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A systematic review and meta-analysis on antibiotic resistance genes in Ghana.

BACKGROUND: Addressing antimicrobial resistance (AMR) poses a complex challenge, primarily because of the limited understanding of bacterial antibiotic resistance genes (ARGs) and the spread of these genes across different domains. To bridge this knowledge gap in Ghana, we undertook a comprehensive systematic review and meta-analysis to quantify and estimate the prevalence of circulating ARGs in bacteria isolated from human, animal, and environmental sources. METHODS: A thorough literature search was conducted across three major databases-Web of Science, PubMed, and Scopus-to retrieve all relevant articles related to ARGs in Ghana from the inception of the databases to February 25, 2024. A risk-of-bias evaluation was performed using the Newcastle-Ottawa Scale (NOS), and the data analysis involved descriptive statistics and proportional meta-analysis. RESULTS: Of the 371 articles initially obtained, 38 met the inclusion criteria. These studies adequately covered Ghana geographically. The most prevalent ESBL gene identified was blaCTX-M, with a prevalence of 31.6% (95% CI: 17.6-45.7), followed by blaTEM (19.5% [95% CI: 9.7-29.3]), and blaSHV (3.5% [95% CI: 0.3-6.6]). The pooled prevalence of carbapenemase genes ranged from 17.2% (95% CI: 6.9-27.6) for blaNDM to 10.3% (95% CI: 1.9-18.7) for blaOXA. Additionally, other ARGs, including sul1, qnrS, gyrA, erm(B), and mecA, were detected, with prevalence ranging from 3.9% (95% CI: 0.0-8.5) to 16.4% (95% CI: 3.1-29.8). Several ARGs were shared across human, animal, and environmental sources. CONCLUSION: This review revealed that bacteria obtained from human, animal, and environmental samples in Ghana shared genes associated with AMR. This finding provides evidence on the interconnection of AMR across these three domains. Horizontal gene transfer, which enables the dissemination of ARGs between genetically diverse bacteria, can occur, necessitating a multidisciplinary approach to addressing antimicrobial resistance in Ghana.

Ghana

Vaccines and vaccinations in the under-fives in Ghana, a tropical developing country.

In this paper, an attempt has been made to focus attention on the important childhood killer but immunizable diseases in Ghana, giving where available morbidity and mortality figures. Immunization schedules currently adopted in Ghana are discussed in the light of immunological considerations, the half-life of acquired maternal antibodies and from the point of view of known epidemiological patterns of these immunizable diseases. An attempt was thus made to justify the adoption of the immunization schedules currently in force in Ghana. Problems relating to some of the vaccines used in immunization of the under-fives in Ghana have been discussed in the light of personal experiences and the experiences of other colleagues, giving--where possible--suggestions for improvement. Finally, the paper delineates problem areas in immunization programmes of the under-fives in Ghana.

Bacterial Vaccines

Comparative prevalence of the mercury resistance gene merA in human feces, food, and environmental water from Japan, Vietnam, and Ghana.

In this study, we investigated the prevalence and abundance of the mercury resistance gene merA in human feces, retail chicken meat, and environmental water samples collected from Japan, Vietnam, and Ghana. A real-time PCR assay developed in this study demonstrated high specificity toward merA sequences from more than 12 bacterial species. Using this assay, merA was detected in 6.8% of human fecal samples in Japan (n = 29), in contrast to significantly higher rates observed in Vietnam (70.2%, n = 47) and Ghana (97.4%, n = 39). Similar geographic trends were evident in the chicken meat samples: 18.5% in Japan (n = 27), 66% in Vietnam (n = 91), and 90% in Ghana (n = 10). Environmental water samples showed a consistently high merA detection rate across all countries (75-100%, n = 21), with substantially higher gene copy numbers in Vietnam and Ghana than in Japan. merA was detected in some water samples, even when total mercury concentrations were below the detection limit, indicating that molecular detection may offer greater sensitivity than traditional physicochemical methods. Mercury-resistant bacteria were successfully isolated and cultured, and Citrobacter freundii was identified as the representative strain. Genomic analysis revealed that merA was located on an IncFIB plasmid, flanked by insertion sequences, suggesting its potential for horizontal gene transfer. These findings highlight merA as a promising biomarker for environmental mercury exposure and support the utility of fecal merA analysis as a proxy for assessing mercury-related public health risks.

Humans

Burkitt's lymphoma in Ghana: urban-rural distribution, time-space clustering and seasonality.

