Extended-Spectrum-Beta-Lactamase (ESBL) production among Escherichia coli and Klebsiella species in Kumasi, Ghana.

In recent times Enterobacteriaceae including Escherichia coli and Klebsiella spp., isolated in Kumasi at the Komfo Anokye Teaching Hospital (KATH) have shown significant resistance to 2nd and 3rd generation cephalosporins. Microbial resistance to these antimicrobials if due to the production of Extended Spectrum-Beta-Lactamases (ESBLs) may also indicate resistance to the aminoglycosides and other antibiotics. A total of 300 non-selected, non-duplicate isolates were collected and ESBL production was phenotypically determined using the Combined Disc Method. 149 (49.67%) of the isolates were ESBL- producing E. coli (44.37%) or Klebsiella spp. (55.03%). ESBL-producing organisms were more common among in-patients (54.60%) than they were among out-patients (46.27%). Meropenem emerged as the antimicrobial agent of choice for the treatment of serious infections associated with ESBL-producers on the basis of in vitro testing. The high level of ESBL production found in these Enterobacteriaceae with the resultant microbial resistance to the available cephalosporins and other agents may pose difficulties with the choice of therapeutic options for the treatment of severe infections. Efforts to prevent and/or control outbreaks of infections with ESBL-producing organisms must emphasize on the judicious use of all antibiotics. Keywords: Extended Spectrum-Beta-Lactamases (ESBLs), Cephalosporins, Enterobacteriaceae

Accuracy of clinical diagnosis, mammography and ultrasonography in preoperative assessment of breast cancer

Background: Cancer of the breast is the most common malignancy affecting women in many parts of the world. Its early detection has, therefore, become necessary to reduce morbidity and mortality from the disease. In sub-Saharan Africa, radiological imaging, histology and management programs are associated with challenges.Objectives: This study seeks to assess the validity of clinical diagnosis, mammography and breast ultrasonography in the preoperative assessment of suspected breast cancer patients for accurate detection of the disease to enable appropriate management.Methods: A prospective cross-sectional study was carried out in the Radiology Department of Komfo Anokye Teaching Hospital, Kumasi, Ghana, between November 2007 and July 2008 with a sample size of 103. All patients with a clinical suspicion of breast cancer who gave informed consent were recruited, underwent bilateral mammography and whole breast ultrasonography and then biopsy for all BIRADS categories 4 or 5 lesions. The histopathology results were retrieved to complete the study.Result: In this study the definition of malignancy was made using histology as the gold standard. A total of 103 patients were recruited for this study with mean age of 55(+15) years, out of which 52 (50.5%) had malignant lesions. The overall sensitivity of clinical diagnosis was 50.5%. While the overall sensitivity and specificity for mammogram and ultrasound were 73.0%, 80.0% and 100%, 80.4% respectively. Conclusion: In conclusion, this study has demonstrated that clinical diagnosis, ultrasound and mammography can potentially predict breast cancer disease with considerable sensitivity and specificity. Funding: Not declaredKeywords: breast cancer, mammography, ultrasonography, histology, clinical diagnosi

Factors associated with failure to screen for syphilis during antenatal care in Ghana: a case control study.

BACKGROUND: There is little data regarding the effect of ramping up new screening interventions on their uptake by target populations into routine care services in developing countries. This study aimed to determine patient-level factors associated with failure of pregnant women to get screened for syphilis during antenatal care, in the context of a national rollout of rapid syphilis point of care tests (POCTs) in Ghana. METHODS: An unmatched 1:2 case control study conducted among women admitted for delivery in two district hospitals in the Ashanti Region of Ghana from August to October 2010, 7 to 9 months after the introduction of POCTs in the region. Cases were women who had not been screened for syphilis during antenatal care and controls were women who had been screened. Patient-reported factors for being unscreened were examined using logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: 160 consecutive unscreened and 327 screened women were recruited. Most women had good knowledge of syphilis (58.7% among unscreened women vs. 64.2% among screened; P=0.24). Factors associated with failure to get screened were: attending antenatal care in a private health facility (adjusted OR, 11.09; 95% CI 5.48-22.48), previous adverse pregnancy outcome (adjusted OR, 1.98; 95% CI 1.22-3.23) and not being screened for HIV during the current pregnancy (adjusted OR, 2.78; 95% CI 1.50-5.13). The odds of being unscreened also increased with decreasing doses of intermittent preventive treatment for malaria in pregnancy received (P trend<0.001) and decreasing education level (P trend=0.02). CONCLUSION: Significant risk factors for not being screened, following the national rollout of syphilis POCTs, related to the type of health facility where antenatal care was received and some of the women's personal characteristics. Targeting of private medical facilities to include syphilis POCTs and support other neglected public health interventions should be a priority

Estimating the uptake of maternal syphilis screening and other antenatal interventions before and after national rollout of syphilis point-of-care testing in Ghana.

