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:Bacterial vaginosis (BV) is highly prevalent in women of African origin and has been associated with adverse birth outcomes (ABO), particularly preterm birth (PTB). However, evidence from sub-Saharan Africa remains limited, and while a previous study conducted in this area examined the prevalence of BV, its impact on pregnancy outcomes was not assessed. This study assessed the prevalence and risk factors of BV in early pregnancy and examined its association with ABO in the middle belt of Ghana. METHODS:This analysis was nested within a prospective cohort of pregnant women in the Kintampo North Municipality and Kintampo South District. Pregnant women <20 weeks' gestational age were screened, consented, enrolled and followed through delivery until one year after birth. At enrolment, sociodemographic, behavioural, and obstetric data were collected, along with biological samples, including vaginal swabs for Gram staining and Nugent scoring. BV status was categorized as BV-negative (0-6) or BV-positive (7-10) and ABO included PTB (<37 weeks), low birthweight (LBW < 2.5 kg), and foetal loss. Data were double-entered in REDCap and analysed in R. Associations between BV and ABO were assessed using chi-square tests, and logistic regression was used to identify risk factors for BV. RESULTS:Of 1,180 pregnant women enrolled, 355 (30.1%) were BV-positive. PTB (9.9% vs. 8.7%; p = 0.50), LBW (13.8% vs. 12.0%; p = 0.39), and foetal loss (4.5% vs. 2.8%; p = 0.14) were all higher among BV-positive women, but none reached statistical significance. Younger age and unmarried status were associated with BV. Unmarried women (AOR 1.63; 95% CI: 1.20-2.22) and those reporting one sexual encounter per week (AOR 1.55; 95% CI: 1.01-2.37) had increased odds of BV. CONCLUSIONS:BV is highly prevalent in early pregnancy in this Ghanaian cohort, particularly among younger and unmarried women, but was not significantly associated with ABO. Targeted screening among high-risk groups is necessary, and future molecular approaches may better characterise BV subtypes linked to ABO in African settings.
Background Globally, malaria remains a leading cause of morbidity and mortality, with pregnant women at the highest risk. However, Plasmodium falciparum and Plasmodium vivax are the main species affecting pregnant women, significantly contributing to anaemia and related complications. Iron deficiency (ID) and malaria-induced inflammation play life-threatening roles in women at various stages of pregnancy, especially in sub-Saharan Africa, where malaria is endemic. Our study aimed to assess the influence of malaria on iron and immunohaematological indices among pregnant women in the Upper East Region of Ghana. Methods A prospective cross-sectional study was conducted at selected urban and rural health facilities in the Upper East Region, Ghana, recruiting 150 pregnant women with or without malaria. Participants’ sociodemographic and economic characteristics were collected through a structured questionnaire. Five millilitres of venous blood were collected from study participants for haematological analysis, malaria microscopy, Rapid Diagnostic Tests (RDTs), and enzyme-linked immunosorbent assay (ELISA). Results Iron deficiency anaemia (IDA) prevalence was 31.4% of the study population, and anaemia was marginally associated with age (p = 0.050). In adjusted analyses, pregnant women with only a primary education had significantly higher odds of elevated HRP2 levels (AOR = 33.38, p = 0.013). Urban residence (AOR = 4.51, p = 0.021) and middle-income status (AOR = 3.60, p = 0.040) were also independently associated with malaria. Compared with malaria-negative controls, pregnant women with malaria had significantly elevated levels of acute-phase proteins (AGP and CRP) and the malaria-specific biomarker HRP2, as well as indicators of reduced iron status (p < 0.05). The infection was also associated with a significantly lower red blood cell count (p = 0.013) and hematocrit (p = 0.021). IDA was significantly linked to elevated CRP levels (p = 0.044), suggesting an acute inflammatory response. Conclusion The study reveals a high prevalence of malaria and anaemia, and their frequent co-occurrence, among pregnant women in northern Ghana. Malaria was associated with altered iron status and adverse immunohaematological changes. These findings underscore the potential value of integrated strategies that address both malaria and anaemia in antenatal care programs in this region.
Abstract BACKGROUND Adverse consequences of neonatal hyperbilirubinemia disproportionately affect babies in low- and middle-income countries. Laboratory measurement of total serum bilirubin is limited in low-resource settings, necessitating simpler alternatives. Our study aimed to evaluate the diagnostic accuracy of visual inspection of jaundice via the World Health Organization Integrated Management of Childhood Illnesses algorithm compared to transcutaneous bilirubinometry for the identification of hyperbilirubinemia in community settings. METHODS Hyperbilirubinemia was assessed by visual inspection for jaundice and transcutaneous bilirubinometry at 0-72 hours, 3-5 days, and 5-14 days postnatal in the PRISMA prospective cohort study in six sites in Asia and Africa. We assessed sensitivity, specificity, and positive and negative percent agreement. RESULTS We analyzed data from 14,331 infants, including 1,852 preterm infants. 15% had hyperbilirubinemia, as defined by transcutaneous bilirubin values and the NICE nomograms, at 3-5 days postnatal. Visual inspection had a sensitivity of 16%, specificity of 96%, positive percent agreement of 56%, and negative percent agreement of 86% at 3-5 days postnatal age, pooled across all sites and gestational ages, versus transcutaneous bilirubin defined by NICE nomograms. CONCLUSION The poor sensitivity of visual inspection underscores an urgent need for accurate, affordable screening tools to improve screening for hyperbilirubinemia. Impact Statement: We found poor sensitivity of visual inspection, identifying fewer than one in five neonatal jaundice cases, suggesting much worse diagnostic accuracy in this community-based context across five low- and middle-income countries (LMICs) as compared to the previous studies conducted in health facilities. Among preterm infants, sensitivity was modestly higher than in term infants but remained clinically inadequate, reinforcing that visual inspection alone is insufficient for this high-risk group. Despite standardized training and biannual refresher sessions, our study suggests that training for health care workers alone is unlikely to make visual inspection a reliable case-detection tool. Our findings suggest that the WHO should re-evaluate the IMCI recommendations to include tools with higher diagnostic accuracy to identify neonatal jaundice. Community-level jaundice screening should move beyond visual inspection alone towards validated, low-cost, objective tools; icterometers and smartphone apps with high diagnostic accuracy are promising alternatives.
