Typhoid fever among children, Ghana.

Typhoid fever (TF) remains a problem of concern in many low-income countries. Salmonella enterica serovar Typhi causes ≈22,000,000 symptomatic infections and 220,000 fatalities worldwide annually (1). However, the effect and incidence of TF in many parts of subSaharan Africa are largely unknown because diagnostic laboratories are lacking and fatal TF is frequently attributed to malaria (2,3). In Ghana, TF ranks among the leading 20 causes of outpatient illness, accounting for 0.92% of hospital admissions (4). We conducted our study at the rural Agogo Presbyterian Hospital in the Ashanti Region of Ghana. The percentage of residents of 99 villages and household clusters of buildings (population size 18–13,559 persons, median 277 persons) with access to the study hospital was assessed in a healthcare utilization survey. A proportional-to-size number of children were randomly selected in each village, and a standardized interview was conducted. TF incidences were calculated for September 2007–November 2008 (Table). A bacteriology laboratory with BACTEC 9050 automated blood culture system (Becton Dickinson, Sparks, MD, USA) was established in the study hospital and run to assess the number of admissions with TF, the incidence of TF in the adjoining community and S. enterica ser. Typhi resistance to a panel of antimicrobial drugs

No Change in Perceptual or Chronotropic Outcome When Altering Preferred Step Frequency for a Short Duration

IIntroduction: Millions of individuals incorporate jogging into their physical activity routines as a leisurely pursuit and as a way to achieve positive health outcomes. People appear to choose jogging speed and the associated step frequency on pure, natural preference. Understandably, kinesthetics are important, but another important underlying factor is metabolic cost. The purpose of this work was to investigate if preferred step frequency (at a preferred jogging pace) also minimizes perceived effort (Borg Rating of Perceived Exertion, 6-20; RPE) and chronotropic stress (heart rate; HR) during a ten-minute activity bout when compared with step frequencies altered by 5%. Methods: Recreationally-trained male subjects underwent two testing visits. The first visit was used to establish RPE and HR responses during a 10-minute jogging activity at preferred speed and step frequency. On a subsequent visit, between two and four days later, with preferred speed maintained, subjects were guided by metronome to strike at either 95% or 105% of their preferred step frequency. The 10-minute runs were randomized, crossed-over, and separated by 20 minutes. RPE and HR were analyzed by repeated measures ANOVA. Results: Fourteen subjects (age: 21.1 ± 0.95; body mass index: 23.2 ± 2.5) enrolled. Preferred jogging speed (speed. 6.4 ± 1.0 miles per hour; 10.2 ± 1.6 kilometers per hour) and step frequency (steps. 161.2 ± 10.3 steps/minute) were determined at the first visit, along with RPE (11.3 ± 1.7) and HR (166.4 ± 12.7). At the second visit, preferred speed was maintained while the frequency of foot-strike was altered. Neither differences in RPE (p = 0.252; 11.3 ± 1.7, 11.6 ± 1.9, 11.8 ± 1.5) nor HR (p = 0.547; 166.4 ± 12.7, 164.7 ± 14.9, 165.2 ± 15.3) were different when comparing the preferred, 95%, and 105% step frequency trials, respectively. Although anecdotal, some subjects verbalized displeasure with the change in pace and most all appeared to markedly alter the initial foot strike phase of the gait to meet the directed foot strike tempo. Discussion: Our data must be interpreted cautiously. While altering step frequency by 5% for a short duration does not appear to alter an individual’s RPE or HR appreciably, the result during longer duration activity may not be the same. In addition, the implications for biomechanical loading and metabolic cost were not presently investigated

INCIDENCE OF SYMPTOMATIC AND ASYMPTOMATIC \u3ci\u3ePLASMODIUM FALCIPARUM\u3c/i\u3e INFECTION FOLLOWING CURATIVE THERAPY IN ADULT RESIDENTS OF NORTHERN GHANA

Adult residents of holoendemic malaria regions in Africa have a naturally acquired immunity (NAI) to malaria that renders them more resistant to new infections, limits parasitemia, and reduces the frequency and severity of illness. Given such attributes, it is not clear how one might evaluate drug or vaccine efficacy in adults without serious confounding. To determine symptomatic and asymptomatic malaria attack rates in adults of northern Ghana, 197 men and women underwent curative therapy for any pre-existing malaria infections at the start of the high transmission (wet) season. They were monitored for first parasitemia and first clinical episode of infection by Plasmodium falciparum over a 20-week period (May–October 1996). The cumulative incidence of primary infection by P. falciparum was 0.98 and incidence density of infection was calculated to be 7.0 cases/person-year. Symptoms were reported by 19.5% of the individuals at the time of first recurrent parasitemia. Incidence of infection, parasite density, and the frequency of symptoms were comparable in males and females. The results suggest that NAI did not provide these adults with significant defense against rapid re-infection and suggest that this population-infection design could serve to demonstrate the efficacy of a drug or vaccine in preventing parasitemia

Podoconiosis and soil-transmitted helminths (STHs): double burden of neglected tropical diseases in Wolaita zone, rural southern Ethiopia

