Benjamin Amoani

Background: Non‐Hodgkin lymphomas (NHL) represent a heterogeneous group of malignancies with varying molecular and immunophenotypic characteristics. In Ghana, NHL is the third most common childhood cancer, highlighting the need for precise diagnostic approaches to improve survival rates. The identification of immunophenotypic biomarkers expressed by both healthy and neoplastic cells of the immune systems has been shown to provide information on the diagnostic and prognostic characterization of tumors leading to personalized treatment of NHL. We evaluated the immunophenotypic profiles of pediatric NHL and their correlation with survival outcomes. Aims: This study aimed to evaluate the immunophenotypic characteristics of three subtypes of non‐Hodgkin lymphoma (NHL) and their associated survival outcomes among children diagnosed at Komfo Anokye Teaching Hospital, Kumasi. Methods: In this retrospective study, 38 NHL patients were recruited from the Komfo Anokye Teaching Hospital from 2018 to 2022. Clinico‐pathological characteristics and treatment outcome were obtained in patients' folders. Formalin fixed paraffin embedded tissues were histologically examined and immunohistochemistry performed using monoclonal antibodies targeting CD3 , CD25 and BCL‐2 . The Kaplan–Meier method was used to obtain survival curves and compared by the log‐rank test. Statistical analysis was performed using SPSS (version 26.0) and XLSTAT. Results: Females accounted for 55.3% of cases, with most patients being under 10 years. Within the first‐year post‐diagnosis, 30.6% of children died, and 27.8% abandoned treatment. BCL‐2 was the most frequently expressed marker (55.3%), with co‐expression observed across all lymphoma types and age groups. Survival analysis was performed on 21/38 participants with complete follow‐up data. The median survival time was 22 months (95% CI: 3.96–40.11), with survival rates declining from 76% at 10 months to 20% at 40 months. Factors significantly associated with poor survival included BCL‐2 expression (poorer survival) and extranodal spread ( p < 0.05). Conclusion: The survival rate for NHL patients in Ghana is very low. BCL‐2 was the most expressed marker, significantly influencing survival outcomes. The extent of tumor spread also influenced survival outcomes. Identifying prognostic factors for early diagnosis and treatment is essential to improving survival outcomes for NHL patients in this setting.

Background: HLA-G (Human Leukocyte Antigen-G) is a non-classical molecule belonging to the major histocompatibility complex (MHC) class I family, located on chromosome 6 within the MHC region, which is pivotal in promoting immune tolerance. The immune-suppressive ability of Human Leukocyte Antigen (HLA-G) and its binding to fetal maternal interface predispose pregnant women to Plasmodium falciparum ( Pf ) infection and pregnancy loss, respectively. Alterations in hematological parameters may accelerate the severity of malaria infection. Limited data is available about the effects of malaria infection on hepatocytes and how this endangers the lives of the mother and the fetus due to liver injury. Thus, this study evaluated HLA-G and Hematobiochemical levels and their association with malaria infection and miscarriage among pregnant women in the Ghanaian population. Materials and Methods: This case-control study recruited forty-six (46) Pf -infected pregnant women and forty-six (46) Pf -uninfected pregnant women from the Bibiani Anhwiaso Bekwai Municipality, Ghana. A well-structured questionnaire was administered to obtain sociodemographic and clinical data from 21 ^st December 2022–20 ^th December 2023. 10 ml venous blood samples were collected from each participant for Pf parasite testing using the Pf HRP2 RDT test kit (CareStart TM Malaria PfHRP2/pLDH Ag RDT, Access Bio, Inc., USA), and the results were confirmed with microscopy. Hematobiochemical profile analyses were done using the Sysmex automated hematology and chemistry analyser. Plasma HLA-G levels were quantified using a sandwich ELISA (Maxisop ELISA plate), and their corresponding concentrations were determined. Results: The results shows a significant difference in the use of IPT-SP and Pf infection, with 31(67.4%) for Pf positive vs 18(39.1%) for Pf negative among those who were not on IPT-SP and 15(32.6%) for Pf positive vs 28(60.9%) for Pf negative for those who were on IPT-SP (p = 0.007)., Multivariate regression crude analysis shows increased ALT levels among the malaria-infected pregnant women [β = 7.091(95% CI = 1.563–32.182) p = 0.011] compared to the negative group. This finding was insignificant after adjusting for age, IPT-SP use and Trimester. ALP, on the other hand, shows significantly increased levels among the malaria-infected pregnant women compared to the malaria-negative pregnant women for both crude [β = 13.301(95% CI = 1.577–112.208) p = 0.017] and adjusted [β = 17.524(95% CI = 1.534–200.20), p = 0.02] analysis. In a comparative analysis, we found that GLR (G) and PLR (H) levels were significantly higher in participants with Pf infections compared to participants without Pf infection ( p < 0.05). We also found that women with a history of miscarriage had considerably higher sHLA-G levels [50.14 (36.30–71.00) vs. 35.44(31.84–42.72)] than women with no history of miscarriage. Conclusion: Pf infection in pregnant Ghanaian women was associated with elevated ALP, GLR, and PLR, indicating hepatic dysfunction and systemic inflammation. The non-use of IPTp-SP among pregnant women was significantly associated with active Pf infection, highlighting the importance of chemoprophylaxis. Increased sHLA-G levels in women with miscarriage suggest an immunological link to pregnancy loss. Further prospective investigation of sHLA-G as a biomarker of adverse pregnancy outcome in malaria-endemic settings with a larger sample size is required.