Epidemiological data are summarized from 236 cases of Burkitt's lymphoma (greater than 90% cytologically or histologically confirmed) seen from 1970 through 1975 at Korle Bu Hospital, Accra, Ghana. The rate of referral from rural areas was greater than that from urban areas, despite a probable bias toward referral from urban areas. The distribution of cases in Ghana appeared to be non-random but we attribute this to variable access to medical care and physician interest. Rainfall did not appear to be an important factor. Seasonal variation and time-space clustering were not observed. The incidence here seems lower than that reported in East Africa. We found no evidence of an environmental influence with a short incubation period, as has been postulated for this disease in East Africa. The higher risk among rural patients is consistent with severe malaria being a factor in the etiology of Burkitt's lymphoma.

Burkitt Lymphoma

Clinical Impact and Genetic Analysis of Enteric Viruses Associated With Acute Gastroenteritis in Greater Accra, Ghana: A Comprehensive Study of Five Viruses.

Enteric viruses are significantly associated with acute gastroenteritis globally. Despite a decrease in severe rotavirus associated diarrhoea, Ghana still records high diarrhoea burden. Meanwhile aetiological investigations in hospital settings do not routinely include viral testing. Rotavirus vaccination is thought to alter enteric viral populations and impact evolution. To better understand virus-specific effects in acute gastroenteritis in both children and adults, we tested fecal samples from 228 patients at two hospitals in Accra from January to December 2019, using multiplex and singleplex PCR assays. The clinical impact of detected viruses was assessed using a modified Vesikari score system. Partial viral genome sequences were obtained by Sanger Sequencing and their genetic diversity and evolutionary history, traced by phylogenetic analyses. At least one enteric virus was found in 86 (37.7%) patient samples, with 36.9% of the population under five infected. Single infections of rotavirus, norovirus, adenovirus, sapovirus and astrovirus were 33, 14, 8, 6, and 1, respectively, while coinfections were 24. Rotavirus accounted for 33.3% of 24 clinically severe cases (modified Vesikari score > 7). Three out of 10 rotavirus cases with evidence of vaccination experienced severe gastroenteritis. Diverse genotypes, including RVA G2P[4], G1P[8], G12P[8] and G12P[6]; AdV F40 and F41; NoV GII.4 Sydney 2012, GII.6 and GI.3, several of which clustered with contemporary strains from the Americas, Europe and Asia, were detected. This study also provides the first report of SaV GI.1, GI.7 and GII.8 detection in humans in Ghana. RVA G2P[4] and AdV F were associated with higher proportions of hospitalizations. While RVA continues to have a profound clinical impact on gastroenteritis, AdV and SaV produce an equally severe disease. In contrast, NoV and AstV showed a generally mild to moderate impact on clinical disease severity.

Humans

Distribution and severity of onchocerciasis in southern Benin, Ghana and Togo.

The Onchocerciasis Control Programme in West Africa has recently extended its operation in southern Benin, Ghana and Togo. To estimate the number of people infected and blinded by onchocerciasis and to describe the distribution and severity of the disease in the extension area, 99 villages were selected, using a stratified random sampling procedure, and surveyed. All the ecological and entomological information available was used in the sampling procedure and in the selection of 87 non-representative villages surveyed to confirm the findings. The study estimated that 590,468 people are infected and 11,715 blind from onchocerciasis out of a rural population of 1,878,234. The Pru, Asukawkaw and Mono river basins were areas with high risk of onchocercal blindness. The Oueme and Zou river basins in Benin and the mountainous areas between Ghana and Togo were classified as areas with medium risk of onchocercal blindness. The other parts of the study area presented low or no risk of onchocercal blindness. By detecting the river basins where villagers are at risk of onchocercal disease this study permits the selection of populations for disease control based on mass distribution of ivermectin, a microfilaricide.

Animals

Plasmodium falciparum: sensitivity to chloroquine in vivo in three ecological zones in Ghana.

4690 children aged 6-15 years in 5 urban and 4 rural communities in 3 ecological zones in Ghana were screened from June 1988 to December 1990 to provide suitable candidates for the World Health Organization standard in vivo test for susceptibility of Plasmodium falciparum to chloroquine. 1880 (40.1%) had parasitaemia, mostly (83.7-98.6%) due to P. falciparum infection. Of the 626 in vivo tests performed, 570 (91.1%) showed sensitivity to chloroquine and 56 (8.9%) responses were classified as resistant to chloroquine at RI (5.1%) and RII (3.8%). The resistance responses were commonest (17.1-22.7%) in the coastal zone, followed by the savanna zone (8.6-10.0%), and lowest in the forest zone (3.1-6.3%). The RII responses occurred mainly in communities in the coastal zone. There was no RIII resistance in any zone. The pattern of RI (early) and RII responses of P. falciparum to chloroquine in this study suggested an increase in sensitivity, or a reduction in resistance, of P. falciparum to chloroquine from the coast to the forest and northern savanna zones, and from the urban to the rural communities in each zone in Ghana.

