George Ghartey-Kwansah

Non-participation in MDA undermines schistosomiasis control and sustains local transmission hotspots in Ghana despite national progress. Schistosomiasis, a neglected tropical disease caused by parasitic flatworms of the genus Schistosoma , remains prevalent in sub-Saharan Africa due to poverty, poor access to clean water and sanitation, and low awareness. This study evaluated the impact of non-participation on MDA effectiveness in the Abee community, Central Region, while identifying barriers to uptake and strategies to improve community engagement. A cross-sectional study was conducted among 298 participants. Schistosomiasis prevalence was assessed by urine microscopy and PCR, and multivariate logistic regression was used to identify factors influencing infection and MDA participation (p ≤ 0.05). Results showed a prevalence of 17.1% by microscopy and 20.1% by PCR. Only 48.7% of participants had ever participated in MDA, with 31.5% never treated. Awareness of schistosomiasis was 60.4%. Multivariate analysis revealed that non-participation in MDA and lack of disease education significantly increased infection risk, while awareness strongly predicted MDA uptake. Microhaematuria and leukocyturia were detected in 6.7% and 8.4% of participants, respectively. These WASH gaps facilitate environmental contamination with Schistosoma haematobium eggs, sustaining transmission despite ongoing MDA efforts. In conclusion, low MDA participation driven by limited awareness and weak WASH infrastructure sustains focal transmission hotspots (17.1–20.1% prevalence) in Abee. Strengthening community engagement, targeted health education, improved MDA access, and integrated WASH interventions is essential to increase coverage and achieve the WHO 2030 elimination targets. Author Summary: Schistosomiasis, also known as bilharzia, is a major neglected tropical disease that affects millions of people, particularly in sub-Saharan Africa. Although Ghana has made progress through mass drug administration (MDA) with praziquantel, the disease continues to persist in some communities. In this study, investigation was done to determine why schistosomiasis persists in the Abee community in Ghana’s Central Region. 298 participants were recruited and tested their urine using both conventional microscopy and a more sensitive molecular (PCR) method. 17.1% tested positive by microscopy and 20.1% by PCR. Strikingly, only 48.7% of participants had ever received praziquantel during MDA campaigns, and nearly one-third (31.5%) had never been treated. People who had never participated in MDA and those with low awareness of the disease were significantly more likely to be infected. Poor sanitation practices were also widespread, with many residents sharing toilets or practicing open defecation. These conditions allow the parasite to continue circulating in the environment. Our findings show that low participation in treatment programmes, limited health education, and inadequate water, sanitation, and hygiene (WASH) infrastructure are the main reasons schistosomiasis transmission persists in this community. This study highlights that MDA alone is not sufficient. Achieving the WHO 2030 elimination targets will require stronger community engagement, improved health education, higher treatment coverage, and better sanitation services.

