Transfusion-transmitted malaria: donor prevalence of parasitaemia and a survey of healthcare workers knowledge and practices in a district hospital in Ghana

Background Transfusion-transmitted malaria (TTM) is a risk of transfusion that has not been well described in malaria endemic regions. The risk of the recipient getting malaria is related to the prevalence of malaria in the blood donors. There is however little information on the prevalence of malaria among donors in Akatsi district of Ghana. Further, the knowledge and practices of healthcare workers to TTM is unknown. The study was undertaken to determine the prevalence of malaria parasite infection among blood donors and to evaluate the knowledge and practices of healthcare workers to TTM in the Akatsi district of Ghana. Methods The study was conducted at Akatsi South District Hospital between May and August 2014. To screen for Plasmodium falciparum, 5 µl of capillary blood was obtained by finger prick from 200 participants (100 donors and 100 healthy controls). Plasmodium falciparum screening was done using CareStart™ Malaria Antigen kit. To obtain information regarding TTM knowledge and practices, questionnaires were completed by 100 health workers including nurses, doctors and laboratory staff. Results The prevalence of P. falciparum was the same (10 %) in both donors and controls. All those who were malaria RDT positive were aged 15–25 years. Out of the 100 healthcare workers (31 males and 69 females) surveyed, 45 % of respondents (45/100) had never heard of transfusion-transmitted malaria. Almost all respondents (91 %) had not attended any lecture/seminar/workshop on blood transfusion in the past 12 months. There were 44 respondents (44 %) who wrongly said malaria was being screened for prior to transfusion in their hospital. However, 98.2 % (54/55) of those who had heard about TTM rightly stated that TTM can be prevented. Conclusion The prevalence of P. falciparum parasitaemia is 10 % in healthy blood donors in the Akatsi district and represents a risk for TTM though the extent of this risk is unclear. Knowledge about TTM in healthcare workers in the district is low. Continuous education and in-service training may be a means to improve TTM knowledge and preventive practices by the health workers in the district

Transfusion-transmitted malaria and bacterial infections in a malaria endemic region

Background and Methods: Blood transfusion saves lives and improves health but the presence of transfusion transmissible infections can have untoward consequences. When undetected, these infections can cause significant morbidity and mortality to transfusion recipients. On the other hand, a high prevalence of transfusion-transmitted infections (TTI) leading to rejection of a large proportion of donated blood can result in blood shortages and subsequent increase in mortality. Malaria and bacterial infections are transfusion transmissible but there is limited data concerning these infections in sub-Saharan Africa. Although the burden of transfusion-transmitted malaria in malaria endemic countries are unknown, it is recommended that all donated blood is screened for malaria parasites and presumptive treatment be given to transfusion recipients. Bacterial contamination in sub-Saharan Africa has been reported to occur in between 8 - 17% of stored blood but the effect of contamination on transfusion recipients has not been determined. Syphilis is currently the only bacterial infection for which routine screening is recommended but screening is not being performed in many blood centres including Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana where this study took place. This study examined the effects of transfusion-transmitted malaria (TTM) and bacterial infections (including syphilis) on transfusion recipients in a malaria endemic area. Four malaria screening tests were compared to assess their usefulness in the context of African blood banks. Pregnant women, children and immune-compromised transfusion recipients from the Departments of Obstetrics and Gynaecology, Paediatrics, Medicine and Oncology in KATH were enrolled into the study. Results: Anti-malarial drugs were routinely prescribed with paediatric transfusions. Fifty patients were evaluated after receiving blood transfusions that were positive for P. falciparum by PCR and seven recipients developed PCR-detectable parasitaemia. In only one recipient (2%) was TTM confirmed. The prevalence of P. falciparum malaria in transfused blood was 4.7% (21/445) by microscopy, 13.7% (60/440) by rapid diagnostic test, 18% (78/436) by polymerase chain reaction and 22.2% (98/442) by enzyme immunoassay. Bacterial contamination was found in 11.5 %( 95% CI 7.0-16.0%) (23/200) of donated blood units but only half of the recipients were observed to developed adverse signs of transfusion related sepsis. The mean duration of storage of blood was 2 days. The prevalence of syphilis sero-positivity in donated blood was 8.0% (95% CI 4.3-11.7%). Seroconversion took place in an 8 year old girl, after receiving a syphilis sero-positive unit of blood. Conclusions: This thesis has shown that malaria parasites may be commonly detected in donor blood but TTM occurs infrequently in recipients living in malaria endemic areas. The high rate of bacterial contamination and its associated transfusion related sepsis poses a safety risk to transfusion recipients. Transfusion-transmitted syphilis remains a risk for transfusion recipients in blood centres with a high prevalence and short duration of storage of donor blood