OBJECTIVE: To compare the uptake of maternal syphilis and HIV screening, intermittent preventive treatment for malaria, and tetanus toxoid administration in three regions of Ghana, before and after the rollout of syphilis point-of-care tests (POCTs). METHODS: Antenatal register records were reviewed in 15 selected health facilities over an eight-month period, 16 months apart. Register records had been evaluated using the maternal record booklets as a gold standard in a separate prior survey. RESULTS: In the evaluation study, the sensitivity of register data was low, ranging from 33.3% for tetanus toxoid administration to 53.8% for syphilis serology. In total, 8282 antenatal client records (4141 in each period) were reviewed. Less than a third of pregnant women received any single intervention at either period (ranging from 17.8% for tetanus toxoid to 29.8% for HIV testing). Overall, HIV screening had a marginal absolute increase of about 2% while the remaining interventions experienced non-significant absolute decreases of 4.1 to 11.1%. When adjusting for under-recording, syphilis screening uptake was 50% before and 33.6% after the introduction of POCTs. CONCLUSION: Use of POCTs for syphilis did not result in increased uptake. Routine monitoring of antenatal interventions using the antenatal register may result in underestimation of their uptake

Performance of Syphilis Sentinel Surveillance in the context of endemic Treponematoses: experience from Ghana.

BACKGROUND: Use of treponemal tests to screen for syphilis (caused by Treponema pallidum pallidum) poses challenges with infection status classification, especially in settings where other treponemal infections are endemic. This study aimed to determine the validity of the syphilis surveillance testing strategy implemented since 2004 using two treponemal tests, and estimate the seroprevalence of active syphilis infection in Ghana where yaws (caused by Treponema pallidum pertenue) is endemic. METHODS: We retested sera from the 2007 HIV sentinel survey (HSS) using a traditional algorithm, quantitative rapid plasma reagin test followed by qualitative Treponema pallidum haemagglutination assay. The adjusted seroprevalence of active syphilis was calculated by applying the proportions of active syphilis within identified categories of HSS samples during the retesting, to the entire population of HSS samples. The 95% confidence intervals (CIs) were calculated for each proportion, and the t-test was used to assess differences in proportions. RESULTS: Of 2,214 samples that were retested, 203 (9.2%) had active syphilis infection, 21 (0.9%) were biological false reactions, 640 (28.9%) were past or treated syphilis infections, and 1,350 (61%) were uninfected. The current syphilis testing strategy overestimated the seroprevalence of active syphilis infection by a third (HSS versus traditional algorithm: 6.0% (95% CI: 5.6-6.3) vs. 4.5% (95% CI: 4.2-4.8); p < 0.001), and had low positive predictive value (16.8%) for detecting active syphilis infection. More than half (51.9%) of HSS syphilis positive cases were actually past/treated treponemal infections, possibly previous exposure to yaws. CONCLUSION: There is an urgent need to review the current syphilis sentinel surveillance testing strategy in Ghana in the context of concurrent endemic treponematoses, to better inform policy

Research report: "It’s all about making a life": young female sex workers vulnerability to HIV and prevention needs in Kumasi, Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.This report presents findings from a qualitative study examining the vulnerability to HIV of young female sex workers (FSW) in Kumasi, Ghana and their prevention needs. The study was conducted by Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST) as part of the Project SEARCH Program funded by PEPFAR and the United States Agency for International Development Ghana. The objectives of this study were to: 1) Investigate knowledge about and perceptions of HIV in young FSW in the Kumasi Metropolitan area, 2) Explore their risk behaviors, and 3) Identify their most urgent prevention needs. A secondary objective was to provide foundational knowledge to inform the design of future studies of girls and young women engaging in sex work in Ghana.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