Background: The coexistence of type 2 diabetes mellitus (T2DM) and malaria presents a significant public health concern, particularly in malaria-endemic regions. T2DM’s immunomodulatory effects may influence immune responses to infectious diseases, but its impact on naturally acquired antibodies against malaria vaccine candidate antigens remains unclear. This study investigated how T2DM-malaria comorbidity affects IgG responses to malaria vaccine candidate antigens (GLURP-R2, GLURP-RO, MSP3, MSP1, AMA-1 and CSP) among individuals in the Central Region of Ghana. Methods: This hospital-based case-control study recruited a total of 144 participants 40 with diabetes, 25 with both diabetes and malaria, 41 with malaria only, and 38 controls (hospital staff without malaria or diabetes matched by age and sex). Malaria status and parasitaemia were confirmed using microscopy, blood glucose levels were measured via glucometer, and antibody levels were quantified using indirect ELISA. Data were analyzed using parametric and non-parametric statistical methods. Results: Patients with malaria-diabetes comorbidity exhibited significantly higher parasitaemia levels compared to those with malaria alone [1702 (IQR1 = 926.50, IQR3 = 4102) vs. 932 (IQR1 = 722.50, IQR3 = 1321), p = 0.02]. Relative to the negative control group, IgG responses to GLURP-R2 were markedly elevated, showing a 1.60-fold increase in the comorbidity group (β = 0.47 [95% CI: 0.10–0.83], p = 0.01) and a 1.43-fold increase in the malaria-only group (β = 0.36 [95% CI: 0.04–0.69], p = 0.03). Among individuals with comorbidity, IgG levels to GLURP-R0 and MSP1 were also 1.43-fold higher (β = 0.36 [95% CI: 0.03–0.68], p = 0.03) and 1.42-fold (β = 0.35 [95% CI: 0.09–0.61], p < 0.05), respectively. Conversely, antibody responses to MSP3, AMA1, and CSP did not differ significantly between the study groups (p > 0.05). In the multivariate regression model adjusted for age and sex, individuals with comorbidity exhibited significantly elevated IgG responses, showing a 1.38-fold increase to GLURP-R0 (β = 0.32 [95% CI: 0.07–0.59], p = 0.027) and a 1.34-fold higher response to MSP1 (β = 0.29 [95% CI: 0.02–0.47], p = 0.048), relative to the malaria-only group. Conclusion: These findings suggest that diabetes may enhance malaria parasite multiplication while also augmenting IgG antibody responses to malaria vaccine candidate antigens in individuals with comorbidity. Further research is required to elucidate the mechanisms by which diabetes influences antibody responses to malaria infection and its potential implications for malaria vaccine development.