Developing Relational Work as a Design Tool in activities with health professionals

This poster explores relations that emerge between professionals in different roles in the public health systems in low-and-middle income countries (LMICs) as they engage in activities related to the surveillance of antimicrobial resistance (AMR). It illustrates the potential for a designed learning activity to promote relational expertise among participants based at the same workplace. Grounded in sociocultural theory and leveraging theoretical contributions from the field of professional learning, we draw on qualitative digital data across a period of six months to examine the development of an AMR Toolkit - a set of activities to encourage dialogic reflection about new sets of relations that are needed as work evolves - and the organization of activities that the Toolkit enabled. Analysis of accounts generated by lead participants (written proformas (n=12); interviews (n=11)) across 12 public health organisations in two LMICs reveal how the concept of relational expertise combined with maintaining a view of the new object of activity in the local system serve in the design of an artefact that supports professionals to come to understanding and negotiate wider work arrangements and practices, envision new practices and engage in re-configurations of relational aspects of work

Carbapenem resistance determinants acquired through novel chromosomal integrations in extensively drug-resistant pseudomonas aeruginosa

Two novel blaDIM-1- or blaIMP-1-containing genomic islands (GIs) were discovered by whole-genome sequence analyses in four extensively drug-resistant (XDR) Pseudomonas aeruginosa isolates from inpatients at a tertiary hospital in Ghana. The strains were of sequence type 234 (ST234) and formed a phylogenetic clade together with ST111, which is recognized as a global high-risk clone. Their carbapenem resistance was encoded by two Tn402-type integrons, In1592 (blaDIM-1) and In1595 (blaIMP-1), both carrying complete tni mobilization modules. In1595 was bound by conserved 25-bp inverted repeats (IRs) flanked by 5-bp direct repeats (DRs) associated with target site duplication. The integrons were embedded in two GIs that contained cognate integrases and were distinguished by a lower GC content than the chromosomal average. PAGI-97A (52.659 bp; In1592), which encoded a P4-type site-specific integrase of the tyrosine recombinase family in its 3′ border, was integrated into tRNA-Pro(ggg) and bracketed by a 49-bp perfect DR created by 3′-end target duplication. GIs with the same structural features, but diverse genetic content, were identified in 41/226 completed P. aeruginosa genomes. PAGI-97B (22,636 bp; In1595), which encoded an XerC/D superfamily integrase in its 5′ border, was inserted into the small RNA (sRNA) PrrF1/PrrF2 locus. Specific insertions into this highly conserved locus involved in iron-dependent regulation, all leaving PrrF1 intact, were identified in an additional six phylogenetically unrelated P. aeruginosa genomes. Our molecular analyses unveiled a hospital-associated clonal dissemination of carbapenem-resistant ST234 P. aeruginosa in which the XDR phenotype resulted from novel insertions of two GIs into specific chromosomal sites

Modeling the acceptance and resistance to use mobile contact tracing apps: a developing nation perspective

