Loa loa encephalopathy temporally related to ivermectin administration reported from onchocerciasis mass treatment programs from 1989 to 2001: implications for the future

Of the 207 Serious Adverse Events (SAEs) following treatment with Mectizan® (ivermectin, Merck, Sharpe & Dohme) that were reported from 1989 to 2001 through the passive SAE surveillance system required of all onchocerciasis mass treatment programs, 65 were cases of 'Probable' or 'Possible' Loa loa Encephalopathy temporally Related to treatment with Mectizan® (PLERM)

Serious adverse events following treatment with ivermectin for onchocerciasis control: a review of reported cases

This paper presents a summary of reported cases of Serious Adverse Events (SAEs) following treatment with Mectizan® (ivermectin, Merck, Sharpe & Dohme) in onchocerciasis mass treatment programs from January 1, 1989 to December 31, 2001 through a passive surveillance system. A total of 207 SAE cases were reported out of approximately 165 million reported treatments delivered during the period under review, giving rise to a cumulative incidence of 1 reported SAE per 800,000 reported treatments. The mean age was 40 years and 70% of the cases were males. The mean time between ivermectin intake and onset of illness was 1 day. For 57% of the cases (n = 118), that was their first exposure to ivermectin. The majority of cases were reported from Cameroon (n = 176; 85%) with peaks in the incidence of SAE reporting in 1989–1991 and 1994–1995 when the program expanded to ivermectin-naïve populations. Fifty-five percent of the cases from Cameroon (i.e. 97 out of 176 cases) were encephalopathic and were reported from the central-southern region of the country; two-thirds of these cases were 'probable' or 'possible' cases of Loa loa encephalopathy temporally related to ivermectin treatment. Reporting bias may explain some but not all of the differences in SAE reporting between the 34 onchocerciasis-endemic countries that have, or have had, mass treatment programs. Further research is needed to understand the apparent clustering of encephalopathy cases in central-southern Cameroon since L. loa infection alone probably does not explain the increased incidence of this type of SAE from this region

Alumni Perceptions of Their Alma Mater of a Public University in Ghana

The purpose of the study was to examine alumni perceptions of their alma mater, thus University of Education, Winneba – Kumasi Campus (UEW-K) in Ghana. The study was a cross-sectional survey of 750 respondents using structured questionnaire personally administered. A usable 408 questionnaire were returned, representing 54.5% response rate and analysed using SPSS Version 20.0. The study found six (6) items highly rated by the alumni as activities carried out by their alma mater, with the highest being academic programs. Additionally, the alumni rated highly four (4) items they perceived as values they received from the university, with the highest being the qualification they obtained from the university. Furthermore, three (3) items were highly rated by the alumni as their willingness to give to their alma mater, with the highest being the desire to give. Recommendations are also made to management of the university to put in place the necessary measures to improve their activities. This paper contributes to the body of knowledge in the area of management and administration in higher education. Keywords: Alma Mater, Alumni, Giving, Higher Education, Management, Perception, Universit

Sustaining the multi-stakeholder dialogue process for dams and development: final report of phase 2 of the Ghana Dams Forum, April 2007-March 2008

Dams / Development projects / National planning / Climate change / Policy / Social impact / Meetings / Group communication / Ghana / Volta Basin / Bui Dam

Terminating childhood: dissonance and synergy between global children’s rights norms and local discourses about the transition from childhood to adulthood in Ghana

Much has been written about the dissonance that exists between children’s rights standards and the reality of children’s lives in the Global South. What has received less attention, however, is the fact these laws are being implemented in countries affected by global social change and the legacy of historical developments. Therefore, this article seeks to move beyond a focus on the dissonance between global children’s rights norms and local realities and instead, explore the extent to which it is possible to identify both distinctions and commonalities in conceptualizations of childhood between local and global discourses with a focus on Ghana

Tackling the Physical Punishment of Children in Resource Poor Contexts: The Utility of a Community Starting Point Approach for Action and Intervention in Children’s Rights Programming

Despite the global wind of change in public attitudes towards the physical punishment of children, partly influenced by the 1989 Convention on the Rights of the Child, the practice remains prevalent in diverse societies. This implies that current efforts are limited as strategies to initiate behaviour change, especially in societies where, the practice is not only condoned, but also where governments lack the capacity, largely as a result of resource scarcity, to enforce legislation. Therefore, this article proposes an alternative approach which foregrounds using the starting point of communities as a more effective strategy to protect children’s rights in such socio-economic contexts. Focusing predominately on sub-Saharan Africa, this paper outlines the rationale for the continuing prevalence of the physical punishment of children before exploring the utility of approaches that take community perspectives as their point of departure for action and intervention and analysing the importance of dialogue to this process

Antibiotic Resistance Profile of Non-Extended Spectrum Beta-Lactamase-producing Escherichia coli and Klebsiella pneumoniae in Accra, Ghana