Background: HIV/AIDS continues to pose a significant public health challenge, affecting millions of people worldwide. In Ghana, HIV affects 1.5% of the population, totaling 330,000 individuals and resulting in more than 14,000 deaths annually. To date, HIV has no cure and remains a chronic infection, often requiring frequent hospital visits. Given the frequent hospital visits associated with HIV/AIDS, patient satisfaction with care plays a significant role in adherence and treatment outcomes. However, factors associated with satisfaction with care and its impact on clinical outcomes has barely been investigated in the Ghanaian setting. This study assessed the level of satisfaction with care and its association with adherence among people living with HIV (PLWH) in Kumasi, Ghana. Methods: This cross-sectional study involved 315 PLWH attending the Komfo Anokye Teaching Hospital and Aniniwah Medical Center. A well-structured validated questionnaire was administered to obtain data on sociodemographic, clinical parameters, lifestyle, and satisfaction with care. The Tilburg Frailty Indicator and Adherence to Chronic Disease Scale were used to assess frailty syndrome and medication adherence. Viral load and other relevant medical records were also retrieved from the folders of participants. Statistical analysis was performed using SPSS version 26 and GraphPad Prism version 8.0. p < 0.05 was considered statistically significant. Results: The proportion of participants satisfied with care was 84.1%. Dissatisfaction with care was mainly due to the long waiting time (36.8%) and the lack of logistics (11.4%). The prevalence of high medication adherence, frailty, viral suppression and rebound were 38.7%, 38.4%, 75.5% and 6.6%, respectively. Dissatisfaction with care [aOR = 0.39, 95% CI (0.18–0.85), p = 0.017] was independently associated with lower odds of high medication adherence. However, no statistically significant association was observed between satisfaction and frailty. Conclusion: The level of satisfaction was high among PLWH, with long waiting time and lack of logistics being the main causes of dissatisfaction with care. Satisfaction with care significantly influenced medication adherence, but had no impact on frailty among participants. This calls for measures to reduce patient long waiting time and upgrading logistics at various HIV treatment centers improve patients’ satisfaction and medication adherence.

Background: Friedewald′s equation remains the most widely used method for estimating LDL‐C in clinical settings, despite the availability of several homogeneous direct assays. However, its accuracy declines under certain clinical conditions, such as unusually high or low levels of triglycerides and total cholesterol. Recently, several novel population‐specific equations have been reported to outperform the Friedewald equation. This study therefore is aimed at evaluating and comparing the accuracy of 13 LDL‐C estimation equations within the Ghanaian population. Methods: A cross‐sectional study was conducted among 976 individuals at Suntreso Government Hospital, Kumasi, Ghana. Fasting venous blood samples were analyzed for lipid profiles. Direct LDL‐C was enzymatically measured and compared with values calculated using 13 equations. Performance was assessed with Pearson correlations, Bland–Altman plots, and Wilcoxon signed‐rank tests. Results: All 13 equations correlated significantly with direct LDL‐C ( r = 0.563–0.857, p < 0.001), with DeLong, Puavilai, Vujovic, Sampson, Choi, and Martin showing the strongest correlations ( r = 0.857). Ahmadi (71.39 mg/dL), Hattori (44.93 mg/dL), Rao (25.8 mg/dL), and Choi (19.58 mg/dL) were the most overestimated LDL‐C formulas, while de Cordova (−5.59 mg/dL) underestimated the direct LDL‐C measurement. Subgroup analyses by age, triglyceride, and total cholesterol levels revealed that the Friedewald and Chen and Zhang formulas exhibited nonsignificant median differences ( p > 0.05) in individuals aged 18–55 years and those with triglyceride levels ≥ 200 mg/dL. Conclusion: The Sampson, Martin, and Puavilai equations demonstrated the most reliable and consistent performance across age and lipid subgroups and should be considered preferred methods for LDL‐C estimation in clinical and research settings in Ghana. Although Friedewald and Chen and Zhang performed adequately in younger adults and individuals with elevated triglycerides, their overall agreement was weaker, highlighting the broader utility of the Sampson, Martin, and Puavilai equations.

