Bacteriological Quality Assessment of swimming pools in the Osu-Labadi Area, Accra

Bacterial contamination of swimming pool water poses public health risks to swimmers and others who come into direct contact with such pools. There has been an increase in the patronage of swimming pools in Ghana for sports and recreation and therefore the need to investigate the pools compliance with sanitary standards. This study examined the bacteriological and physicochemical (pH, temperature and residual chlorine) levels of swimming pool water in Osu-Labadi, Accra, Ghana to determine the levels of bacterial pollution. Six outdoor swimming pools were randomly selected for this cross-sectional study. Microbiological examination was conducted on a total of 18 samples collected monthly in the evening after the pools had been used. This took place over a 3 month period, from March to May 2014, using standard microbiological and analytical methods. The results of the study indicated that the total viable bacteria count of all the pool water exceeded the acceptable limits. All 6 pools were contaminated by E. coli, Enterobacter faecalis and Klebsiella pneumonia, as well, 5 out of the 6 pools were contaminated by Enterobacter cloacae, Staphylococcus aureus, and Streptococcus agalactiae. The residual chlorine level in all the pools was below the recommended level of 1.0 mg/liter. Statistical analysis showed significant association between water contamination with microbial indicators and physicochemical aspects such as pH, temperature and residual chlorine (p<0.05). The high microbial load count and the isolation of pathogenic bacteria from the pools is an indication of the need to improve monitoring by pool health authorities, improve pool disinfection standards and educate swimmers on hygiene before entering pools. Key words: swimming pool, microbial load, residual chlorine, bacterial contaminant

Diagnostic utility of procalcitonin versus C-reactive protein as markers for early-onset neonatal sepsis at Korle-Bu Teaching Hospital

Introduction: Symptoms of sepsis are non-specific among neonates and diagnosis requires a high index of suspicion. The study sought to evaluate the utility of procalcitonin (PCT) versus C-reactive protein (CRP) in diagnosing early-onset neonatal sepsis.Methods: This was a crosssectional study in which neonates admitted to the neonatal intensive care unit, with signs suggesting sepsis were categorized according to an adapted criteria from Tollner's sepsis score and case definition of bloodstream infection as: ''highly probable'', ''probable'' and ''less probable''. Laboratory investigations including blood culture, complete blood count, PCT and CRP levels were done before first antimicrobial drug administration.Results: A total of 62 neonates less than 12 hours postnatal age (0.16-9.82 hours) were recruited. Proportion of neonates with PCT>2 ng/mL was 91% (20/22) in the ''highly probable'' group compared to 31.6% (6/19) in the ''probable group'' (p<0.001). Neonates with CRP>5 mg/L was 54.4% (12/22) in the ''highly probable'' group compared to 26.3% (5/19) in the ''probable group'' (p = 0.07). The receiver operator characteristics for PCT and CRP were; sensitivity (87.5% vrs 50%), specificity (63.0% vrs 72.2%), positive predictive value (44.1% vrs 37.5%) and negative predictive value (93.8% vrs 81.3%), respectively.Conclusion: PCT was a better predictive marker for neonatal sepsis within the first 12 hours of life than CRP in this setting, however, its low specificity relative to CRP suggests that neonates without patent infection are more likely to be incorrectly diagnosed with sepsis using this test.Keywords: Diagnostic marker, neonatal sepsis, predictive value, sensitivity, specificit

The Reliability of Using Vitek 2 Compact System to Detect Extended-Spectrum Beta-lactamase-producing Isolates in Escherichia coli and Klebsiella pneumoniae in Accra, Ghana

