Malaria remains a major cause of morbidity and mortality in sub-Saharan Africa. Severe Plasmodium falciparum malaria is primarily driven by parasite sequestration in deep vascular tissues. Standard diagnostic tools, such as peripheral parasitaemia determination, do not always reflect the total parasite burden. Plasma Plasmodium falciparum Histidine-Rich Protein 2 (PfHRP2) level has emerged as a potential biomarker for estimating total parasite biomass, which may better reflect disease severity than peripheral parasitaemia. However, it is still unclear how PfHRP2-estimated parasite biomass varies across different clinical malaria syndromes, how well it predicts severity compared to circulating parasitaemia, and how prior antimalarial treatment influences these measures. Addressing these gaps is critical to improving severity assessment and guiding timely interventions. Data from 118 children diagnosed with cerebral malaria (CM, n = 58), severe malaria anaemia (SMA, n = 28), or uncomplicated malaria (UM, n = 32) were collected in five referral hospitals in Accra from 2012 to 2016. Total parasite burden (PTot) was estimated using PfHRP2-based biomass measurement while the circulating parasite burden (PCir) was determined from peripheral parasite density. The sequestered parasite burden (PSeq), which represent the difference between PTot and PCir, was also evaluated. Additionally, the impact of prior antimalarial treatment on parasite burden was assessed. PTot and PSeq were consistently higher than PCir in severe malaria syndromes. In UM, PTot and PCir were similar, while the median PCir was lower in CM than in UM, suggesting greater sequestration in severe disease. After regaining consciousness, CM patients exhibited decreased PTot and PSeq values compared to their values at initial clinical evaluation. Higher PSeq estimates were associated with coma. Prior antimalarial treatment also reduced PCir but did not significantly change PTot. PfHRP2-derived total parasite biomass demonstrated a stronger association with severe malaria syndromes than peripheral parasitaemia. Accounting for prior antimalarial treatment is essential, as it may lower circulating parasite counts without affecting total biomass. Incorporating total parasite biomass assessments into clinical evaluation could enhance disease severity classification and inform timely interventions in endemic regions.

Tick-borne protozoan parasites pose significant risks to veterinary health worldwide, affecting both companion animals and livestock. When wildlife and domestic animals come into contact due to habitat encroachment, the likelihood of pathogen transmission increases, with ticks serving as potential vectors. This study investigated the occurrence of tick-borne pathogens of veterinary concern in ticks collected from wildlife commonly hunted and sold at the Atwemonom Bushmeat Market in Kumasi, Ghana. Ticks removed from wildlife carcasses were identified morphologically and screened using primers targeting a 560 bp fragment of the ssrRNA gene, the 345 bp region of the 16 S rRNA gene, and Sanger sequencing. A total of 211 ticks were collected from 46 wildlife carcasses representing three host species. The dominant tick species was Ixodes aulacodi (49.76

Breast cancer (BC) is a serious public health concern in sub-Saharan Africa, with Ghana incurring a staggering 5026 cases and 2369 deaths in 2022. The insufficiency of accurate epidemiological information, limited access to health care, late diagnoses, and insufficient screening procedures hinder policy implementation. While numerous treatment methods, such as chemotherapy, radiation, and immunotherapy, exist, patients with BC respond differently. The variation in response can be accounted for by a combination of genetic, environmental, and socioeconomic factors specific to the Ghanaian population. This review examines the unique molecular and immunologic characteristics of BC in Ghana and their implications for therapeutic effectiveness in personalized treatment. Precision medicine is suggested as imperative in the design of biomarker-guided therapies to consider the BC molecular heterogeneity that is prevalent among Ghanaian patients. However, there is still a challenge of late-stage diagnosis due to insufficient diagnostic infrastructure. Early detection efforts through investment in next-generation sequencing and health care training are imperative. Besides, immune checkpoint inhibitors show promising therapeutic utility in triple-negative breast cancer (TNBC), and clinical trials in the Ghanaian population should be considered. This article emphasizes the need for community education to counteract misconceptions and ensure timely health care-seeking behaviours. To minimize mortality rates and improve patient care for BC in Ghana, a concerted approach through research funding, policy reform, and collaborative stakeholder engagement is imperative, in addition to advancements in diagnostics and therapeutics in the local context.