Background Both podoconiosis and soil-transmitted helminth (STH) infections occur among barefoot people in areas of extreme poverty; however, their co-morbidity has not previously been investigated. We explored the overlap of STH infection and podoconiosis in Southern Ethiopia and quantified their separate and combined effects on prevalent anemia and hemoglobin levels in podoconiosis patients and health controls from the same area. Methods and Principal Findings A two-part comparative cross-sectional study was conducted in Wolaita zone, southern Ethiopia. Data were collected from adult patients presenting with clinically confirmed podoconiosis, and unmatched adult neighborhood controls living in the same administrative area. Information on demographic and selected lifestyle factors was collected using interviewer-administered questionnaires. Stool samples were collected and examined qualitatively using the modified formalin-ether sedimentation method. Hemoglobin level was determined using two different methods: hemoglobinometer and automated hematology analyzer. A total of 913 study subjects (677 podoconiosis patients and 236 controls) participated. The prevalence of any STH infection was 47.6% among patients and 33.1% among controls (p<0.001). The prevalence of both hookworm and Trichuris trichiura infections was significantly higher in podoconiosis patients than in controls (AOR 1.74, 95% CI 1.25 to2.42, AOR 6.53, 95% CI 2.34 to 18.22, respectively). Not wearing shoes and being a farmer remained significant independent predictors of infection with any STH. There was a significant interaction between STH infection and podoconiosis on reduction of hemoglobin level (interaction p value = 0.002). Conclusions Prevalence of any STH and hookworm infection was higher among podoconiosis patients than among controls. A significant reduction in hemoglobin level was observed among podoconiosis patients co-infected with hookworm and ‘non-hookworm STH’. Promotion of consistent shoe-wearing practices may have double advantages in controlling both podoconiosis and hookworm infection in the study area

Choroidal vascularity map in unilateral central serous chorioretinopathy: A comparison with fellow and healthy eyes

Background: To map the choroidal vascularity index and compare two eyes in patients with unilateral central serous chorioretinopathy (CSCR). Methods: This was a retrospective, observa-tional study performed in patients with unilateral CSCR. Choroidal thickness (CT) and Choroidal vascularity index (CVI) were measured and mapped in various zones according to the early treatment diabetic retinopathy (ETDRS) grid. Results: A total of 20 CSCR patients (20 study and 20 fellow eyes) were included in the study. Outer nasal region CT was seen to be significantly lower than central CT (p = 0.042) and inner nasal CT (p = 0.007); outer ring CT was significantly less than central (p = 0.04) and inner ring (p = 0.01) CT in CSCR eyes. On potting all the CVI values against the corresponding CT values, a positive correlation was seen in CSCR eyes (r = 0.54, p &lt; 0.01), which was slightly weaker in fellow eyes (r = 0.3, p &lt; 0.01) and a negative correlation was seen in healthy eyes (r = −0.262, p &lt; 0.01). Conclusions: Correlation between CVI and CT was altered in CSCR eyes as compared to fellow and normal eyes with increasing CVI towards the center of the macula and superiorly in CSCR eyes

Multi-centre point-prevalence survey of hospital-acquired infections in Ghana

Background: There is a paucity of data describing hospital-acquired infections (HAIs) in Africa. Objective: To describe the prevalence and distribution of HAIs in acute care hospitals in Ghana. Methods: Between September and December 2016, point-prevalence surveys were conducted in participating hospitals using protocols of the European Centre for Disease Prevention and Control. Medical records of eligible inpatients at or before 8am on the survey date were reviewed to identify HAIs present at the time of the survey. Findings: Ten hospitals were surveyed, representing 32.9% of all acute care beds in government hospitals. Of 2107 inpatients surveyed, 184 HAIs were identified among 172 patients, corresponding to an overall prevalence of 8.2%. The prevalence values in hospitals ranged from 3.5% to 14.4%, with higher proportions of infections in secondary and tertiary care facilities. The most common HAIs were surgical site infections (32.6%), bloodstream infections (19.5%), urinary tract infections (18.5%) and respiratory tract infections (16.3%). Device-associated infections accounted for 7.1% of HAIs. For 12.5% of HAIs, a micro-organism was reported; the most commonly isolated micro-organism was Escherichia coli. Approximately 61% of all patients surveyed were on antibiotics; 89.5% of patients with an HAI received at least one antimicrobial agent on the survey date. The strongest independent predictors for HAI were the presence of an invasive device before onset of infection and duration of hospital stay. Conclusion: A low HAI burden was found compared with findings from other low- and middle-income countries

Classification of large-scale environments that drive the formation of mesoscale convective systems over southern West Africa

Mesoscale convective systems (MCSs) are frequently observed over southern West Africa (SWA) throughout most of the year. These MCS events are the dominant rain-bearing systems, contributing over 50 % of annual rainfall over SWA. However, it has not yet been identified what variations in typical large-scale environments of the seasonal cycle of the West African monsoon may favour MCS occurrence in this region. Here, nine distinct synoptic states are identified and are further associated with being a synoptic-circulation type of either a dry, transition, or monsoon season using self-organizing maps (SOMs) with inputs from reanalysis data. We identified a pronounced annual cycle of MCS numbers with frequency peaks in April and October that can be associated with the start of rainfall during the major rainy season and the maximum rainfall for the minor rainy season across SWA, respectively. Comparing daily MCS frequencies, MCSs are most likely to develop during transition conditions featuring a northward-displaced moisture anomaly (2.8 MCSs per day), which can be linked to strengthened low-level westerlies. Considering that these transition conditions occur predominantly during the pre- and post-monsoon period, these patterns may in some cases be representative of monsoon onset conditions or a delayed monsoon retreat. On the other hand, under monsoon conditions, we observe weakened low-level south-westerlies during MCS days, which reduce moisture content over the Sahel but introduce more moisture over the coast. Finally, we find a majority of MCS-day synoptic states exhibiting positive zonal wind shear anomalies. Seasons with the strongest zonal wind shear anomalies are associated with the strongest low-level temperature anomalies to the north of SWA, highlighting that a warmer Sahel can promote MCS-favourable conditions in SWA. Overall, the SOM-identified synoptic states converge towards high-moisture and high-shear conditions on MCS days in SWA, where the frequency at which these conditions occur depends on the synoptic state.</p