HIV vulnerability of men and women who inject drugs in Kumasi, Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.Reducing vulnerability to HIV infection among key populations in Ghana is a major goal for the National AIDS Control Program (NACP) and the GAC. While a number of studies have explored HIV risk behaviours among several key vulnerable populations in Ghana including female sex workers, men who have sex with men, and prisoners, little is known about the drug use and sexual vulnerability of people who inject drugs (PWID). In addition, no programs have been implemented to reduce the vulnerability among this population. This report provides the findings from a qualitative study that aimed to understand the social, economic and behavioral vulnerability to HIV of PWID in Kumasi and to inform the development and implementation of HIV prevention programs for this population. The research was conducted by a collaborative team comprised of researchers from Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST) School of Medical Sciences. It is one of nine studies under the Operations Research on Key Populations project funded by the United States Agency for International Development (USAID). The study was designed and carried out in collaboration with the Ghana AIDS Commission (GAC).Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Program brief: HIV vulnerability and prevention needs of young female sex workers in Kumasi, Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.Adult HIV prevalence in Ghana in 2013 has been estimated at 1.31%.1 Among female sex workers (FSW), prevalence is, however, much higher at 12.9%, compared to 2.2% in the general female population. HIV prevalence among FSW in the Ashanti region is 13%, the second highest FSW prevalence after the Greater Accra Region (16.3%).2 Sex work plays a significant role in HIV transmission, with 2.4% of sex workers, 13.2% of male clients, and 22.2% of clients’ partners contributing to new HIV infections.2 While recent national and regional prevalence and behavior data on FSWs are available, little qualitative research has been published on sex workers in Kumasi, and specifically on younger sex workers. This qualitative study was conducted by Boston University’s Center for Global Health and Development and the Kwame Nkrumah University of Science and Technology with funding from the United States Agency for International Development (USAID)/Ghana. The study objectives were to: (1) investigate knowledge about and perceptions of HIV among young FSW in Kumasi, capital of the Ashanti region and second largest city in Ghana; (2) explore their HIV risk behaviors; and (3) identify their HIV prevention needs. Focus group discussions and in-depth interviews were done with 48 FSW Ten key informant interviews were held with health care providers at local clinics.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Research report: "Using what you have to get what you want": Vulnerability to HIV and prevention needs of female post‐secondary students engaged in transactional sex in Kumasi, Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.This report presents findings from a qualitative study examining vulnerability to HIV of female post‐secondary students engaged in transactional sex in Kumasi, Ghana and their prevention needs. The study was conducted by Boston University’s Center for Global and Health and Development (CGHD) and the Kwame Nkrumah University of Science and Technology (KNUST) as part of Project SEARCH funded by the United States Agency for International Development Ghana. Participants were recruited from five post‐secondary institutions in the greater Kumasi area. Our objective is to provide academic institutions, the Ghana AIDS Commission (GAC), the National AIDS Control Program, donors, and other stakeholders with rich data to inform research and programmatic efforts in Kumasi specifically, as well as academic institutions in general. We set out to document what forms of transactional sex female students are engaging in, who their partners are, and what motivates them to participate. We asked students about the individual and structural vulnerabilities for HIV reported by female post‐secondary students involved in transactional sex and what their prevention needs are. We also interviewed a small sample of faculty, residence hall matrons, and hotel staff to get their perspective on the behavior of female students practicing transactional sex that might put them at risk for HIV. The findings of this study can be used as well to inform the design of future studies of young women engaging in transactional sex in Ghana. With such limited understanding of HIV transmission among young female post‐secondary students engaged in transactional sex, research is needed to determine how this group contributes to the overall HIV epidemic. The Ghana AIDS Commission has recognized the need for further research among communities engaged in less well‐defined risky sex practices in the National Strategic Plan for Most‐at – Risk Populations (MARP) 2011‐2015.4 This study attempts to fill in gaps in the research regarding transactional sex, taking into account the complexities and nuances of the practice, in addition to examining the needs of female students for targeted HIV prevention programs.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201

Program brief: "Using what you have to get what you want: HIV vulnerability and prevention needs of female post‐secondary students engaged in transactional sex in Kumasi, Ghana

This study was implemented by Boston University in collaboration with the Kwame Nkrumah University of Science and Technology with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 2010. The content and views expressed here are the authors’ and do not necessarily reflect the opinion or policy of USAID or the U.S. Government.HIV prevalence among young Ghanaian men and women aged 15–24 years old is estimated at 1.7%.1 HIV prevalence in the specific population of female post-secondary students is unknown. The Ghana AIDS Commission (GAC) recognizes the need for further research in communities participating in less well-defined risky sex practices. This study was conducted by Boston University’s Center for Global Health and Development and the Kwame Nkrumah University of Science and Technology with funding from the United States Agency for International Development/Ghana. The objective was to provide academic institutions, the GAC, the National AIDS Control Program, donors, and other stakeholders with data to inform research and programmatic efforts in Kumasi, specifically, as well as academic institutions, in general. Study participants were recruited from five post-secondary institutions in the greater Kumasi area. Data were collected on students’ perceptions of transactional sex (TS) on campus, individual and structural HIV vulnerabilities, and prevention needs through in-depth interviews with seven female post-secondary students involved in TS and focus groups with twenty-nine female and male students. Key informant interviews were also conducted with faculty, residence hall matrons, and hotel staff. Non-commercial transactional sex is defined here as engaging in sex for the purposeof obtaining material goods, financial support, or grades.Support from the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under Project SEARCH Task Order No. GHH‐I‐00‐07‐00023‐00, beginning August 27, 201