Adolescent

Mixing of Schistosoma haematobium strains in Ghana.

In Ghana, Schistosoma haematobium exists as two strains, one transmitted by Bulinus rohlfsi and the other by B. globosus. In Anyaboni, a resettlement town, where the field station of the UNDP/WHO Schistosomiasis Research and Control Project is located, the residents contract the "rohlfsi" strain of the parasite from the Volta Lake and the "globosus" strain from a stream near the town. The present studies indicate that there is mixing of the two parasite strains on a community and an individual basis. In Anyaboni, the parasite developed well in both B. rohlfsi and B. globosus. In another village 25 km from Accra, where B. globosus was the only vector, the parasite developed well in B. globosus but was refractory in B. rohlfsi. In a village near the Volta Lake where B. rohlfsi was the sole vector, the parasite developed well in B. rohlfsi but was refractory in B. globosus. However, complete separation of the two strains is uncommon in Ghana because extensive mixing has already occurred owing to migration of people and snails.

Animals

The training of traditional birth attendants in Ghana: experience of the Danfa Rural Health Project.

Three quarters of deliveries in Ghana are still attended by untrained personnel, including traditional birth attendants (TBA's), and maternal mortality remains high. The Ministry of Health is exploring ways of improving this situation. Recently, training traditional birth attendants to improve maternal and child health practices and promote family planning has been considered. Most TBA's in rural Ghana are elderly illiterate farmers. The Danfa Project has identified and trained 57 of these TBA's with the objective of developing a programme that might be replicated elsewhere in the country. This paper describes the design of the programme and problems encountered and makes recommendations to others who may be considering similar programmes in other countries.

Female

Utilisation by sheep of herbage under tree crops in Ghana.

A study conducted into the utilisation by sheep of herbage under a mango/cashew plantation at Kade (Ghana) showed the native herb, Asystasia gangetica to be the most preferred herbage. Centrosema pubescens was preferred to Pueraria phaseoloides. The physical condition of the herbage affected their preference but the crude protein content did not have any influence. The mean daily digestible dry matter intake of yearling rams (g/kg W0.75) was 34, 31 and 39 for animals on Brachiaria lata/Pueraria phaseoloides, Pueraria phaseoloides and Centrosema pubescens/Aystasia gangetica stands respectively. Intake was not correlated with crude protein levels of the herbage. The mean carrying capacity of the associations was found to be between 11 and 18 sheep/ha/annum.

Animal Feed

Canine spirocercosis in Accra, Ghana.

The prevalence of canine spirocercosis in the Accra region of Ghana was found to be 18 per cent, lesions being found in the oesophagus and in several other sites. In two of the 96 cases, the dogs had died of aortic rupture, probably caused by this parasite.

Animals

Expression patterns of plasma microRNAs in patients with cervical cancer from two teaching hospitals in Ghana.

AIM: Early cervical cancer diagnosis is a global challenge that needs to be addressed by the discovery of less invasive diagnostic and prognostic approaches. Circulating miRNAs are stable in plasma and their diagnostic potentials have been elucidated in some cancers. Therefore, in this cross-sectional study, we determined the patterns of expression of 7 selected circulating microRNAs that differ between patients with cervical cancer receiving therapy, patients with cervical not on therapy and healthy females. The goal was to investigate the diagnostic and prognostic potential of these selected miRNAs. METHODS: Total RNA was extracted from plasma samples collected from 53 participants recruited from Komfo Anokye Teaching Hospital and the Cape Coast Teaching Hospital, Ghana. Complementary DNA (cDNA) synthesis was performed, followed by quantitative polymerase chain reaction (qPCR) to amplify and quantify the expression levels of the target microRNAs. Expression levels of seven microRNAs-hsa-miR-146a, hsa-miR-29a, hsa-miR-29b, hsa-miR-34a, hsa-miR-233, hsa-miR-155, and hsa-miR-27a were compared among three groups: healthy controls (n = 27), patients with cervical cancer on therapy (n = 13), and those not on therapy (n = 13). RESULTS: miR-155 and miR-27a showed statistically significant differential expression between cancer patients and healthy controls. In addition, miR-29b expression levels differed significantly between stage 4b and stage 4a of patient with cervical cancer undergoing treatment. CONCLUSION: These findings suggest that circulating plasma miRNAs may serve as non-invasive biomarkers for the early detection of cervical cancer, monitoring disease progression, and evaluating treatment response.

Humans

Epidemiology of bovine brucellosis in the coastal savanna zone of Ghana.

