Bone marrow suppression and severe anaemia associated with persistent Plasmodium falciparum infection in African children with microscopically undetectable parasitaemia

BACKGROUND: Severe anaemia can develop in the aftermath of Plasmodium falciparum malaria because of protracted bone marrow suppression, possibly due to residual subpatent parasites. MATERIALS AND METHODS: Blood was collected from patients with recent malaria and negative malaria microscopy. Detection of the Plasmodium antigens, lactate dehydrogenase (Optimal(®)), aldolase and histidine rich protein 2 (Now malaria(®)) were used to differentiate between patients with (1) no malaria, (2) recent cleared malaria, (3) persistent P. falciparum infection. Red cell distribution width (RDW), plasma levels of soluble transferrin receptor (sTfR) and erythropoietin (EPO) were measured as markers of erythropoiesis. Interleukin (IL) 10 and tumour necrosis factor (TNF)α were used as inflammation markers. RESULTS: EPO was correlated with haemoglobin, irrespective of malaria (R = -0.36, P < 0.001). Persistent P. falciparum infection, but not recent malaria without residual parasites, was associated with bone marrow suppression i.e., low RDW (P < 0.001 vs. P = 0.56) and sTfR (P = 0.02 vs. P = 0.36). TNF-α and IL-10 levels were not associated with bone marrow suppression. CONCLUSION: In the treatment of malaria, complete eradication of parasites may prevent subsequent development of anaemia. Severely anaemic children may benefit from antimalarial treatment if antigen tests are positive, even when no parasites can be demonstrated by microscopy

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&gt;2 ng/mL was 91% (20/22) in the ''highly probable'' group compared to 31.6% (6/19) in the ''probable group'' (p&lt;0.001). Neonates with CRP&gt;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

Complement activation in Ghanaian children with severe Plasmodium falciparum malaria

<p>Abstract</p> <p>Background</p> <p>Severe anaemia (SA), intravascular haemolysis (IVH) and respiratory distress (RD) are severe forms of <it>Plasmodium falciparum </it>malaria, with RD reported to be of prognostic importance in African children with malarial anaemia. Complement factors have been implicated in the mechanism leading to excess anaemia in acute <it>P. falciparum </it>infection.</p> <p>Methods</p> <p>The direct Coombs test (DCT) and flow cytometry were used to investigate the mean levels of RBC-bound complement fragments (C3d and C3bαβ) and the regulatory proteins [complement receptor 1 (CD35) and decay accelerating factor (CD55)] in children with discrete clinical forms of <it>P. falciparum </it>malaria. The relationship between the findings and clinical parameters including coma, haemoglobin (Hb) levels and RD were investigated.</p> <p>Results</p> <p>Of the 484 samples tested, 131(27%) were positive in DCT, out of which 115/131 (87.8%) were positive for C3d alone while 16/131 (12.2%) were positive for either IgG alone or both. 67.4% of the study population were below 5 years of age and DCT positivity was more common in this age group relative to children who were 5 years or older (Odds ratio, OR = 3.8; 95%CI, 2.2–6.7, p < 0.001). DCT correlated significantly with RD (β = -304, p = 0.006), but multiple regression analysis revealed that, Hb (β = -0.341, p = 0.012) and coma (β = -0.256, p = 0.034) were stronger predictors of RD than DCT (β = 0.228, p = 0.061). DCT was also not associated with IVH, p = 0.19, while spleen size was inversely correlated with Hb (r = -402, p = 0.001). Flow cytometry showed similar mean fluorescent intensity (MFI) values of CD35, CD55 and C3bαβ levels on the surfaces of RBC in patients and asymptomatic controls (AC). However, binding of C3bαβ correlated significantly with CD35 or CD55 (p < 0.001).</p> <p>Conclusion</p> <p>These results suggest that complement activation contributed to anaemia in acute childhood <it>P. falciparum </it>malaria, possibly through induction of erythrophagocytosis and haemolysis. In contrast to other studies, this study did not find association between levels of the complement regulatory proteins, CD35 and CD55 and malarial anaemia. These findings suggest that complement activation could also be involved in the pathogenesis of RD but larger studies are needed to confirm this finding.</p

Clinical and laboratory characteristics of children with sickle cell disease on hydroxyurea treated with artemether-lumefantrine for acute uncomplicated malaria

IntroductionLimited information exists on any interactions between hydroxyurea (HU) and antimalarials in sickle cell disease (SCD). We evaluated changes in clinical and laboratory parameters among children with SCD on HU therapy treated with artemether-lumefantrine (AL) for acute uncomplicated malaria (UM).MethodsA prospective, non-randomized, pilot study of 127 children with SCD (23, UM; 104, steady state) were recruited from three hospitals in Accra. UM participants were treated with standard doses of AL and followed up, on days 1, 2, 3, 7, 14, and 28. Venous blood was collected at baseline and follow-up days in participants with UM for determination of malaria parasitaemia, full blood count, reticulocytes, and clinical chemistry. Further, Plasmodium falciparum identification of rapid diagnostic test (RDT) positive samples was done using nested polymerase chain reaction (PCR).ResultsAmong SCD participants with UM, admission temperature, neutrophils, alanine-aminotransferase, gamma-glutamyl-transferase, and haemoglobin significantly differed between HU recipients (HU+) and steady state, while white blood cell, neutrophils, reticulocytes, bilirubin, urea, and temperature differed significantly between non-HU recipients (no-HU), and steady state. Mean parasitaemia (HU+, 2930.3 vs. no-HU, 1,060, p = 0.74) and adverse events (HU+, 13.9% vs. no-HU, 14.3%), were comparable (p = 0.94). Day 28 reticulocyte count was higher in the HU+ (0.24) (0.17 to 0.37) vs. no-HU, [0.15 (0.09 to 0.27), p = 0.022]. Significant differences in lymphocyte [HU+ 2.74 95% CI (−5.38 to 58.57) vs. no-HU −0.34 (−3.19 to 4.44), p = 0.024]; bilirubin [HU+, −4.44 (−16.36 to 20.74) vs. no-HU −18.37 (−108.79 to −7.16)]; and alanine aminotransferase, [HU+, −4.00 (−48.55 to 6.00) vs. no-HU, 7.00 (−22.00 to 22.00)] were observed during follow up.ConclusionParasite clearance and adverse event occurrence were comparable between SCD children treated with AL irrespective of HU status. However, distinct patterns of changes in laboratory indices suggest the need for larger, more focused studies