Antimicrobial resistance (AMR) has emerged as a significant global health challenge, particularly in low- and middle-income countries where surveillance data remain limited. Understanding local microbial patterns and resistance trends is critical for guiding empirical therapy and implementing effective antimicrobial stewardship policies. This study aimed to characterize the microbial profile and antimicrobial resistance patterns of pathogens from clinical specimens at the Cocoa Clinic Laboratory, Ghana, from 2019 to 2023. A retrospective analysis was conducted on 6,395 clinical specimens collected between January 2019 and December 2023 from a secondary-level hospital in Accra, Ghana. Samples, including midstream urine, high vaginal swabs (HVS), and blood, were processed for bacterial and fungal isolation using standard microbiological techniques. Descriptive and trend analyses were conducted on specimen types, pathogen prevalence, and resistance patterns. Antimicrobial susceptibility testing was performed, and data were analyzed using Microsoft Excel, SPSS version 27, and GraphPad Prism 8. A total of 6,395 clinical specimens were analyzed, of which 22.2% (95% CI: 19.6-24.9) yielded positive microbial growth. Urine samples constituted the majority of positive cultures (50.6%), followed by HVS (30.3%), with other specimen types accounting for 19.1%. Gram-negative organisms predominated (62.7%), with Escherichia coli emerging as the leading bacterial isolate across most years and specimen types. Notably, a shift in pathogen distribution was observed in 2023, when Candida species became the most frequently isolated organism, suggesting a possible change in pathogen distribution (p < 0.001). Females exhibited a higher culture positivity than males (61% vs. 39%, p < 0.0001), and adults aged 18-64 years accounted for the majority of isolates. Antimicrobial susceptibility testing revealed high effectiveness of amikacin, ciprofloxacin, and gentamicin (> 89% susceptibility), whereas cefuroxime, co-trimoxazole, and ampicillin/sulbactam showed high resistance rates (> 68%). Overall, temporal trends indicated an increase in infection rates from 2021 to 2023, contrasting with lower detection during the early COVID-19 period. This highlights an urgent need for continuous AMR surveillance, strict antibiotic stewardship, and the development of targeted infection control strategies. These findings provide valuable baseline data to inform clinicians, policymakers, and public health authorities in optimizing treatment guidelines and combating AMR in Ghana.

Intestinal parasitic infections (IPIs) pose a significant public health threat in endemic regions, where multiple species of parasites co-circulate, resulting in polyparasitism and an increased disease burden. Despite efforts to control these infections, the complex interactions between different intestinal parasites, and environmental determinants remain poorly understood. This study aimed to investigate the distribution and co-occurrence patterns of major intestinal parasites as well as associated factors influencing IPIs. A retrospective facility-based study was conducted using hospital records of pregnant women over a 12-month period in Northern Ghana to assess the prevalence and associated factors of intestinal parasitic infections (IPIs). Stool samples had been examined using the formol-ether concentration microscopy technique. Data were cleaned and analyzed in R using descriptive statistics, chi-square tests, and logistic regression analyses to examine associations between IPIs and factors such as age group, malaria status, season, and stool consistency. A total of 1,606 participants were involved in the study. The overall prevalence of IPIs was 20.86% (95% CI: 18.94-22.91), while the co-infection rate was 1.74% (95% CI: 1.21-2.51). The most frequently identified parasites were Entamoeba histolytica/dispar/moshkovskii complex (n = 89, 5.5%), intestinal flagellates (n = 86, 5.4%), and Giardia lamblia (n = 33, 2.1%). The most common co-infections were Entamoeba coli with intestinal flagellates (n = 10, 0.6%) and Entamoeba coli with Entamoeba histolytica/dispar/moshkovskii complex (n = 9, 0.56%). Significant associations were observed between IPIs and the presence of red blood cells (RBCs) in stool (χ² = 31.92, df = 1, p < 0.001), white blood cells (WBCs) in stool (χ² = 35.07, df = 1, p < 0.001), and stool consistency (χ² = 21.41, df = 4, p < 0.001). Other factors such as malaria status (χ² = 1.24, df = 1, p = 0.264), presence of yeast-like cells in stool (χ² = 0.89, df = 1, p = 0.345), and season (χ² = 1.33, df = 1, p = 0.248) were not significantly associated with IPIs. This study demonstrates a considerable burden of IPIs among pregnant women in Northern Ghana, with protozoan parasites being the predominant Intestinal parasites identified. The findings highlight the importance of routine parasitological screening, the need to improve sanitation and hygiene interventions, and targeted health education during antenatal care to reduce the burden of IPIs and improve maternal health outcomes. Not applicable.

