Possible future trajectory of COVID-19: emphasis on Africa

Coronavirus disease 2019 (COVID-19) has caused morbidity and mortality in many countries. COVID-19 has also negatively affected the economy of several nations. The dynamics of interaction between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and host, and possible evolution of the virus into more virulent strains pose a threat to global eradication. With the advent of vaccination in most countries, vaccine hesitancy, especially in Africa, is expected to reduce. We also believe that the COVID-19 vaccine would have substantial impact on reducing incidence, hospitalizations, and deaths. A predictor model for COVID-19 infection pattern through to 2025 suggests that recurrent outbreaks are likely to occur. There is a prediction that Africa would not fully recover from the economic crises posed by the pandemic; nonetheless, we expect that economic activities on the continent will improve as countries undertake mass vaccinations and populace attain herd immunity. The growth of e-commerce has been remarkable during the pandemic and we don´t expect trend to decline anytime soon. The pandemic has led to technology and digital platform utilization and/or improvement, which invariably has the tendency to improve quality of lives in the future. These include effective big data monitoring, online shopping, among others. Our future trajectory for recurrent waves of COVID-19 is that these may occur in winter months in temperate climates. We believe that COVID-19 has strengthened Africa´s resilience to future pandemics

Covid-19 pandemic in resource-poor countries : challenges, experiences and opportunities in Ghana

The novel coronavirus, SARS-CoV-2, which causes COVID-19, is seen world-wide. In developing countries, adequate health facilities and staff numbers are a concern. Ghana recorded its first 2 cases of COVID-19 on 12 March 2020. On 30 March 2020, a partial lockdown for 14 days was imposed and later extended along with other measures. By the end of the initial lockdown, 19 April 2020, an estimated 86,000 people had been traced and 68,591 tests performed. Of the 68,591 tests, there were 1,042 (1.5%) positive cases, 9 deaths, and 99 recoveries, with Ghana ranked number one among African countries in administering tests per million people. Ghana’s effective track and trace system, as well as lockdown and other measures, have helped limit mortality with only 85 recorded deaths by 23 June 2020. Scientists from three facilities of the University of Ghana have also successfully sequenced the genomes of COVID-19 from 15 confirmed cases, and the Food and Drugs Authority in Ghana have also helped address shortages by fast-tracking certification of hand sanitizers and local production of 3.6 million standardized personal protective equipment. There has also been the development of prototypes of locally-manufactured mechanical ventilators to meet local need at intensive care units. Most people have also resorted to changing diets and the use of supplements to boost their immune system. Although initial results are encouraging, further research is needed to understand the dynamics of COVID-19 in Ghana and provide additional guidance

Susceptibility pattern of uropathogens to ciprofloxacin at the Ghana police hospital

Introduction: Reports of increasing resistance of uropathogens to antimicrobials is of global concern. Culture and drug susceptibility tests remain a vital guide to effective therapy. The aim of this study was to determine the susceptibility pattern of isolated uropathogens to ciprofloxacin at the Ghana Police Hospital. Methods: A total of 705 mid-stream urine samples were collected from patients suspected of having  urinary tract infection, and visited the Ghana Police Hospital's laboratory from December 2013 to March  2014. Samples were cultured and isolates identified by standard methods, after which isolates  susceptibility to ciprofloxacin was determined. Results: Prevalence of urinary tract infection among patients' whose samples were analyzed was 15.9%. Predominant uropathogens isolated were E .coli (46.4%), Coliform (41.1%) and Coliform spp. with Candida (6.2%). Other isolates were Pseudomonas spp. (2.7%), Salmonella spp. (1.8%), Candida spp. (0.9%) and Klebsiella spp (0.9%). The overall resistance among the top three isolated uropathogens to ciprofloxacin was 35.9%. Resistance pattern demonstrated by  respective isolates to ciprofloxacin were: E. coli (38.5%), Coliform (54.3%), and Coliform spp. with Candida (15%). The other isolates showed 100% sensitivity.Conclusion: This study revealed a relatively high ciprofloxacin resistance among isolated uropathogens,  hence, the need for prudent prescribing and use of  ciprofloxacin in urinary tract infection management.Key words: Urinary tract infection, isolates, susceptibility, antibiotics, uropathogen

Antimicrobial point prevalence surveys in two Ghanaian hospitals : opportunities for antimicrobial stewardship

