Samuel Blay Nguah

Diabetes mellitus in children, adolescents and young adults presents major clinical, social, and psychological challenges, particularly in low- and middle-

BACKGROUND: Addressing the rising burden of stroke in low-income countries will require pragmatic and scalable interventions targeting major risk factors. Under routine care settings, P =0.008). The primary outcome was achieved in 163 (67%) patients with PINGS versus 109 (43%) in the usual care arm, with a between-group difference of 24% (95% CI, 15%–33%; P P =0.12). CONCLUSIONS: Leveraging mobile health intervention with minimal sophistication and task shifting to nurses on top of usual care safely improved blood pressure control among stroke survivors in a low-resource setting. Further study is warranted to confirm these findings and understand outcome drivers. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04404166.

Background and Aims: Anemia remains a major contributor to pediatric morbidity and mortality in sub‐Saharan Africa, yet contemporary data from tertiary pediatric emergency settings are limited, particularly among children older than 5 years. This study assessed the prevalence, factors associated with anemia, hematological characteristics, and short‐term clinical outcomes among children admitted to a pediatric emergency unit (PEU) in Kumasi, Ghana. Methods: This prospective observational study enrolled children aged 2 months to 17 years admitted to the PEU of Komfo Anokye Teaching Hospital, Ghana, between November 2024 and January 2025. Sociodemographic, dietary, and clinical data were obtained through caregiver interviews and medical record review. Anemia was defined and graded using age‐ and sex‐specific World Health Organization hemoglobin thresholds. Red cell indices were used to describe anemia morphology. Logistic regression analysis was employed to identify factors independently associated with anemia. Results: Among 318 children enrolled, 66.7% had anemia. Mild, moderate, and severe anemia accounted for 14.8% (47/318), 34.6% (110/318), and 17.3% (55/318) of cases, respectively. Among children aged 6–59 months, 65.3% (113/173) were anemic. Moderate anemia predominated across age groups, while severe anemia was more frequent among older children. Microcytic anemia with elevated red cell distribution width was the most common morphological pattern, suggesting a high burden of iron deficiency. Anemia was independently associated with clinically presumed iron deficiency, sickle cell disease, and malaria rapid diagnostic test positivity. Nearly one‐quarter of participants required blood transfusion, reflecting the severity of presentations. Conclusion: Anemia was highly prevalent among children admitted to a tertiary pediatric emergency unit in Ghana and was frequently associated with severe disease requiring blood transfusion. Strengthened strategies focusing on early identification of hemoglobinopathies, prompt malaria control, and improved nutritional assessment and counseling are urgently needed within emergency and inpatient pediatric care.

Background: The burden and effects of anaemia remain high worldwide, with predictors varying by location, demographics, and socioeconomic factors. Knowing localised, specific predictors of anaemia helps develop targeted local interventions. We therefore set out to determine the prevalence and predictors of anaemia in a semiurban and rural community in Ghana. Methods: From June to August 2021, a community‐based cross‐sectional study using multilevel sampling was conducted in the Ejura‐Sekyedumase Municipality, Ghana. Four hundred and seventy‐six children, aged one to five, were recruited from four communities in the Kasei Subdistrict. Using a structured questionnaire, clinical, demographic, anthropometric, dietary and laboratory data, including blood haemoglobin, were obtained. The data were entered into EpiData and analysed with R statistical software. A multivariate ordinal logistic regression model was used to identify independent predictors of increasing anaemia severity. Results: The prevalence of anaemia was 76.3% (95% CI: 72.2–80.0), with mild, moderate and severe anaemia being 28.8% (95% CI: 24.7–33.1), 44.3% (95% CI: 39.8–48.9) and 3.2% (95% CI: 1.8–5.1), respectively. Two hundred and fifty (52.5%) children had malaria parasitaemia. Independent predictors of worsening anaemia severity were increasing age (aOR: 0.96, 95% CI: 0.95–0.98, p < 0.001), child eating from his/her bowl as opposed to communal eating (aOR: 0.47, 95% CI: 0.28–0.80, p = 0.005), stunting (aOR: 1.83, 95% CI: 1.17–2.88, p = 0.009), malaria parasitaemia (aOR = 3.62, 95% CI: 2.42–5.46, p < 0.001) and mothers’ religion (aOR: 2.44, 95% CI: 1.62–3.68, < 0.001). Conclusions: The Ejura‐Sekyedumase Municipality has a high burden of anaemia and malaria parasitaemia in children between one and five years old. Malaria parasitaemia, communal eating, younger age and the mother’s religion were significantly associated with worsening anaemia. It is recommended that intermittent antimalarial treatment, routine administration of iron and trace elements, and counselling at well‐baby and antenatal clinics on specific predisposing dietary habits be instituted for children under five years of age.