Schistosomiasis, an endemic neglected tropical disease in areas with poor sanitation, causes physical and mental defects in both children and adults. Various strategies, especially drug administration for morbidity control, have been implemented to combat the disease in Ghana and globally. Despite these efforts, schistosomiasis remains prevalent in Ghana, negatively impacting children's academic performance, growth, and overall quality of life. This study aimed to determine the prevalence of schistosomiasis in school children at Esuekyir, a peri-urban community in Ghana. A cross-sectional study using simple random sampling technique to select participants and collect stool and urine samples from 246 school children in Esuekyir was adopted. Microscopy of urine and stool samples was performed involving urine sedimentation and stool formol-ether sedimentation techniques to analyse for parasite eggs. Questionnaires were developed to help detect risk factors that expose these children to the disease. The prevalence of urogenital schistosomiasis in children at Esuekyir was 15.45% while that of intestinal schistosomiasis was 6.957.0%. There was one case of co-infection of urogenital and intestinal schistosomiasis from a 13 year old primary student. Children in primary school had higher risks of infection due to their activities around the water body. There was a significant association between class groups and urogenital schistosomiasis (p-value = 0.042). The presence of schistosomiasis in school children highlights the importance of targeted interventions and public health initiatives in addressing this specific disease condition especially in primary school children. Findings from the research revealed a higher prevalence of urogenital schistosomiasis in the study population as compared to intestinal schistosomiasis.

Malaria is endemic in the Central region of Ghana, however, the ecological and the seasonal variations ofPlasmodiumpopulation structure and the intensity of malaria transmission in multiple sites in the region have not been explored. In this cross-sectional study, five districts in the region were involved. The districts were Agona Swedru, Assin Central and Gomoa East (representing the forest zone) and Abura-Asebu-Kwamankese and Cape Coast representing the coastal zone. Systematically, blood samples were collected from patients with malaria. The malaria status was screened with a rapid diagnostic test (RDT) kit (CareStart manufactured by Access Bio in Somerset, USA) and the positive ones confirmed microscopically. Approximately, 200 μL of blood was used to prepare four dried blood spots of 50μL from each microscopy positive sample. ThePlasmodiumgenome was sequenced at the Malaria Genome Laboratory (MGL) of Wellcome Sanger Institute (WSI), Hinxton, UK. The single nucleotide polymorphisms (SNPs) in the parasite mitochondria (PfMIT:270) core genome aided the species identification ofPlasmodium. Subsequently, the complexity of infection (COI) was determined using the complexity of infection likelihood (COIL) computational analysis. In all, 566 microscopy positive samples were sequenced. Of this number,Plasmodiumgenome was detected in 522 (92.2%). However, whole genome sequencing was successful in 409/522 (72.3%) samples. In total, 516/522 (98.8%) of the samples containedP.falciparummono-infection while the rest (1.2%) were eitherP.falciparum/P.ovale(Pf/Po) (n = 4, 0.8%) orP.falciparum/P.malariae/P.vivax(Pf/Pm/Pv) mixed-infection (n = 2, 0.4%). All the fourPf/Poinfections were identified in samples from the Assin Central municipality whilst the twoPf/Pm/Pvtriple infections were identified in Abura-Asebu-Kwamankese district and Cape Coast metropolis. Analysis of the 409 successfully sequenced genome yielded between 1–6P.falciparumclones per individual infection. The overall mean COI was 1.78±0.92 (95% CI: 1.55–2.00). Among the study districts, the differences in the mean COI between ecological zones (p = 0.0681) and seasons (p = 0.8034) were not significant. However, regression analysis indicated that the transmission of malaria was more than twice among study participants aged 15–19 years (OR = 2.16, p = 0.017) and almost twice among participants aged over 60 years (OR = 1.91, p = 0.021) compared to participants between 20–59 years. Between genders, mean COI was similar except in Gomoa East where females recorded higher values. In conclusion, the study reported, for the first time,P.vivaxin Ghana. Additionally, intense malaria transmission was found to be higher in the 15–19 and > 60 years, compared to other age groups. Therefore, active surveillance forP.vivaxin Ghana and enhanced malaria control measures in the 15–19 year group years and those over 60 years are recommended.