Background of the study: Malaria is a paramount health concern mostly among infants and young children. The World Health Organization recommends iron fortification for children with iron deficiency anaemia living in malaria-endemic regions like Ghana. However, the intricate interplay between genetic polymorphisms and nutritional interventions in malaria susceptibility and severity remains unclear. The Human Leukocyte Antigen-G (HLA-G) locus within the Major Histocompatibility Complex (MHC) genes has surfaced as a critical player in regulating immune responses and influencing disease outcomes. Therefore, we aimed to evaluate the effect of HLA-G 14 bp polymorphism and its associated risk of malaria severity among Ghanaian infants and young children on iron fortification. Methodology: This secondary double-blinded cluster randomized controlled trial involved 432 archival samples from the Tain District and Wenchi Municipal in the Bono Region. Participants aged between 6 and 36 months and consuming semi-solid foods were recruited in the study while children with malaria infection or other known medical conditions were excluded. Capillary blood samples were taken for anaemia determination using a haematology autoanalyzer, malaria infection status, and parasitaemia were assessed via microscopy, and HLA-G 14 bp polymorphism using PCR. Hardy-Weinberg equilibrium and multivariate regression models were used to analyze the data obtained. Results: The research findings indicate that among the iron-fortified children with HLA-G, 14 bp + /- and 14 bp-/- variants are likely to develop severe malaria. Also, the HLA-G 14 bp + /- variant was linked to a higher risk of anaemia development among participants who received iron supplements. Conclusion: The study results indicated that iron-fortified individuals carrying the HLA-G 14 bp insertion/deletion polymorphism have an elevated risk of developing severe malaria, which in turn predisposes them to anaemia.

Background and aim: Assessing health promotion among adolescents and young adults is vital to identify healthy and unhealthy behaviours as well as to evaluate health promotion interventions. However, there is no valid and reliable scale to assess health promotion among Ghanaians. For the first time, this study determined the validity and reliability of the original version of the Short‐Form Adolescent Health Promotion (AHP) scale among adolescents and young adults in Ghana. Method: This cross-sectional methodological study included 617 adolescents and young adults within Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi, Ghana. A well-structured questionnaire was used to collect sociodemographic data from study participants. The AHP-Scale was also used to collect data on participants health promoting behaviors. The scale’s validity was evaluated using Kaiser-Meyer-Olkin (KMO), Bartlett’s test of sphericity and Exploratory Factor Analysis (EFA), whilst the reliability was assessed using the Cronbach’s ɑ coefficient. Statistical analysis was performed using SPSS software version 26. Results: The KMO and the Bartlett’s test of sphericity were reported to be 0.899 and χ² (276) = 6682.338 respectively, allowing for EFA with orthogonal rotation. The EFA revealed five factors covering 54.62% of the total variance. The factor loading order of the items did not exactly correspond to the order obtained in the original version of the scale’s validity analysis as the original scale had six factors. This six-factor loading scale was valid in regards to construct validity. The obtained factors included: life appreciation, exercise, stress management, nutrition, and social support. In this current study, Cronbach’s ɑ was calculated at 0.87 for the whole scale and between 0.71 and 0.92 for its subscales. Thus, indicating the current scale reliable. Conclusion: The six-factor loading scale of the Adolescent Health Promotion scale developed in the present study is acceptable for the validity and reliability assessment. However, the construct validity of this scale should be checked in other samples as it did not cover a large variance of the population. Large population wide studies are also needed to augment the current study findings with additional modifications for the adopted AHP scale.

Background. WHO recommends HBV-negative babies in high-prevalence (8%) countries receive anti-HBV vaccination. Ghana initiated mass immunization in 2002, but concerns remain about vaccine effectiveness and long-term protection. We evaluated immune characteristics and factors following hepatitis B vaccination among Ghanaian adolescents who received HBV vaccines. Methods. In this longitudinal cross-sectional study, 74 participants were enrolled from the Kumasi Metropolis, Ghana. Sociodemographic and lifestyle characteristics of participants were obtained using a questionnaire. Blood samples were obtained before and after booster administration for anti-HBsAg, IL-6, and IL-10 estimations using ELISA kit (Shanghai Chemical Ltd., China). Anti-HBsAg titers ≥10 mIU/ml were considered protective. Statistical analyses were done using SPSS version 26.0 and R programming language, was considered statistically significant. Results. We found 100% seroconversion rate, with 25.7% seroprotection rate (anti-HBsAg >10 mIU/ml). Gender ( ), age ( ), and exercising ( ) were significantly associated with seroprotection. Following booster administration, 59.4% were hyporesponders (10 ≤ anti-HBsAg titre ≤99 mIU/ml) whilst 40.6% were good responders (anti-HBsAg titre ≥100 mIU/ml). Exercise ( ) was significantly associated with immune response after booster administration. Moreover, we reported significant positive correlation between cytokines [IL-6 (r = 0.817, ) and IL-10 (r = 0.928, ) ] and anti-HBsAg titre. Conclusion. Approximately two thirds of adolescents vaccinated at birth lack protective levels of antibodies against hepatitis B virus. Booster vaccines could aid in mounting protective levels of anti-HBsAg. Physical exercise was negatively associated with immune response to hepatitis B vaccinations.