Extended-spectrum beta-lactamases (ESBLs) are plasmid-mediated beta-lactamases that are capable of hydrolysing ?-lactams except carbapenems and cephamycins. The global increased prevalence of ESBL-producing bacteria creates an urgent need for laboratory diagnostic methods that will accurately and rapidly identify the presence of ESBL phenotypes in clinical isolates. The Vitek 2 System (bioMérieux, France) is a rapid automated microbiological system used for bacteria and yeast identification, antimicrobial susceptibility testing (AST), resistance mechanism detection and epidemiologic trending and reporting using its advanced expert system. This present work sought to determine the reliability of routinely using Vitek 2 System to accurately and rapidly detect ESBL-producing E. coli and K. pneumoniae in Accra. The ESBL phenotypes for 400 E. coli and K. pneumoniae isolates were determined using the Vitek 2 system and combined disc synergy method. The results were used to determine the sensitivity, specificity, negative predictive value and positive predictive value of the Vitek 2 ESBL test through comparative analysis with the combined disk synergy method which is the reference method recommended by CLSI. The findings of this work indicated that the sensitivity, specificity, positive predictive value and negative predictive value of Vitek 2 system was 98.5%, 98.9%, 99% and 98.5% respectively. Consequently, Vitek 2 system is a reliable semi-automated microbiology system which may be used for routine, accurate and rapid detection of ESBL strains in health facilities in Accra, Ghana. Keywords: Vitek 2 Compact System, Extended spectrum beta-lactamase, bioMérieux, E. coli and K.  pneumoni

Phenotypic Characterization of AmpC beta-lactamase among Cefoxitin Resistant Escherichia coli and Klebsiella pneumoniae Isolates in Accra, Ghana

AmpC ?-lactamases hydrolyze penicillins, cephalosporins and cephamycins and resist inhibition by clavulanate, sulbactam, and tazobactam. Strains with AmpC genes are inherently resistant to multiple agents, making the selection of an effective antibiotic difficult. This present work sought to investigate the occurrence of AmpC beta-lactamases-producing phenotypes in E. coli and K. pneumoniae and their antimicrobial sensitivity profile. Four hundred K. pneumoniae and E. coli non-duplicate isolates were collected and their antibiotic sensitivity testing for cefoxitin and other 16 antibiotics were determined using Vitek 2 Compact System (bioMérieux, Marcy I’Etoile, France).  The isolates resistant to cefoxitin were confirmed as AmpC beta-lactamases-producing phenotypes with disk synergy testing (DST) using cefotaxime or ceftazidime with or without boronic acid. An increase in zone diameter of ?5mm in the presence of boronic acid indicates the presence of AmpC beta-lactamases in the test organism. The results showed that of the 50 cefoxitin resistant isolates screened from 400 bacterial isolates, 5(10%) were AmpC beta-lactamase-producers with 60%, 60%, 60%, 80% and 100% multiply antibiotic resistance in gentamicin, ciprofloxacin, norfloxacin, trimethoprim/sulfamethoxazole and tetracycline respectively. Nitrofurantoin which indicated 100% susceptibility with MIC90 of 32µg/ml may be a therapeutic option especially for non-life-threatening urinary tract infection. Imipenem was the antibiotic of choice with 100% susceptibility rates (MIC90 of ?1µg/ml). Though the insignificant (p>0.05) levels of AmpC beta-lactamase phenotypes may not require routine detection in health facilities, there is the need to implement evolutionary antibiotic administration policies and pragmatic infection control measures in the hospitals.      Keywords: AmpC beta-lactamase, Cefoxitin, ?-lactams, E. coli, K. pneumonia

Phenotypic Determination and Antimicrobial Resistance Profile of Extended Spectrum Beta-lactamases in Escherichia coli and Klebsiella pneumoniae in Accra, Ghana

