental health. METHODS: We conducted a mixed methods study in two districts in the Northern and Southern Belts of Ghana. Using the Depression Anxiety and Stress Scale-21 and guided interviews, we collected quantitative and qualitative data from 287 livestock farmers and 24 key-informants respectively. Mental health scores were categorized using standard guidelines. We evaluated the factors that explained variations in mental wellbeing using general linear models (α = 0.05). RESULTS: About 85% (240/287) of the livestock farmers lost cattle within 1 year. Of these, 91% lost cattle to animal diseases, 50% to theft and 27% to pasture shortages. Qualitative findings reveal that due to poor access to veterinary services, farmers treat livestock diseases themselves with drugs from unregulated sources and often sell diseased cows for meat to recover losses. Findings showed that 60% of livestock farmers had poor mental health. Of those, 72% were depressed, 66% anxious and 59% stressed. Mental wellbeing was negatively associated with the number of adverse events experienced, proportion of livestock lost to most of the major loss factors, emotional attachment to livestock and self-reported physical illnesses in farmers, but positively associated with increasing herd size [F (8,278) = 14.18, p < 0.001, R2 = 0.29]. CONCLUSIONS: Livestock diseases are the leading cause of losses to livestock farmers, whose mental wellbeing is negatively affected by these losses. Although an adaptive strategy by farmers to compensate for poor veterinary services, the arbitrary use of veterinary drugs and sale of diseased cattle pose health risks to the public. Further research to evaluate the performance of veterinary services in Ghana, mental health problems and risk to human health due to potential high-risk meat entering the food chain, is needed

A tuberculin skin test survey among Ghanaian school children

Ghana has not conducted a national tuberculin survey or tuberculosis prevalence survey since the establishment of the National Tuberculosis Control Programme. The primary objective of this study was therefore to determine the prevalence of tuberculin skin sensitivity in Ghanaian school children aged 6-10 years in 8 out of 10 regions of Ghana between 2004 and 2006. Tuberculin survey was conducted in 179 primary schools from 21 districts in 8 regions. Schools were purposively selected so as to reflect the proportion of affluent private and free tuition public schools as well as the proportion of small and large schools. Of the 24,778 children registered for the survey, 23,600 (95.2%) were tested of which 21,861 (92.6%) were available for reading. The age distribution showed an increase in numbers of children towards older age: 11% of the children were 6 years and 25%, 10 years. Females were 52.5% and males 47.5%. The proportion of girls was higher in all age groups (range 51.4% to 54.0%, p < 0.001). BCG scar was visible in 89.3% of the children. The percentage of children with a BCG scar differed by district and by age. The percentage of children with a BCG scar decreased with increasing age in all districts, reflecting increasing BCG vaccination coverage in Ghana in the last ten years. The risk of tuberculosis infection was low in the northern savannah zones compared to the southern coastal zones. Using a cut-off of 15 mm, the prevalence of infection ranged from 0.0% to 5.4% and the Annual Risks of Tuberculosis Infection 0.0% to 0.6%. There was an increase in the proportion of infected children after the age of 7 years. Children attending low and middle-class schools had a higher risk of infection than children attending upper-class schools. Tuberculosis infection is still a public health problem in Ghana and to monitor the trend, the survey needs to be repeated at 5 years interva

Genome sequence of Mycobacterium yongonense RT 955-2015 isolate from a patient misdiagnosed with multidrug-resistant tuberculosis: First clinical detection in Tanzania

Background: Mycobacterium yongonense is a recently described novel species belonging to Mycobacterium avium complex, which is the most prevalent aetiology of non-tuberculous mycobacteria associated with pulmonary infections, and poses tuberculosis diagnostic challenges in high-burden, resource-constrained settings. Methods: Whole genome shotgun sequencing and comparative microbial genomic analyses were used to characterize the isolate from a patient diagnosed with multidrug-resistant tuberculosis (MDR-TB) after relapse. Results: The genome sequence of the first case of M. yongonense (M. yongonense RT 955-2015) in Tanzania is presented. Sequence analysis revealed that the RT 955-2015 strain had a high similarity to M. yongonense 05-1390(T) (98.74%) and Mycobacterium chimaera DSM 44623(T) (98%). Its 16S rRNA showed similarity to Mycobacterium paraintracellulare KCTC 290849(T) (100%), Mycobacterium intracellulare ATCC 13950(T) (100%), M. chimaera DSM 44623(T) (99.9%), and M. yongonense 05-1390(T) (98%). The strain exhibited a substantially different rpoB sequence to that of M. yongonense 05-1390 (95.16%), but closely related to that of M. chimaera DSM 44623(T) (99.86%), M. intracellulare ATCC 13950(T), (99.53%), and M. paraintracellulare KCTC 290849(T) (99.53%). Conclusions: In light of the OrthoANI algorithm and phylogenetic analysis, it was concluded that the isolate was M. yongonense Type II genotype, which is an indication that the patient was misdiagnosed with TB/MDR-TB and received inappropriate treatment. (C) 2018 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Relationship between animal health and livestock farmers’ wellbeing in Ghana: beyond zoonoses