Background: Placental infections caused by Schistosoma spp. and sexually transmitted microorganisms can adversely impact pregnancy outcomes. However, the association between molecular detection of these pathogens in placental tissue and corresponding histopathological inflammation remains unclear, particularly in sub-Saharan African populations. Methods: In this cross-sectional study, placental parenchyma specimens with limited membrane sampling were collected from 103 Ivorian and Ghanaian mothers without known pregnancy or birth complications. Tissue pieces adjacent to PCR-tested samples were analyzed by real-time PCR targeting Chlamydia trachomatis, Mycoplasma hominis, Neisseria gonorrhoeae, Schistosoma spp., Streptococcus agalactiae, Trichomonas vaginalis, Ureaplasma parvum and Ureaplasma urealyticum. Corresponding adjacent tissues were examined by routine histopathology, supplemented with immunohistochemistry when higher pathogen DNA quantities were detected, to assess inflammatory changes. Results: Real-time PCR detected U. urealyticum in 15 out of 103 cases (14.6%, ±0.7%), U. parvum in 13 (12.6%, ±0.6%), S. agalactiae in 11 (10.7%, ±0.5%), the S. haematobium complex in four (3.9%, ±0.2%), M. hominis in four (3.9%, ±0.2%), confirmed N. gonorrhoeae in two (1.9%, ±0.1%) and non-confirmed N. gonorrhoeae in one (1.0%, ±0.1%), T. vaginalis in two (1.9%, ±0.1%), and C. trachomatis (non-lymphogranuloma venereum serovar) in one (1.0%, ±0.1%). Overall, pathogen DNA levels were low, with only four positive PCR results yielding cycle threshold (Ct) values below 30 and none below 25. Histopathological examination revealed no relevant inflammatory changes in any samples. Conclusions: Placental parenchyma tissues with limited membrane sampling testing positive for Schistosoma spp. or sexually transmitted pathogens by molecular methods demonstrated no corresponding histopathological inflammation. These findings warrant confirmatory studies to better characterize potential region-specific placental infection phenotypes and their clinical significance.

Background: Helicobacter pylori ( H. pylori ) infection is highly prevalent in low‐resource settings and has been implicated in adverse health outcomes beyond the gastrointestinal tract, including potential effects on early neurodevelopment. However, data from sub‐Saharan Africa is limited. Methods: We conducted a prospective cohort study among 229 mother–child dyads from Ghana and Côte d'Ivoire to assess the association between H. pylori infection and early child development at 12 months of age. Child development was evaluated using the Developmental Milestones Checklist (DMC), encompassing locomotor, fine motor, language, and personal–social domains. H. pylori infection status was determined by stool antigen testing. Quantile regression models, adjusted for socioeconomic status and sex, were applied to analyze associations between H. pylori infection and DMC scores. Results: Among 229 children, 38 (16.6%) tested positive for H. pylori . The median total motor score was higher in H. pylori ‐negative children (45, IQR 41–50) compared to positive children (43, IQR 40–45; p = 0.031). At the 75th percentile, H. pylori infection was significantly associated with a 7‐point reduction in the motor domain score (estimate = −7; 95% CI: −11.1 to −2.9; p = 0.001; FDR‐adjusted p = 0.003) and a 10‐point reduction in total DMC score (estimate = −10; 95% CI: −17.5 to −2.6; p = 0.009; FDR‐adjusted p = 0.027) after multivariable adjustment. No significant associations were observed at lower or median quantiles, nor in language or personal‐social domains. Conclusion: H. pylori infection at 12 months of age is significantly associated with impaired motor development among children performing in the upper range of developmental achievement. These findings underscore the potential neurodevelopmental impact of early‐life H. pylori infection in high‐prevalence, resource‐limited settings and highlight the importance of integrating infection control strategies into early childhood development programs. Further research is warranted to elucidate infection‐related neurodevelopmental risks in early childhood.

