Abu Abudu Rahamani

Background: The lack of a short-course of safe and effective macrofilaricidal therapy for lymphatic filariasis (LF) hinders elimination efforts, especially in the endgame scenario. Preclinical studies in mice demonstrated that high-dose rifampicin (RIF) plus albendazole (ALB) produced macrofilaricidal effects within seven days, prompting this randomised, open-label, parallel-group, interventional phase II pilot trial to determine the efficacy of high-dose RIF plus ALB against LF in humans. Methods: In three LF-endemic districts of Ghana’s Upper East Region, circulating filarial antigen (CFA)-positive individuals aged 18 to 55 years identified using the Alere Filariasis Test Strip were enrolled into the study. The participants were randomised through a centralized computer-generated randomisation into four treatment arms. They were treated according to the arm they were assigned to and followed up at 4-, 6-, 12-, and 18-months post-treatment to monitor changes in CFA status and levels, as well as adverse events. Outcome assessors were blinded to minimize assessment bias. Results: A total of 69 eligible participants were randomised into four treatment arms: RIF (35 mg/kg/day) + ALB (400 mg/day) for 7 days (n = 17), RIF (35 mg/kg/day) + ALB (400 mg/day) for 14 days (n = 18), ALB alone for 14 days (n = 17), and an untreated controlled group participating in standard mass drug administration (n = 17). All regimens were well tolerated, with no serious adverse events. Even though CFA positivity declined across all groups, with maximal reductions at 18 months, the RIF + ALB 7-day regimen consistently showed the highest decline, while ALB alone was the least effective. RIF + ALB groups exhibited early antigen decline by 4 months, unlike comparator groups, where reductions occurred from 12 months. Conclusions: These findings suggest macrofilaricidal activity of high-dose RIF plus ALB, supporting further trials in larger, microfilaraemic populations. The trial was registered in the Pan African Clinical Trials Registry on 9 September 2020 under the code PACTR202009704006025.Funding was by the European and Developing Countries Clinical Trials Partnership 2 (EDCTP2), with grant code TMA2018SF-2451-ASTAWOL, and by the German Federal Ministry of Education and Research (Bundesministerium fur Bildung und Forschung-BMBF) under agreement with Gesellschaft für Internationale Zusammenarbeit (GIZ) through agreement number: 81204851.

Background: Hepatitis B virus (HBV) infection remains a major public health challenge in sub‐Saharan Africa, including Ghana, despite the infant vaccination programs. Limited data exist on HBV prevalence and predictors in informal sector populations, who may face unique occupational and behavioral exposures. This study assessed the prevalence and predictors of HBV infection among sellers and workers at Kejetia Market, Ghana′s largest commercial hub. Methods: A cross‐sectional study was conducted among 489 adult market workers from December 4, 2024, to January 25, 2025. Participants were selected through stratified random sampling across occupational groups. Data on sociodemographic, occupational, and behavioral factors were collected using structured questionnaires. On‐site testing for Hepatitis B surface antigen (HBsAg) was performed using the Hightop One Step Rapid Test kit. Bivariate and multivariate logistic regression analyses were used to identify independent predictors of HBV infection. p < 0.05 was considered statistically significant. Results: The overall prevalence of HBV infection was 7.36% (36/489), consistent with intermediate‐to‐high endemicity. Multivariate analysis identified three independent predictors of HBV infection. Female gender (aOR = 0.455, 95% CI: 0.221–0.937; p = 0.033) and absence of tattoos (aOR = 0.283, 95% CI: 0.110–0.730; p = 0.009) were associated with lower risk of HBV infection, whereas unvaccinated individuals had 3.37‐fold increased odds of getting the infection (95% CI: 1.395–8.142; p = 0.007). HBV prevalence declined progressively with increasing vaccine doses, from 9.2% in unvaccinated individuals to 2.3% among those who had completed three or more doses. Conclusion: HBV infection is common among Kejetia Market workers, with prevalence exceeding both continental and global estimates. Gender, tattooing, and vaccination status were significant predictors of infection. These findings highlight the urgent need for targeted adult Hepatitis B vaccination programs and strengthened occupational health interventions. They also emphasize the importance of regulating high‐risk practices such as informal tattooing within Ghana′s informal sector to reduce HBV burden and achieve Ghana′s contribution to the WHO goal of eliminating HBV by 2030.

: Filarial lymphedema (LE) remains a significant global problem despite the progress made toward elimination of lymphatic filariasis (LF). In Ghana, the main approach to LF is preventive chemotherapy, but this has minimal impact on individuals who have already developed LE. In 2018–2020, a 24-month randomized, double-blind, placebo-controlled trial was conducted to evaluate the efficacy of stringent hygiene measures using the Essential Package of Care with or without additional administration of doxycycline (DOX) to improve filarial leg LE. This study enrolled 356 participants with LE stages 1–3 from two districts in the Upper East Region of Ghana. In addition to regular training on appropriate care for their affected legs, participants were randomized to receive 6 weeks of either 200 mg/day DOX (n = 117), 100 mg/day DOX (n = 120), or matching placebo (n = 119). Participants were seen every 2 months, with clinical measurements done at 6, 12, 18, and 24 months to assess the status of affected legs. There was a trend toward later appearance of acute attacks after DOX, but surprisingly, DOX showed no effect on LE stage progression. In all groups, leg LE improvement was more common (DOX 200 mg: n = 23 [20%]; DOX 100 mg: n = 23 [19.5%]; placebo: n = 32 [27.4%]) than LE worsening (DOX 200 mg: n = 2 [1.7%]; DOX 100 mg: n = 3 [2.5%]; placebo: n = 2 [1.7%]). Overall, these data show a strong benefit from adherence to a strict hygiene protocol, with some added potential benefit for DOX in preventing acute attacks.

Chronic lymphedema caused by infection of Wuchereria bancrofti is a disfiguring disease that leads to physical disability, stigmatization, and reduced quality of life. The edematous changes occur mainly on the lower extremities and can progress over time due to secondary bacterial infections. In this study, we characterized participants with filarial lymphedema from Ghana and Tanzania as having low (stage 1–2), intermediate (stage 3–4), or advanced (stage 5–7) lymphedema to determine CD4⁺ T cell activation patterns and markers associated with immune cell exhaustion. A flow cytometry-based analysis of peripheral whole blood revealed different T cell phenotypes within participants with different stages of filarial lymphedema. In detail, increased frequencies of CD4⁺HLA-DR⁺CD38⁺ T cells were associated with higher stages of filarial lymphedema in patients from Ghana and Tanzania. In addition, significantly increased frequencies of CCR5⁺CD4⁺ T cells were seen in Ghanaian participants with advanced LE stages, which was not observed in the Tanzanian cohort. The frequencies of CD8⁺PD-1⁺ T cells were augmented in individuals with higher stage lymphedema in both countries. These findings show distinct activation and exhaustion patterns in lymphedema patients but reveal that immunological findings differ between West and East African countries.