The human gut microbiome, consisting of bacteria, archaea, fungi, and viruses, influences various physiological processes of the body. The gut microbiome composition is shaped by factors such as diet, geography, and antibiotic use. Malaria has been a global health challenge over the years, especially in low- and middle-income countries. This study investigated how asymptomatic malaria infection altered gut microbial communities in Ghanaian children, offering insights for novel malaria control strategies. Standard aseptic phlebotomy procedures were employed to collect venous blood samples for Plasmodium species detection. The gut microbial community was profiled by sequencing the 16S rRNA V4 region, and sequence data were processed using the DADA2 pipeline in R. Asymptomatic malaria infections were predominantly mixed with P. falciparum and P. malariae. Microbiome analysis revealed that Firmicutes and Bacteroidetes comprised nearly 70% of the total microbial population. Asymptomatic individuals showed a decrease in Firmicutes abundance from 52.5% to 44.0% and an increase in Bacteroidetes from 34.7% to 45.6%. There was also a slight increase in the abundance of Proteobacteria from 3.0% to 4.8%. At the genus level, Prevotella_9 was the most abundant and exhibited the highest variability in the infected groups. The Alloprevotella and Streptococcus genera increased in both infected groups, but Escherichia-Shigella was significantly elevated in only those with mixed infections. Faecalibacterium significantly declined in asymptomatic malaria-infected individuals compared to healthy controls, with variability further reduced in mixed infections. Beta-diversity analysis indicated a significant effect of malaria status on microbial composition (PERMANOVA, p < 0.05), explaining approximately 19.1% of the total variation captured by a 2D Principal Component Analysis (PCA) projection. These findings suggest a potential link between malaria infection and gut microbiota alterations and highlight microbial shifts associated with disease status.

Ticks of the genus Haemaphysalis, akin to other tick genera, are obligate hematophagous ectoparasites of medical and veterinary importance, serving as vectors for various pathogens. Haemaphysalis ticks, like Haemaphysalis muhsamae (H. muhsamae) within the Haemaphysalis leachi group, have previously had taxonomic uncertainties, which recent revisions have validated. Historically restricted to Eastern and Southern Africa, knowledge of their presence in West Africa has remained uncertain. This study aimed to confirm the presence of H. muhsamae in Ghana and to investigate its distribution, host associations and infestation patterns across ecological zones and seasons. A total of 3816 ticks were collected from wild mammal carcasses at two bushmeat markets between 2020 and early 2021. Morphological examination and molecular analysis targeting the mitochondrial cytochrome oxidase I (COI) gene confirmed the presence of H. muhsamae in Ghana for the first time. Of the total, 140 ticks (3.7%) were identified as H. muhsamae, predominantly infesting the African civet (Civettictis civetta), striped ground squirrel (Xerus erythropus) and Kusimanse mongoose (Crossarchus obscurus). The species occurred in both forest (3.9%) and coastal savannah (3.5%) zones, with infestation intensity highest on African civets (p = 0.0032) and significantly greater during the wet season in the coastal savannah (p = 0.0213). Phylogenetic analysis showed close genetic similarity between Ghanaian specimens and those from the Democratic Republic of the Congo, suggesting a shared evolutionary lineage. These findings expand the known distribution of H. muhsamae and underscore the importance of ongoing tick surveillance and molecular characterization to better understand tick-borne disease risks in West Africa.

Background:More than 80% of children living with cancer reside in developing countries like Ghana, with over 1000 new cases projected each year. Spatial analysis of pediatric cancers provides insights into possible environmental risk factors, potential genetic associations, and the identification of clusters or hotspots, which can guide further investigation into causal factors and inform population-level interventions. Aim:This retrospective observational study aimed to investigate the spatial distribution dynamics of pediatric cancer cases diagnosed at the Komfo Anokye Teaching Hospital, Ghana. Methods:Poisson regression and spatial statistical tools, including Kernel Density Estimation (KDE) and Kulldorff's spatial scan statistics, were used to analyze 652 pediatric cancer cases recorded from 2018 to 2022 in Southern Ghana. Results:The results revealed increasing pediatric cancer cases over the 5 years. Burkitt Lymphoma, Leukemia, Nephroblastoma, Other Non-Hodgkins Lymphoma, and Retinoblastoma had higher incidence among children, with males having a 24% higher incidence rate compared to females (Incident Rate Ratios [IRR] estimated at 1.24 at p < 0.01, 95% confidence interval [CI): 1.06, 1.45). Further, the KDE plot consistently revealed a high density of reported cases in the central part of the study area, with a noticeable directional diffusion of pediatric cancer cases toward the northwest from 2018 to 2022. Three significant clusters of relative risk between 1.65 and 2.17, p < 0.01, were identified, covering parts of the Bono East and Ashanti Regions of Ghana. Conclusion:Clustering cancer cases could suggest a possible environmental influence on the occurrence of the disease. Although this study offers relevant baseline information, comprehensive epidemiological investigations are necessary to establish specific environmental risk factors and potential gene-environment interactions contributing to this pediatric cancer clustering.