One of the major challenges facing health professionals is the prevalence of antibiotic resistance. Most Gram-negative bacteria produce beta-lactamases which are enzymes that in-activate ?-lactams. Recent publications suggested that extended spectrum beta-lactamase production in E. coli and K. pneumoniae is one of the main causes of antimicrobial resistance in penicillins, cephalosporins and some non-beta-lactam antibiotics in Accra. This present work sought to determine the resistance profile of antimicrobials to non-ESBL-producing isolates in Accra. The 400 K. pneumoniae and E. coli isolates were screened for non-ESBL-producing strains using the combined disk method. The minimum inhibition concentration for 17 antibiotics was determined using Vitek 2 Compact System (bioMérieux, Marcy I’Etoile, France).  Among the 400 total bacterial isolates, 198 (49.5%) were non-ESBL producers. Co-resistances to ampicillin (66.7%), piperacillin (59.1%), tetracycline (77.8%) and trimethoprim/sulphamethoxazole (68.2%) have been collaborated in this work. The increasing rise in resistance to the beta-lactam/beta-lactamase inhibitor combination antibiotics such as amoxicillin/clavulanic acid (13.6%) and piperacillin/tazobactam (18.7%) is problematic since they have become the empirical drug of choice for treating most infections. The steady increase in resistance to gentamicin (17.2%) as well as the floroquinolones such as ciprofloxacin (39.4%) and norfloxacin (34.9%) is alarming. In the absence of ESBLs, cephalosporins generally have been effective in treating infections caused by enterobacteria. Nitrofurantoin remains reliable for managing non-life threatening urinary tract infections. Amikacin and imipenem continue to be effective third-line treatment options for Gram-negative bacteria infections.  As antibiotic resistance increases and the development of new antimicrobials declines, it is imperative that we use antimicrobials that are still effective rationally. Evidence based antibiotic prescriptions and usage as well as regular evaluation of antibiotic resistance will help to control the spread of antibiotic resistance in Accra, Ghana. Keywords: Extended spectrum beta-lactamase, Resistance, Antibioti

Antibiotic Resistance Profile of CTX-M-type Extended-Spectrum Beta-Lactamases in Escherichia coli and Klebsiella pneumoniae in Accra, Ghana

Extended-spectrum beta-lactamases (ESBLs) are plasmid-mediated beta lactamases that are capable of hydrolysing beta-lactams except carbapenems and cephamycins. The most common ESBL types include CTX-M, TEM and SHV. This genetic diversity in the various ESBL-producing organisms may reflect characteristic differences in relation to pathogenesis, antibiotic resistance expression, response to therapy, transmission and infection control. This work sought to determine the characteristic antibiotic minimum inhibition concentrations (MICs) and antimicrobial sensitivity profile of CTX-M-type ESBLs in Accra. Hundred (100) DNA templates were extracted from ESBL-producing K. pneumoniae and E. coli isolates. The specific ESBL types were determined by polymerase chain reaction with specific primers and reaction conditions. The MICs of the antibiotics were determined using Vitek 2 Compact System (bioMérieux, Marcy I’Etoile, France). The results showed that CTX-M-type ESBL have cefotaxime MIC in the resistant range of >64 µg/ml. The CTX-M-type ß-lactamases showed co-resistances to gentamicin (88.6%), tetracycline (71.4%), trimethoprim-sulphamethoxazole (98.6%).The resistance of CTX-M-type ESBL producing organisms to fluoroquinolones have been well established in this work with resistances in ciprofloxacin (71.4%) and norfloxacin (71.4%) with MIC90 being >4 µg/ml and >16 µg/ml respectively. The beta-lactam-beta-lactamase inhibitor combination of piperacillin-tazobactam was more susceptible to CTX-M-type ESBL than amoxicillin-clavulanate. Imipenem and amikacin has been established as the in vitro drug of choice for the management of organisms producing CTX-M-type ESBL in this present work. Efforts should be made to control the increasing prevalence of CTX-M-type producing organisms in the communities and hospital settings in Accra with their adverse multiple-drug resistance. Keywords: Extended spectrum beta-lactamase, CTX-M-type ESBL, Resistance, Antibiotics

The Mectizan(® )Donation Program – highlights from 2005

Through the Mectizan(® )Donation Program, Merck & Co., Inc. has donated Mectizan (ivermectin, MSD) for the treatment of onchocerciasis worldwide since 1987. Mectizan has also been donated for the elimination of lymphatic filariasis (LF) since 1998 in African countries and in Yemen where onchocerciasis and LF are co-endemic; for LF elimination programs, Mectizan is co-administered with albendazole, which is donated by GlaxoSmithKline. The Mectizan Donation Program works in collaboration with the Mectizan Expert Committee/Albendazole Coordination, its scientific advisory committee. In 2005, a total of 62,201,310 treatments of Mectizan for onchocerciasis were approved for delivery via mass treatment programs in Africa, Latin America, and Yemen. Seventy-seven percent and 20% of these treatments for onchocerciasis were for countries included in the African Programme for Onchocerciasis Control (APOC) and the former-Onchocerciasis Control Programme in West Africa (OCP), respectively. The remaining 3% of treatments approved were for the six onchocerciasis endemic countries in Latin America, where mass treatment is carried out twice-yearly with the goal of completely eliminating morbidity and eventually transmission of infection, and for Yemen. All 33 onchocerciasis endemic countries where mass treatment with Mectizan is indicated have ongoing mass treatment programs. In 2005, 42,052,583 treatments of co-administered albendazole and Mectizan were approved for national Programs to Eliminate LF (PELFs) in Africa and Yemen. There are ongoing PELFs using albendazole and Mectizan in nine African countries and Yemen; these represent 35% of the total number of countries expected to require the co-administration of these two chemotherapeutic agents for LF elimination. In Africa, the expansion of existing PELFs and the initiation of new ones have been hampered by lack of resources, technical difficulties with the mapping of LF endemicity, and the co-endemicity of LF and loiasis. Included in this review are recommendations recently put forward for the co-administration of albendazole and Mectizan in areas endemic for LF, loiasis, and onchocerciasis