Coping with life in a squatter settlement: The case of migrant women in Kumasi, Ghana

With inner city migrant enclaves in Kumasi bursting at their seams and unable to accommodate the unending streams of in-migrants, a  large-scale squatter settlement emerged on a disused Race Course to provide alternative shelter and quickly developed income generating opportunities. Its recent development, and the predominance of single-unattached women who were in the past seen as passive movers, provides a special research opportunity. Based on a sample of 100 female  respondents, the research found that this overcrowded, unprotected,  insecure and unsanitary environment was particularly challenging for the women as they coped with issues associated with their unique needs for shelter, safety and security. Contrary to popular perception, the settlement accommodated not only long-distance migrants but also Asantes who traditionally consider Kumasi as their home territory and were therefore expected to have been accommodated by a network of family members in indigenous Asante suburbs. Efforts to reduce their vulnerabilities will involve addressing their special needs through the delivery of affordable rentalunits and commercial space.Keywords: migrant women, coping mechanisms, squatter settlement

Lowered Serum Triglyceride Levels among Chronic Hepatitis B-Infected Patients in Ghana

Dyslipidemia is a common finding in most studies of liver diseases. Little is however known about the effect of the two pathological stages of chronic hepatitis B (CHB) infection – chronicsymptomatic and asymptomatic – on the distribution of serum lipids in CHB infection. We conducted a study on CHB-infected patients attending specialist care at the Gastro-Intestinal (GI) Clinic at the Komfo Anokye Teaching Hospital (KATH) during a 7-month period. 64 participants were randomly sampled over the period. On the basis of serological and liver enzyme assays, participants were categorised as chronic asymptomatic, chronic symptomatic and healthy individuals. The relationship between the hosts pathological stage of infection were evaluated with the indices of lipid metabolism – LDL, HDL, triglyceride, and total serum cholesterol using ANOVA. The 64 volunteers recruited in the study were found to consist of 18 patients (28.1%) who were chronic symptomatic, 35 patients (54.7%) who were chronic asymptomatic hepatitis B, and 11 (17.2%) were healthy subjects. Significant overall male dominance was observed among all categories of population enrolled (p=0.0063). Serum triglyceride levels decreased more among the CHB-infected population compared to the healthy individuals (p=0.0010) with value lowest among the chronic symptomatic population. Basal serum cholesterol, HDL, and LDL were unaffected by the disease. This work reveals that serum triglyceride is significantly lowered in CHB infection and that the extent of this decrease in host is independent of the pathological stage of the infection.Keywords: chronic hepatitis B, lipid metabolism, triglyceride, chronic symptomati

Intermittent Screening and Treatment versus Intermittent Preventive Treatment of Malaria in Pregnancy: A Randomised Controlled Non-Inferiority Trial

BACKGROUND: The effectiveness of intermittent preventive treatment of malaria in pregnancy (IPTp) may be compromised by the spread of resistance to sulphadoxine/pyrimethamine (SP) across Africa. But little information exists on alternative drugs for IPTp or alternative strategies for the prevention of malaria in pregnancy. Therefore, we have investigated whether screening with a rapid diagnostic test and treatment of those who are positive (IST) at routine antenatal clinic attendances is as effective and as safe as SP-IPTp in pregnant women. METHODS AND FINDINGS: During antenatal clinic sessions in six health facilities in Ghana held between March 2007 and September 2007, 3333 pregnant women who satisfied inclusion criteria were randomised into three intervention arms (1) standard SP-IPTp, (2) IST and treatment with SP or (3) IST and treatment with amodiaquine+artesunate (AQ+AS). All women received a long-lasting insecticide treated net. Study women had a maximum of three scheduled follow-up visits following enrollment. Haemoglobin concentration and peripheral parasitaemia were assessed between 36 and 40 weeks of gestation. Birth weight was measured at delivery or within 72 hours for babies delivered at home. Parasite prevalence at enrollment in primigravidae and in multigravidae was 29.6% and 10.2% respectively. At 36-40 weeks of gestation the prevalence of asymptomatic parasitaemia was 12.1% in study women overall and was very similar in all treatment groups. The risk of third trimester severe anaemia or low birth weight did not differ significantly between the three treatment groups regardless of gravidity. IST with AQ+AS or SP was not inferior to SP-IPTp in reducing the risk of low birth weight (RD  =  -1.17[95%CI; -4.39-1.02] for IST-SP vs. SP-IPTp and RD = 0.78[95%CI; -2.11-3.68] for IST-AQAS vs. SP-IPTp); third trimester severe anaemia (RD = 0.29[95%CI; -0.69-1.30] for IST-SP vs. SP-IPTp and RD  =  -0.36[95%CI;-1.12-0.44] for IST-AQAS vs. SP-IPTp). CONCLUSION: The results of this study suggest that in an area of moderately high malaria transmission, IST with SP or AS+AQ may be a safe and effective strategy for the control of malaria in pregnancy. However, it is important that these encouraging findings are confirmed in other geographical areas and that the impact of IST on placental malaria is investigated. TRIAL REGISTRATION: ClinicalTrials.gov NCT00432367 [NCT00432367]

A Sub-Microscopic Gametocyte Reservoir Can Sustain Malaria Transmission

Novel diagnostic tools, including PCR and high field gradient magnetic fractionation (HFGMF), have improved detection of asexual Plasmodium falciparum parasites and especially infectious gametocytes in human blood. These techniques indicate a significant number of people carry gametocyte densities that fall below the conventional threshold of detection achieved by standard light microscopy (LM).To determine how low-level gametocytemia may affect transmission in present large-scale efforts for P. falciparum control in endemic areas, we developed a refinement of the classical Ross-Macdonald model of malaria transmission by introducing multiple infective compartments to model the potential impact of highly prevalent, low gametocytaemic reservoirs in the population. Models were calibrated using field-based data and several numerical experiments were conducted to assess the effect of high and low gametocytemia on P. falciparum transmission and control. Special consideration was given to the impact of long-lasting insecticide-treated bed nets (LLIN), presently considered the most efficient way to prevent transmission, and particularly LLIN coverage similar to goals targeted by the Roll Back Malaria and Global Fund malaria control campaigns. Our analyses indicate that models which include only moderate-to-high gametocytemia (detectable by LM) predict finite eradication times after LLIN introduction. Models that include a low gametocytemia reservoir (requiring PCR or HFGMF detection) predict much more stable, persistent transmission. Our modeled outcomes result in significantly different estimates for the level and duration of control needed to achieve malaria elimination if submicroscopic gametocytes are included.It will be very important to complement current methods of surveillance with enhanced diagnostic techniques to detect asexual parasites and gametocytes to more accurately plan, monitor and guide malaria control programs aimed at eliminating malaria