Techno-economic analysis of a biomass-powered inclined bed dryer for maize drying

The study assessed the technical performance and economic viability of a 200 kg capacity biomass-powered inclined bed dryer for drying maize. The dryer recorded an average air temperature of 73.54˚C in the plenum, which reduced the moisture content from 23.25% (w.b) to 13.61% (w.b) at a drying time of 2 hours 40 minutes. This resulted in a drying rate, drying efficiency, and specific energy consumption of 9.50 kg/h, 71.37%, and 25.70 MJ/kg, respectively. The germination potential of dried maize grains was 80% compared to 93% for grains assessed before drying. Stress-crack analysis revealed a lower percentage of no-cracks for dried maize (71%) than maize gains before drying (98%). There was a statistically significant difference between the dried and the undried maize grains for germination viability (p = 0.01) and stress crack analysis (p = 0.00) at α=0.05. At a drying charge of US$2.4 per 100 kg bag of maize, the investment cost could be regained at a pay-back period of 6 months and 15 operation days and a benefit-cost ratio of 1.27. The drying system is economically viable at net present value of US$ 1313.48 and internal rate of return of 44%. Evidently, adopting the dryer could contribute to reducing post-harvest loss of maize at the smallholder level and increase farmer's income

Electricity Access, Community Healthcare Service Delivery, and Rural Development Nexus: Analysis of 3 Solar Electrified CHPS in Off-Grid Communities in Ghana

Over 600 million people living in sub-Saharan Africa do not have access to electricity. Modern healthcare services, including vaccine refrigeration, which require electricity are therefore lacking in such energy-deprived communities. In this work, analysis has been conducted on how electricity access can help improve healthcare service delivery and rural development, with a case study on 3 different off-grid solar photovoltaic (PV) systems in community-based health planning and services (CHPS) in Ghana. Analysis from this study showed that for the 3.0 kWp solar PV systems installed at the various sites, the in-house electricity consumptions are between 4.30 and 7.58 kWh per day. It was found out that excess electricity generation of 148–304 kWh per month is available and can be used to provide other economic services including phone charging, torchlight battery charging, and small-sized cold storage services to generate income for the maintenance of the systems, which is critical for sustainability of solar PV installations in rural poor communities. The study results also showed that electrified health facilities which are able to provide basic healthcare services have potential impact on community health outcomes and rural development. Assessment conducted at the CHPS compounds revealed that, generally, there is improvement in healthcare service delivery resulting in time savings of 15-43 hours per month for the inhabitants which can potentially be used for productive work. The time savings were more significant in females and children than in males. In many rural agro-based communities in developing countries, female and children are usually the workforce engaged in various farming activities. This paper concludes that access to electricity in CHPS compounds helps to improve community health outcomes and increases time availability for women to engage in productive work that can potentially result in significant socioeconomic activities and rural development

Coconut Wastes as Bioresource for Sustainable Energy: Quantifying Wastes, Calorific Values and Emissions in Ghana

Coconut husks with the shells attached are potential bioenergy resources for fuel-constrained communities in Ghana. In spite of their energy potential, coconut husks and shells are thrown away or burned raw resulting in poor sanitation and environmental pollution. This study focuses on quantifying the waste proportions, calorific values and pollutant emissions from the burning of raw uncharred and charred coconut wastes in Ghana. Fifty fresh coconuts were randomly sampled, fresh coconut waste samples were sun-dried up to 18 days, and a top-lit updraft biochar unit was used to produce biochar for the study. The heat contents of the coconut waste samples and emissions were determined. From the results, 62&ndash;65% of the whole coconut fruit can be generated as wastes. The calorific value of charred coconut wastes was 42% higher than the uncharred coconut wastes. PM2.5 and CO emissions were higher than the WHO 24 h air quality guidelines (AQG) value at 25 &deg;C, 1 atmosphere, but the CO concentrations met the WHO standards based on exposure time of 15 min to 8 h. Thus, to effectively utilise coconut wastes as sustainable bioresource-based fuel in Ghana, there is the need to switch from open burning to biocharing in a controlled system to maximise the calorific value and minimise smoke emissions

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&gt;2 ng/mL was 91% (20/22) in the ''highly probable'' group compared to 31.6% (6/19) in the ''probable group'' (p&lt;0.001). Neonates with CRP&gt;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