Background: Improved knowledge regarding antimicrobial use in Ghana is urgently needed to reduce antimicrobial resistance (AMR). This includes point prevalence studies (PPS) in hospitals. Objectives were: (i) provide baseline data in two hospitals (Keta Municipal Hospital – KMH and Ghana Police Hospital – GPH) and identify priorities for improvement; (ii) assess the feasibility of conducting PPS; (iii) compare results with others. Methods: Standard PPS design using the Global PPS paper forms, subsequently transferred to their template. Training undertaken by the Scottish team. Quality indicators included rationale for use; stop and review dates, and guideline compliance. Results: Prevalence of antibiotic use was 65.0% in GPH and 82.0% in KMH. Penicillins and other beta-lactam antibiotics were the most prescribed in both hospitals, with third generation cephalosporins mainly used in GPH. Antibiotic treatment was mainly empirical and commonly administered intravenously (IV), duration was generally short with timely oral switching, and infections were mainly community acquired. Encouragingly, good documentation of the indications for antibiotic use in both hospitals and 50.0-66.0% guideline compliance (although for many indications no guideline existed). In addition, almost all prescribed antibiotics had stop dates and there appeared no missed doses. The duration of use for surgical prophylaxis was generally more than one day (69.0% in GPH and 77.0% in KMH). Conclusions: These two hospitals were the first in Ghana to use the Global PPS system. We found the PPS was feasible and relatively rapid, achieved with limited training. Targets for improvement identified included broad-spectrum antibiotics, duration of treatment and high empiric use

Supporting global antimicrobial stewardship : antibiotic prophylaxis for the prevention of surgical site infection in low and middle income countries (LMICs): a scoping review and meta-analysis

Background: The Scottish Antimicrobial Prescribing Group (SAPG) is supporting two hospitals in Ghana to develop antimicrobial stewardship. Early intelligence gathering suggested that surgical prophylaxis was suboptimal. We reviewed the evidence for use of surgical prophylaxis to prevent surgical site infections (SSI) in low and middle-income countries (LMICs) to inform this work. Methods: MEDLINE, Embase, Cochrane, CINHAL and Google Scholar were searched from inception to 17 February, 2020 for trials, audits, guidelines and systematic reviews in English. Grey literature, websites and reference lists of included studies were searched. Randomised clinical trials reporting incidence of SSI following Caesarian section were included in two meta-analyses. Narrative analysis of studies that explored behaviours and attitudes was conducted. Results: This review included 51 studies related to SSI and timing of antibiotic prophylaxis in LMICs. Incidence of SSIs is higher in LMICs, infection surveillance data is poor and there is a lack of local guidelines for antibiotic prophylaxis. Education to improve appropriate antibiotic prophylaxis is associated with reduction of SSI in LMICs.The random effects pooled mean risk ratio of SSI in Caesarian section was 0.77 (95% CI: 0.51 to 1.17) for pre-incision versus post-incision prophylaxis and 0.89 (95% CI: 0.55 to 1.14) for short versus long duration, Reduction in cost and nurse time was reported in shorter duration SAP. Conclusion: There is scope for improvement but interventions must include local context and address strongly held beliefs. Establishment of local multidisciplinary teams will promote ownership and sustainability of change

Susceptibility pattern of uropathogens to ciprofloxacin at the Ghana police hospital

Abstract Introduction: Reports of increasing resistance of uropathogens to antimicrobials is of global concern. Culture and drug susceptibility tests remai

Fight against Covid-19 in Africa : positive lessons for suture pandemics from Ghana

Introduction: The novel coronavirus which causes COVID-19 has affected all continents, Africa inclusive. In Ghana, the first two cases of COVID-19 were recorded on 12th March, 2020; after which the Government took measures to limit and stop importation of the virus. We wanted to document experiences of Ghana during this pandemic to provide future guidance. Methods: We conducted a review of publicly available information on measures taken by Ghana to reduce the spread of coronavirus, and care for the sick. Results: On 30th March 2020, a 14-day partial lockdown was imposed in affected regions in Ghana, along with other measures (closure of borders, mandatory wearing of facemasks, etc). Three major laboratories, as well as other government hospital laboratories, served as stations for COVID-19 testing. Some hospitals had been dedicated as COVID-19 treatment centres, whilst other major hospitals served as support centres. In July, 2020, Ghana opened its first Infectious Disease Isolation and Treatment Centre. The Government of Ghana introduced measures to facilitate local production of face masks, medical scrubs, hospital gowns and head gear. Additionally, the Food and Drugs Authority in Ghana fast-tracked testing and approval of alcohol based hand sanitizers. As at 28th August, 2020, Ghana had recorded 43,949 COVID-19 cases, with only 270 deaths (case fatality of 0.6%). Discussion: We believe Ghana serves as a good example of a low- and middle-income country that has made relevant strides in dealing with the COVID-19 pandemic. Nonetheless, setting-specific approaches are important in the fight against this pandemic

Neonatal Sepsis in a Resource-Limited Setting: Causative Microorganisms and Antimicrobial Susceptibility Profile