Background and Aim: Frailty is a condition marked by accumulation of biological deficits and dysfunctions that come with aging and it is correlated with high morbidity and mortality in patients with cardiovascular diseases, particularly hypertension. Hypertension continues to be a leading cause of cardiovascular diseases and premature death globally. However, there is dearth of literature in sub‐Saharan Africa on frailty syndrome among hypertensives on medication. This study evaluated frailty syndrome and its associated factors among Ghanaian hypertensives.Methods: This cross‐sectional study recruited 303 patients with hypertension from the University Hospital, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. Data on sociodemographic, lifestyle and clinical factors were collected using a well‐structured questionnaire. Medication adherence was measured using Adherence in Chronic Disease Scale, and frailty was assessed by Tilburg Frailty Indicator. Statistical analyses were performed using SPSS Version 26.0 and GraphPad prism 8.0. p‐value of < 0.05 and 95% confidence interval (CI) were considered statistically significant.Results: The prevalence of frailty was 59.7%. The proportion of high, medium and low medication adherence was 23.4%, 64.4% and 12.2%, respectively. Being ≥ 70years (adjusted odds ratio [aOR]: 8.33, 95% CI [3.72–18.67], p < 0.0001), unmarried (aOR: 2.59, 95% CI [1.37–4.89], p = 0.0030), having confirmed hypertension complications (aOR: 3.21, 95% CI [1.36–7.53], p = 0.0080), medium (aOR: 1.99, 95% CI [1.05–3.82], p = 0.0360) and low antihypertensive drug adherence (aOR: 27.69, 95% CI [7.05–108.69], p < 0.0001) were independent predictors of increased odds of developing frailty syndrome.Conclusion: Approximately 6 out of 10 Ghanaian adult patients with hypertension experience frailty syndrome. Hypertension complications, older age, being unmarried, and low antihypertensive drug adherence increased the chances of developing frailty syndrome. These should be considered in intervention programmes to prevent frailty among patients with hypertension.

Plant species have been used traditionally to treat numerous inflammatory disorders because of their known medicinal properties. This study aimed to assess the anti-inflammatory effect of aqueous ethanolic leaf extract of Persicaria lanigera using acute inflammatory models. The safety profile of the Persicaria lanigera extract was assessed using an acute toxicity model. The anti-inflammatory effect of the Persicaria lanigera leaf extract (100600mg·kg⁻¹, p.o.) was studied in carrageenan-induced paw oedema, zymosan-induced knee joint arthritis, and histamine-induced paw oedema in SpragueDawley rats (n=5). It was observed that the Persicaria lanigera leaf extract administered prophylactically significantly inhibited paw oedema from 99.01±12.59 to 59.10±4.94, 56.08±3.65, and 48.62±3.27 at 100mg·kg⁻¹, 300mg·kg⁻¹, and 600mg·kg⁻¹, while the standard drug, aspirin, showed 41.84±9.25 in carrageenan-induced paw oedema, respectively. Furthermore, the extract decreased knee joint inflammation significantly from 62.43±5.73 to 32.07±2.98 and 24.33±8.58 at 300mg·kg⁻¹ and 600mg·kg⁻¹ in zymosan-induced knee joint inflammation, respectively. In the histamine-induced paw oedema model, the extract significantly inhibited oedema to 61.53±9.17, 54.21±9.38, and 54.22±9.37 at the same doses. Aqueous ethanolic leaf extract of Persicaria lanigera is safe and attenuates inflammation in acute inflammation models.