Purpose: This study proposes and validates an integrated theoretical model involving the theory of planned behavior (TPB), health belief model (HBM), personal norms and information privacy to understand determinants of acceptance and resistance to the use of mobile contact tracing app (MCTA) in a pandemic situation. Design/methodology/approach: This study draws on online surveys of 194 research respondents and uses partial least squares structural equation modeling (PL-SEM) to test the proposed theoretical model. Findings: The study establishes that a positive attitude towards MCTA is the most important predictor of individuals' willingness to use MCTA and resistance to use MCTA. Furthermore, barriers to taking action positively influence resistance to the use of MCTA. Personal norms negatively influence resistance to the use of MCTA. Information privacy showed a negative and positive influence on willingness to use MCTA and use the resistance of MCTA, respectively, but neither was statistically significant. The authors found no significant influence of perceived vulnerability, severity, subjective norms and perceived behavioral control on either acceptance or use resistance of MCTA. Originality/value: The study has been one of the first in the literature to propose an integrated theoretical model in the investigation of the determinants of acceptance and resistance to the use of MCTA in a single study, thereby increasing the scientific understanding of the factors that can facilitate or inhibit individuals from engaging in the use of a protection technology during a pandemic situation. Peer review: The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-10-2021-0533. © 2023, Michael Adu Kwarteng, Alex Ntsiful, Christian Nedu Osakwe and Kwame Simpe Ofori.Horizon Europe (HORIZON) [101071300]; [IGA/FaME/2023/009]; [FSR FORD 5-6/2021-23/FaME/003]; [IGA/FaME/2022/003]; [IGA/FaME/2021/003

Detecting Data Leakage in Cloud Computing Environment (A Case Study of General Hospital Software)

Abstract Generally sensitive data are leaked by users or data entry operators and identifying those operators is paramount and should be done at an early stage to forestall any catastrophe

The impact of sodium contamination in tin sulfide thin-film solar cells

Through empirical observations, sodium (Na) has been identified as a benign contaminant in some thin-film solar cells. Here, we intentionally contaminate thermally evaporated tin sulfide (SnS) thin-films with sodium and measure the SnS absorber properties and solar cell characteristics. The carrier concentration increases from 2 × 10[superscript 16] cm[superscript −3] to 4.3 × 10[superscript17] cm[superscript−3] in Na-doped SnS thin-films, when using a 13 nm NaCl seed layer, which is detrimental for SnS photovoltaic applications but could make Na-doped SnS an attractive candidate in thermoelectrics. The observed trend in carrier concentration is in good agreement with density functional theory calculations, which predict an acceptor-type Na[subscriptSn] defect with low formation energy.United States. Department of Energy (SunShot Initiative, Contract No. DE-EE0005329)National Science Foundation (U.S.) (Grant No. CHE-11115577)Alexander von Humboldt FoundationNational Science Foundation (U.S.). Graduate Research Fellowship ProgramMIT Energy Initiative (Fellowship)United States. Department of Energy. Office of Energy Efficiency and Renewable Energy (Postdoctoral Research Award)National Science Foundation (U.S.) (Award No. DMR-08-19762)National Science Foundation (U.S.). Center for Nanoscale Systems (Award No. ECS-0335765

Pattern of drug utilization for treatment of uncomplicated malaria in urban Ghana following national treatment policy change to artemisinin-combination therapy