Background: Pregnancy in patients with diabetes is known to be associated with complications. Improving glycaemic control can improve pregnancy outcomes. Aims: This study assessed pregnancy outcomes among adolescents and young women with diabetes at Paediatric and Adolescent Diabetes Clinic, Komfo Anokye Teaching Hospital, Kumasi, Ghana. Methods: A clinical review involving eighteen children and young women with diabetes who became pregnant during follow-up care at Paediatric and Adolescent Diabetes Clinic in Ghana. Girls and young women suspected to be pregnant were referred to antenatal clinic for confirmation. Multidisciplinary care including comprehensive antenatal care was given to each participant throughout the pregnancy. Questionnaire was used to gather demographic and clinical information of participants including pregnancy outcomes. Results: A total of eighteen adolescents and young women got pregnant and were included in the study. They were attending school when they got pregnant, 55.6% were in Senior High School, 33.3% were in Junior High School and 11.1% were in Teacher Training College. The mean age at pregnancy was 18.39 years (SD 2.97). Two pregnancies ended in abortion while 16 resulted in 18 live births (14 singleton and 2 twin deliveries). All deliveries were supervised, 56.3% delivered via cesarean section. Two births were preterm, occurring at 30 and 32 weeks of gestation. Neonatal outcomes were generally favorable: all babies were clinically well, 55.6% had 5-minute APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score between 8 and 10, while 44.4% had 5-minute APGAR score between 6 and 7. Only one infant (5.6%) had a congenital malformation. One baby died at one month due to septicemia. Conclusion: Structured multidisciplinary interventions led to positive pregnancy outcomes among young females with diabetes in Ghana.

Background and Aims: Sickle cell disease (SCD) is the most common clinically significant genetic disorder affecting about 300,000 newborns globally each year. In Ghana, a prevalence of 1.8% exists among newborns. With increasing life expectancy, assessment of the effect of progressive organ damage on quality of life becomes essential. Organs involved could be the lungs, heart, brain, kidney, and bones. This study aims to describe major organ dysfunction and its associated factors in children aged 6–16 years with SCD in the Kumasi Centre for Sickle Cell Disease (KC‐SCD) patient cohort in Kumasi, Ghana. Methods: It will be a cross‐sectional study conducted over a 1‐year 8‐month period at the pediatric sickle cell clinic of the Komfo Anokye Teaching Hospital (KATH). All patients, except those coming for acute care or emergency visits, will be eligible for enrollment. Data on sociodemographic details, medical history, and previous complications, anthropometry, and pubertal stage will be collected. Full blood count, reticulocyte counts, lactate dehydrogenase counts, lung function tests, electrocardiogram, echocardiogram, mental health status assessment and pubertal staging will be conducted to assess end organ dysfunctions. Data will be entered into a REDCap database, cleaned, and exported to the STATA statistical software for analysis. The prevalence of specific end‐organ dysfunction will be determined based on predefined criteria. Subsequently, the relationship between the various end‐organ dysfunctions and clinical and laboratory covariates will be determined using inferential analysis. Conclusion: These results will help to know the burden of end organ damage in our pediatric population and subsequently feed into the recommendations and hospital policies for screening for end organ dysfunction.

Background: Poststroke cognitive impairment is prevalent worldwide, with no satisfactory preventative therapeutic strategies. We report on the effect of a cardiovascular polypill on cognitive performance among recent stroke survivors. Methods and Results: The SMAART (Stroke Minimization through Additive Anti‐atherosclerotic Agents in Routine Treatment) trial was a phase II randomized trial primarily assessing the polypill versus usual care for secondary prevention after a recent ischemic stroke. Participants allocated to the experimental arm were provided 2 Polycaps taken orally once a day for 12 months. A capsule of Polycap contained aspirin 100 mg, simvastatin 20 mg, hydrochlorothiazide 12.5 mg, ramipril 5 mg, and atenolol 50 mg. Participants in the usual care arm received standard secondary prevention therapy. We compared slopes of the trajectory of raw scores in the executive, language, memory, and visuospatial cognitive domains and aggregated cognitive scores over 12 months via a linear mixed‐effects model. We enrolled 148 eligible participants (n=74 in each arm) and 59 versus 64 participants in the polypill and usual care arms, respectively, at month 12. Compared with the usual care arm, the slopes of cognitive performance over 12 months in the polypill arm were steeper by 2.02 units (95% CI, 0.52–3.53), P =0.009 in executive domain, 1.88 units (95% CI, 0.42–3.34), P =0.012 in language domain, 2.60 (0.03–5.17), P =0.049 in memory domain, 0.55 (−0.80 to 1.91), P =0.42 in the visuospatial domain, and global cognitive performance 6.87 units (95% CI, 1.44–12.30), P =0.013. Conclusions: The cardiovascular polypill is associated with a signal of better cognitive performance over 12 months among stroke survivors. Further definitive trials are warranted. Registration: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT03329599.

Collaboration in research has increased over the years with many advances in medical knowledge. With understanding and good faith, many of these partnerships have yielded remarkable results and significantly improved our world. The inequity has resulted in many untoward effects since much of this collaborative research is between persons from richer or high-income countries and poorer or lower-income ones. Helicopter Research or “parachute research” refers to the situation where a more resourced partner in a research collaboration goes into the less resourced partner's location, conducts research, exports the data, and publishes the findings, often with no or very little input from or acknowledgement of the less resourced counterpart. This does not only occur between richer and poorer nations but also even within the same country where the relationship is asymmetrical.