Extended-spectrum beta-lactamases (ESBLs) are plasmid-mediated beta lactamases commonly found in the Enterobacteriaceae that are capable of hydrolysing ?-lactams except carbapenems and cephamycins. ESBLs confer resistance to several non-ß-lactam antibiotics. ESBL-producing organisms appear susceptible to cephalosporins in vitro using conventional breakpoints but ineffective in vivo. This work sought to determine the occurrence of ESBL in E. coli and K. pneumoniae and their antibiotic resistance profile. Four hundred K. pneumoniae and E. coli non-duplicate isolates were collected at the Central Laboratory of Korle Bu Teaching Hospital and Advent Clinical Laboratories. They were definitively identified and their minimum inhibition concentration and antibiotic sensitivity testing for 17 antibiotics were determined using Vitek 2 Compact System (bioMérieux, Marcy I’Etoile, France).  The isolates were confirmed as ESBL-producing strains using the Combination Disk Synergy Method. The results indicated that 202 (50.5%) of the bacterial isolates were ESBL-producing phenotypes with high resistant to gentamicin, ciprofloxacin, tetracycline and trimethoprim/sulfamethoxazole indicating 82.2%, 79.7%, 70.8% and 97% resistant rates respectively. imipenem and amikacin were the antibiotics of choice with 99% and 94.1% susceptibility rates (MIC90 of ?1µg/ml and 4µg/ml respectively). It is imperative to routinely detect ESBL-phenotypes in health facilities, implement appropriate antibiotic administration policy and infection control measures in the hospitals.   Keywords: Extended Spectrum Beta-lactamase, Antimicrobial Resistance, ?-lactams, K. pneumoniae, E. col

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the Global Burden of Disease Study 2015

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Building capacity for urban management in Ghana: some critical considerations

Abstract Severe capacity gaps continue to constrain e!ective urban management in Ghana, despite numerous donor-supported training programmes. This paper examines the nature of these capacity gaps and analyses speci"cally the factors contributing to the low attraction and retention of local government sta!: politicisation of the bureaucracy, excessive use of external experts, excessive state intervention in skill development and low remuneration of local government sta!. Against this background, the paper reviews critically a recent capacity building initiative: the establishment of the (new) Institute of Local Government Studies in Accra. Suggestions to improve capacity building for urban management in Ghana are o!ered. These include the need to prepare a coherent strategy to guide and co-ordinate stakeholder inputs in capacity building; to place training in the context of institutional development; and encourage the development and use of local expertise in donor assisted projects; and, promote merit-based remuneration of local government sta!

Prevalence of congenital malaria in high-risk Ghanaian newborns: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Congenital malaria is defined as malaria parasitaemia in the first week of life. The reported prevalence of congenital malaria in sub-Saharan Africa is variable (0 - 46%). Even though the clinical significance of congenital malaria parasitaemia is uncertain, anti-malarial drugs are empirically prescribed for sick newborns by frontline health care workers. Data on prevalence of congenital malaria in high-risk newborns will inform appropriate drug use and timely referral of sick newborns.</p> <p>Methods</p> <p>Blood samples of untreated newborns less than 1 week of age at the time of referral to Korle Bu Teaching hospital in Accra, Ghana during the peak malaria seasons (April to July) of 2008 and 2010 were examined for malaria parasites by, i) Giemsa-stained thick and thin blood smears for parasite count and species identification, ii) histidine-rich protein- and lactic dehydrogenase-based rapid diagnosis tests, or iii) polymerase chain reaction amplification of the merozoite surface protein 2 gene, for identification of sub-microscopic parasitaemia. Other investigations were also done as clinically indicated.</p> <p>Results</p> <p>In 2008, nine cases of <it>Plasmodium falciparum</it> parasitaemia were diagnosed by microscopy in 405 (2.2%) newborns. All the nine newborns had low parasite densities (≤50 per microlitre). In 2010, there was no case of parasitaemia by either microscopy or rapid diagnosis tests in 522 newborns; however, 56/467 (12%) cases of <it>P</it>. <it>falciparum</it> were detected by polymerase chain reaction.</p> <p>Conclusion</p> <p>Congenital malaria is an uncommon cause of clinical illness in high-risk untreated newborns referred to a tertiary hospital in the first week of life. Empirical anti-malarial drug treatment for sick newborns without laboratory confirmation of parasitaemia is imprudent. Early referral of sick newborns to hospitals with resources and skills for appropriate care is recommended.</p