<p>Abstract</p> <p>Background</p> <p>Change of first-line treatment of uncomplicated malaria to artemisinin-combination therapy (ACT) is widespread in Africa. To expand knowledge of safety profiles of ACT, pharmacovigilance activities are included in the implementation process of therapy changes. Ghana implemented first-line therapy of artesunate-amodiaquine in 2005. Drug utilization data is an important component of determining drug safety, and this paper describes how anti-malarials were prescribed within a prospective pharmacovigilance study in Ghana following anti-malarial treatment policy change.</p> <p>Methods</p> <p>Patients with diagnosis of uncomplicated malaria were recruited from pharmacies of health facilities throughout Accra in a cohort-event monitoring study. The main drug utilization outcomes were the relation of patient age, gender, type of facility attended, mode of diagnosis and concomitant treatments to the anti-malarial regimen prescribed. Logistic regression was used to predict prescription of nationally recommended first-line therapy and concomitant prescription of antibiotics.</p> <p>Results</p> <p>The cohort comprised 2,831 patients. Curative regimens containing an artemisinin derivative were given to 90.8% (n = 2,574) of patients, although 33% (n = 936) of patients received an artemisinin-based monotherapy. Predictors of first-line therapy were laboratory-confirmed diagnosis, age >5 years, and attending a government facility. Analgesics and antibiotics were the most commonly prescribed concomitant medications, with a median of two co-prescriptions per patient (range 1–9). Patients above 12 years were significantly less likely to have antibiotics co-prescribed than patients under five years; those prescribed non-artemisinin monotherapies were more likely to receive antibiotics. A dihydroartemisinin-amodiaquine combination was the most used therapy for children under five years of age (29.0%, n = 177).</p> <p>Conclusion</p> <p>This study shows that though first-line therapy recommendations may change, clinical practice may still be affected by factors other than the decision or ability to diagnose malaria. Age, diagnostic confirmation and suspected concurrent conditions lead to benefit:risk assessments for individual patients by clinicians as to which anti-malarial treatment to prescribe. This has implications for adherence to policy changes aiming to implement effective use of ACT. These results should inform education of health professionals and rational drug use policies to reduce poly-pharmacy, and also suggest a potential positive impact of increased access to testing for malaria both within health facilities and in homes.</p

Public perceptions on the use of antibiotics at a market place in Kumasi, Ghana: A cross-sectional study

Background: Ghana launched its National Action Plan (NAP) to curb the spread of AMR in 2017. The current study was designed to gather data on the public perception concerning antibiotic use by surveying a population at Kejetia market in Kumasi with the aim of informing the design and implementation of public health campaigns linked to the NAP in Ghana. Method: A cross sectional study was conducted at the Kejetia market in Kumasi, Ghana between November 2017 and January 2018. Participants were adults over 18 years of age and data were gathered via a questionnaire regarding participants’ perceptions on the acquisition, use and disposal of antibiotics. Results: The number of participants was 302 of which nearly 60% were female. Statistically significant associations were identified between gender and level of education (p<0.05, Fisher’s exact test). Amoxicillin and metronidazole were the most commonly used antibiotics. Females were three times more likely to use these agents for diarrhoea than males and more likely to purchase them from non-pharmacy outlets and market pedlars. Conclusion: This study shows access to and the and misuse of antibiotics without prescriptions amongst this surveyed population. Antibiotics were also used more by females and by people with a lower level of education. This research highlights antibiotic misuse within a target population that needs addressing by implementation of the NAP

Impact of Inconsistent Policies for Transfusion-Transmitted Malaria on Clinical Practice in Ghana

Background: Policies concerning the prevention of transfusion transmitted malaria (TTM) are the responsibility of blood transfusion services and malaria control programmes. To prevent spreading drug resistance due to over-use of malaria drugs, recent malaria treatment guidelines recommend prompt parasitological confirmation before treatment is started. In contrast, blood safety policies from the World Health Organisation (WHO) recommend presumptive malaria treatment for recipients of blood in endemic countries but evidence supporting this approach is lacking. Our study documented how these conflicting policies relating to malaria transmission through blood transfusion impact on clinical practice in a teaching hospital in West Africa. Methods/Principal Findings: We randomly selected and reviewed case notes of 151 patients within 24 hours of their receiving a blood transfusion. Transfusion practices including the confirmation of diagnosis and anti-malarial treatment given were compared across three departments; Obstetrics and Gynaecology (O&amp;G), Paediatrics and Medicine. Overall, 66 (44%) of patients received malaria treatment within 24 hrs of their blood transfusion; of which only 2 (3%) received antimalarials based on a laboratory confirmation of malaria. Paediatric patients (87%) received the most anti-malarials and only 7 % and 24 % of recipients in medicine and O&amp;G respectively received anti malarials. In 51 patients (78%), the anti-malarials were prescribed at the same time as the blood transfusion and anti-malarials prescriptions exceeded the number of patient