Background. Empiric treatment of suspected neonatal sepsis must be based on data on setting-specific causative pathogens and their respective susceptibilities to antimicrobials, as well as universal treatment guidelines. This approach will ensure better therapeutic outcomes and reduce mortality. Objectives. The objectives of this study were to determine the bacteriological profile and antibiotic susceptibility pattern of isolated microorganisms responsible for neonatal sepsis in a regional hospital in Ghana. Methods. This was a retrospective study that assessed causative microorganisms and antimicrobial susceptibility profiles of neonates suspected of sepsis at the Greater Accra Regional Hospital from January 2018 to December 2019. Blood culture was done using a fully automated BACTEC 9240 blood culture system. Bacteria isolates were identified by Gram staining and conventional biochemical methods. Antimicrobial susceptibility testing was done by Kirby–Bauer’s disc diffusion method, and interpretations were carried out according to clinical and laboratory standards. Culture and antibiotic sensitivity reports were obtained and the data subsequently analyzed. Results. Of 2514 blood samples collected from neonates suspected of neonatal sepsis, 528 (21.0%) of the samples were found to be culture-positive. The majority of these positive cultures were from male neonates (68.9%). A total of 11 different pathogens were isolated, of which Gram-positive organisms had a preponderance of 72.0% over Gram-negative organisms (28.0%). Staphylococcus epidermidis was the most common pathogen identified, accounting for 60.0% of isolates. The most prevalent Gram-negative bacteria were Klebsiella spp. (13.6%). Most Gram-positive microorganisms showed sensitivity to amikacin, meropenem, vancomycin, and piperacillin/tazobactam. Gram-positive isolates were found to be resistant to ampicillin and penicillin, but moderately susceptible to flucloxacillin. Most Gram-negative isolates were sensitive to meropenem. Conclusion. The prevalence of culture-proven sepsis was 21.0%. The most prevalent Gram-negative bacteria were Klebsiella spp. As there is some level of antibiotic resistance observed in the current study, it is necessary for routine microbial analysis of samples and their antibiogram

A pilot study evaluating the prescribing of ceftriaxone in hospitals in Ghana: findings and implications.

Background and objectivesWidespread empiric use of antibiotics exists especially in developing countries. This is a concern since inappropriate use of antibiotics, including their extended inappropriate use, will increase resistance rates. Consequently, there is a need to evaluate antibiotic utilisation across healthcare sectors to improve future use. This includes ceftriaxone, widely used among hospitals including those in Ghana.MethodsA cross-sectional study to evaluate the appropriateness of ceftriaxone prescribing in a leading hospital in Ghana. Ceftriaxone prescribing in patient-record cards was assessed using a modified WHO drug-utilization evaluation criteria as well as referencing the national standard treatment guidelines in Ghana and the ceftriaxone package insert.ResultsA total of 251 patients were assessed. Ceftriaxone was most commonly prescribed for comorbid malaria with bacterial infections, urinary tract infections, sepsis and gastroenteritis. The appropriateness of the indication was 86% (n = 218). The doses most prescribed were 1g (41%) and 2g (39%). Stat dose and once-daily dosage regimen constituted 51.4% and 84.5%, respectively. The most common duration of treatment was 1 (51.4%) and 2 days (35.1%). The overall appropriateness of prescribing was 93% against a pre-set threshold of 97%.ConclusionThe appropriateness of ceftriaxone prescribing was high in this leading hospital in Ghana; however, there is room for improvement with targeted education initiatives, with further research planned

Acute Oral Toxicological Profile of Croton membranaceus Mull. Arg. Aqueous Stem Extract, a Herbal Treatment for Benign Prostate Hyperplasia, in Male Sprague–Dawley Rats

Croton membranaceus Mull. Arg. is a traditional medicinal plant frequently employed in Ghana for the treatment of benign prostatic hyperplasia and prostate cancer. The objective of this study was to determine the acute oral toxicity of the aqueous stem extract of Croton membranaceus (CMASE) in male Sprague–Dawley (S-D) rats. The acute toxicity of CMASE was evaluated using S-D rats randomly divided into four groups of five animals each. Three groups (low dose, median dose, and high dose) of rats received single oral doses of CMASE (1000, 2500, and 5000 mg/kg body weight, respectively) using an oral gavage. The control group was given distilled water. After 14 days of daily observations, hematological, biochemical, and histopathological analyses were conducted on the rats. From the results obtained, doses of CMASE up to 5000 mg/kg did not cause death or induce any clinical indications of toxicity during the study period. Also, the mean body weight and the hematological indices assessed were not significantly affected by the various doses of CMASE compared to the control group. However, serum uric acid and creatinine levels decreased significantly (p<0.001) 14 days after the extract administration. Serum liver function enzyme levels, including alkaline phosphatase (ALP), alanine aminotransferases (ALT), and aspartate aminotransferases (AST), and serum proteins (total proteins and albumin) exhibited significant (p<0.001) non dose-dependent changes (increases and decreases) in treated groups compared to the controls. Other biochemical indices, however, did not differ significantly between the treated groups and the controls. The gross pathological and histological analysis of the heart, liver, and kidney tissues did not reveal any significant changes in histoarchitecture. The oral LD50 of CMASE in rats was greater than 5000 mg/kg, indicating that the extract was relatively safe. It must, however, be used with care as a substitute for the roots