Introduction: Livestock production is a key livelihood source for many people in developing countries. Poor control of livestock diseases hamper livestock productivity, threatening farmers’ wellbeing and food security. This study estimates the effect of livestock mortalities attributable to disease on the wellbeing of livestock farmers. Methods: Overall, 350 ruminant livestock farmers were randomly selected from three districts located in the north, middle and southern belts of Ghana. Mixed-effect linear regression models were used to estimate the relationship between animal health and farmer wellbeing. Farmer wellbeing was assessed using the WHOQOL-BREF tool, as the mean quality-of-life in four domains (physical, psychological, social, and environmental). Animal health was assessed as annual livestock mortalities to diseases adjusted for herd size, and standardized in tropical livestock units to account for different ruminant livestock species. We adjusted for the potential confounding effect of farmers’ age, sex, educational attainment, farmland size, socio-economic status, perception of disease risk to herd, satisfaction with health, previous experience of disease outbreaks in herds, and social support availability by including these as fixed effects, and community as random effects, in a pre-specified model. Results: Our results showed that farmers had a median score of 65.5 out of 100 (IQR: 56.6 to 73.2) on the wellbeing scale. The farmers’ reported on average (median) 10% (IQR: 0 to 23) annual herd mortalities to diseases. There was a significantly negative relationship between increasing level of animal disease-induced mortality in herds and farmers’ wellbeing. Specifically, our model predicted an expected difference in farmers’ wellbeing score of 7.9 (95%CI 1.50 to 14.39) between a farmer without any herd mortalities to diseases compared to a (hypothetical) farmer with 100% of herd mortalities caused by diseases in a farming year. Thus, there is a reduction of approximately 0.8 wellbeing points of farmers, for the average of 10% disease-induced herd mortalities experienced. Conclusions: Disease-induced livestock mortalities have a significant negative effect on farmers’ wellbeing, particularly in the physical and psychological domains. This suggests that veterinary service policies addressing disease risks in livestock, could contribute to improving the wellbeing of livestock dependent populations, and public food security

Multiplex Recombinase Polymerase Amplification Assay for Simultaneous Detection of Treponema pallidum and Haemophilus ducreyi in Yaws-Like Lesions

Yaws is a skin debilitating disease caused by Treponema pallidum subspecies pertenue with most cases reported in children. World Health Organization (WHO) aims at total eradication of this disease through mass treatment of suspected cases followed by an intensive follow-up program. However, effective diagnosis is pivotal in the successful implementation of this control program. Recombinase polymerase amplification (RPA), an isothermal nucleic acid amplification technique offers a wider range of differentiation of pathogens including those isolated from chronic skin ulcers with similar characteristics such as Haemophilus ducreyi (H. ducreyi). We have developed a RPA assay for the simultaneous detection of Treponema pallidum (T. pallidum) and H. ducreyi (TPHD-RPA). The assay demonstrated no cross-reaction with other pathogens and enable detection of T. pallidum and H. ducreyi within 15 min at 42 °C. The RPA assay was validated with 49 clinical samples from individuals confirmed to have yaws by serological tests. Comparing the developed assay with commercial multiplex real-time PCR, the assay demonstrated 94% and 95% sensitivity for T. pallidum and H. ducreyi, respectively and 100% specificity. This simple novel TPHD-RPA assay enables the rapid detection of both T. pallidum and H. ducreyi in yaws-like lesions. This test could support the yaws eradication efforts by ensuring reliable diagnosis, to enable monitoring of program success and planning of follow-up interventions at the community level

Using 16s rRNA sequencing to characterize the microbiome of tropical cutaneous ulcer disease: insights into the microbial landscape and implications for diagnosis and treatment.

Cutaneous ulcers are common in yaws-endemic areas. Although often attributed to 'Treponema pallidum subsp. pertenue' and Haemophilus ducreyi, quantitative PCR has highlighted a significant proportion of these ulcers are negative for both pathogens and are considered idiopathic. This is a retrospective analysis utilising existing 16S rRNA sequencing data from two independent yaws studies that took place in Ghana and the Solomon Islands. We characterized bacterial diversity in 38 samples to identify potential causative agents for idiopathic cutaneous ulcers. We identified a diverse bacterial profile, including Arcanobacterium haemolyticum, Campylobacter concisus, Corynebacterium diphtheriae, Staphylococcus spp. and Streptococcus pyogenes, consistent with findings from previous cutaneous ulcer microbiome studies. No single bacterial species was universally present across all samples. The most prevalent bacterium, Campylobacter ureolyticus, appeared in 42% of samples, suggesting a multifactorial aetiology for cutaneous ulcers in yaws-endemic areas. This study emphasizes the need for a nuanced understanding of potential causative agents. The findings prompt further exploration into the intricate microbial interactions contributing to idiopathic yaw-like ulcers, guiding future research toward comprehensive diagnostic and therapeutic strategies