Nosocomial infections have gradually become an emerging threat to the healthcare system over the past decades and have been attributed to poor decontamination of hospital articles and weak antibacterial stewardship policies. This study sought to investigate the effect of disinfection on the prevalence and resistance profile of bacterial contaminants on oxygen device accessories, and clinical surfaces at the emergency unit of a tertiary health facility in Ghana. The study employed a cross-sectional study design to evaluate the occurrence of bacteria on surfaces in a tertiary hospital. Luminal swabs of the oxygen device accessories and swabs from clinical surfaces used by healthcare providers were collected for isolation and identification of bacteria. The identified bacteria isolates were then tested for their susceptibility to antibacterial agents. Data from this study were analyzed using Excel (Microsoft Office Suite), and GraphPad Prism 8 software programs. A quarter of the total 44 bacterial isolates obtained from both post-disinfected and pre-disinfected surfaces were Gram-positive, with the remaining isolates being Gram-negative. Pseudomonas aeruginosa was the most frequent bacteria species isolated (41%) followed by Citrobacter sp. (21%). P. aeruginosa, S. aureus, and S. pneumoniae were found to be highly resistant to Chloramphenicol (36%), and Sulfamethoxazole (100%); whereas Ciprofloxacin (91%) was the most effective antibacterial drug used. The almost equal prevalence of multidrug-resistant bacteria from both post-disinfected and pre-disinfected surfaces of inanimate objects, and oxygen device accessories connote an ineffective disinfection process which may influence resistance in bacterial contaminants. This requires the overhaul of disinfection protocol and training of hospital staff, and rational use of antibacterial agents at the hospital to mitigating the burden of nosocomial infections.

Avicennia africana is an important ethnomedicinal plant that has long been used to treat malaria and several other diseases. Despite the plant’s antimalarial and other therapeutic properties, there is limited evidence-based data on its potential toxicity. Hence, the purpose of the current study was to assess the safety of A. africana leaf ethanolic extract (AAE). The study was designed to ascertain the cytotoxic effects of the crude extract on red blood cells (RBCs) as well as the acute and subacute toxicity in Wistar albino rats in accordance with Organization for Economic Co-operation and Development (OECD) guidelines “Test No. 423” and CPMW/SWP/1042/99. The pulverized, shade-dried plant leaves were sequentially macerated with 70% ethanol to obtain the crude extract (AAE). The extract’s cytotoxic activity (CC50) against the uninfected human red blood cells (RBCs) was determined using the 3-(4,5-Dimethylythiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. For the acute toxicity studies, the rats (male and female) were divided randomly into six groups of five rats (n = 5) and dosed orally once with the following dose levels: 100, 300, 1000, 3000, and 5000 mgkg−1, p.o. of the extracted AAE, with the control group receiving only the vehicle. In the repeated dose toxicity studies, the rats (both sexes) were orally administered daily with AAE at 100, 300, and 1000 mgkg−1 for 14 days. Rat body weights were measured, and blood samples were tested for haematological and biochemical markers. Internal organs like the heart, kidney, liver, and spleen were collected, inspected, and weighed, and histological examinations were performed. The median lethal dose (LD50) value is greater than 5000 mgkg−1 body weight, with no significant change in bodyweight or relative organ weight (ROWs) of the extract-treated groups or control group. The extract showed greater cytotoxicity activity (CC50), which was >100 μg/mL, compared to the reference drug (artesunate).The dosage groups of 100 and 300 mgkg−1bwt had neutrophilia and lymphocytopenia ( p < 0.05 ). However, changes in these haematological parameters may not be dose dependent and could be stress related. All the serum biochemical markers studied in rats given AAE did not show any significant change ( p > 0.05 ). Histopathological examination of internal organs of AAE-treated rats did not show any significant abnormalities resulting from the extract treatment compared to the control group. Based on the findings in the present study, the LD50 value of AAE was found to exceed 5000 mgkg−1 in the acute toxicity test, while the no observed adverse effect level (NOAEL) in rats was 1000 mgkg−1 p.o. In the sub-acute toxicity tests. Histopathological analysis revealed no morphological abnormalities in the vital organs.