323 sera from cattle raised in four locations in a coastal savanna area of Ghana were screened for brucellosis using the Rose Bengal plate test. The overall prevalence rate was 9.3%. No significant difference was seen between the infection rates in females (11.3%) and in males (4.3%). Generally, regardless of the sex of the animal, older animals (> or = 2 years) had significantly higher infection rates (11.6%) than younger animals (3.5%). In the females, the older animals had a relatively higher infection rate (13.5%) compared to nil (0) for the younger ones. However, in the males the converse was true, with younger animals having a relatively higher infection rate (6%) compared to the matured males (2.4%). 31% of the 42 herds examined tested positive for brucella antibodies in the Rose Bengal plate test. The need to monitor bovine brucellosis and educate the population at risk on dangers of infection is emphasised.

Age Factors

Endemic pyoderma in Ghana: a survey in rural villages.

The prevalence and characteristics of pyoderma in a randomly sampled rural population in Ghana has been studied. Findings are compared with studies reported in recent literature which describe pyoderma in other countries. In the present study, conducted in 1975 as part of the Danfa Project's Village Health Survey, pyoderma was diagnosed in 19.4% of villagers examined. Peak rates occurred in the five to nine-year-old age group, and pyoderma was more prevalent among males and unskilled labourers and farmers than among those engaged in more sedentary occupations. Non-bullous impetigo was most common (72% of lesions) and, in contrast to other studies, non-group A-streptococci predominated in these lesions (82% of streptococcal lesions were Group G, 18% Group C). Current knowledge of transmission and control of pyoderma is discussed.

Age Factors

Elephantiasis: a disease of development in north east Ghana.

A reconnaissance survey for the presence of lymphatic filariasis is made in 41 chiefdoms of north east Ghana. Four disease levels are identified culminating in hyperendemic disease foci associated with two Government-introduced rice irrigation projects. Attention is also drawn to the disease effects of small village dams. Multiple concurrent infections are noted. Within the most stricken irrigation villages, aspects of concealment, stigma and marriage are considered. Failure to control lymphatic filariasis has led to hospital avoidance and neglect of the disease jointly by patients, physicians and nurses. Culpability rests with the irrigation authority and Government health services. An outline is given of possible measures for disease control. A multisectoral policy of 'prevention before development' is strongly advocated.

Agriculture

Light trap collections of ovipositing Simulium squamosum in Ghana.

At a site near Boti waterfalls in southern Ghana a total of 14 644 female and two male Simulium squamosum were caught in four nights in Monks Wood light traps. The highest catch, of 6520 females, was obtained in a single night with an ultraviolet light tube that had a one-second flash rate. About 12% of the females caught were gravid and dissections of non-gravids showed that they had oviposited very recently. The traps were clearly catching females before or soon after oviposition. The same traps caught none or very few blackflies when placed in two other localities near Akosombo. Trap location appeared very important in sampling ovipositing females of S. squamosum.

Animals

Human Oesophagostomum infection in northern Togo and Ghana: epidemiological aspects.

Recently, it has been established that human infection with Oesophagostomum bifurcum is common in northern Togo and northeastern Ghana. Two surveys were conducted in this area. In a regional survey, O. bifurcum infection appeared to occur in 38 of 43 villages. The highest prevalences (up to 59%) occurred mostly in small isolated villages and were usually associated with high hookworm infection rates. The infection was relatively rare in children under five years of age (7% infected). In older individuals, females showed higher prevalences than males (30% vs. 24%). In a second survey, the entire population of two high-prevalence villages was examined. Infection rates were low in children under three years of age, but rose quickly thereafter, suggesting intense transmission. A stable level of infection was reached by 10 years of age. Oesophagostomum larvae were found more frequently in hookworm-positive than in hookworm-negative coprocultures, and possible explanations for the association between infection with Oesophagostomum and hookworm are discussed.

Adolescent

A study of bacterial meningitis in Kumasi, Ghana.

A prospective study of acute bacterial meningitis in infants and children in Kumasi, Ghana identified 69 cases by culture or antigen detection. Of these, 50.7% (n = 35) were S. pneumoniae, 34.8% (n = 24) N. meningitidis and 14.5% (n = 10) H. influenzae. The mortality for each pathogen was 36.4%, 17.4% and 30%, respectively, showing no significant difference. In pneumococcal meningitis, the most significant clinical factor associated with an increased mortality rate or subsequent neurological sequelae was a lowered level of consciousness at admission (chi 2 = 8.66, d.f. = 1, p = 0.003). Antibiotic susceptibilities were determined in the 40 positive isolates. Six cases of N. meningitidis and two of S. pneumoniae were penicillin-resistant, and there was a single case of chloramphenicol-resistant S. pneumoniae.

Adolescent