PAVON has developed a malaria microscopy competency training scheme to augment competency in malaria microscopy. Here, data accrued from training activities between 2020 and 2023 in Botswana are presented. Three trainings were done for 37 central and peripheral level technicians for a two-week period. The scheme consisted of basic theory on Plasmodium parasites, malaria epidemiology and diagnosis. The practicals focused on standard slide preparation, staining, parasite detection, speciation and counting. Scores were assessed by the Wilcoxon signed rank test. Participants who excelled joined the WHO External Competency Assessment for Malaria Microscopy (ECAMM). The median competency scores for the three trainings were detection: 100 (IQR = 94–100), 100 (IQR = 94–100) and 92 (IQR = 92–100), respectively, from pre-test scores of 40 (IQR = 27–54), 44 (IQR = 32–52) and 20 (IQR = 10–40) (z = 2.937, p < 0.003, z = 3.110, p = 0.002 and (z = 2.251, p = 0.024), respectively. Speciation: 93 (IQR = 86–96), 81 (IQR = 73–96) and 88, (IQR = 88–100) from pre-test scores of 50 (IQR = 30–50), 36 (IQR = 20–45) and 17 (IQR = 17–50) (z = 2.936, p < 0.003, z = 3.152, p = 0.002 and z = 3.237, p = 0.001). The competency scores achieved in the ECAMM were 98/98 and 97/98 for sensitivity and specificity pre- and post-tests detection. The training was effective in raising the competency skills of participants and is open to NMPs (National Malaria Programs) for critical capacity building.

Blood group O is reported to confer some degree of protection from severe malaria in endemic setting. This protection is believed to be due to reduced and smaller rosette formation in people of blood group O which can easily be cleared by the host immune system. Also, sickle cell trait (HbAS) is reported to disrupt the adhesion of infected erythrocytes to microvascular endothelial walls, which could protect pregnant women from placental malaria. We determined the association between HbAS and ABO blood group, and placental malaria amongst pregnant women of all parities. The study enrolled 221 pregnant women. Peripheral blood samples were taken for malaria smears, ABO blood grouping and haemoglobin (Hb) electrophoresis. A structured questionnaire was used to age, bed net usage, and the number of Sulphadoxine-pyrimethamine (SP) doses taken by a pregnant woman. Two hundred and twenty-one (221) pregnant women were enrolled and out of this number, 110 (49.8%) were primiparae and 111 (50.2%) multiparae, with a mean age of 23.7±5.2. Placental malaria (PM) prevalence by PCR detection was 19.4% (43/221). Of those who were malaria positive 58.1% (25/43) were primiparae. Primiparae who are of blood group O were more susceptible to PM [P=0.04, (OR); 2.85, 95% (Cl), 1.12-9.01]. But sickle cell trait did not reduce the prevalence of PM [P=0.84 (OR); 0.92, 95% (Cl), 0.43-1.99]. Non-blood group O primiparae women were protected against placental malaria. This could be why some primiparae women are protected from PM, just like multiparae women.

Introduction: Chest tubes are inserted regularly in clinical practice. It is a life-saving therapeutic procedure. But there can be complications if the appropriate size or length of insertion is not considered carefully. There are charts that guide, but there is no clear mathematical relationship between the age and body surface area (BSA), and the appropriate size and length of insertion. We carried out this study to develop a formula that provides a more precise guide using the child’s age or BSA. Additionally, in the absence of a chart, the clinician can easily remember the formula to determine the most appropriate size and length. Patients and methods: Children aged 12 years and below who had chest tube insertion at the National Cardiothoracic Centre from July 2015 to August 2016 were retrospectively enrolled into the study. The inclusion criteria was those who had the chest tube data recorded in their notes. This was the derivative cohort. The chest tube type used was SURUCATH ULTRA®. The BSA was calculated using the Mosteller formula. The statistical analysis was performed using Microsoft excel 2013. Formulae were developed from the data of the derivative cohort, and used to determine the appropriate chest tube size and length of insertion on a validation cohort from January 2021 to April 2022. Results: In the derivative cohort, there were 50 children, 34.0% being males. The mean age was 4.2 ± 2.9 years. The weight ranged from 3.5 – 50 kg, the height ranged from 50 – 159 cm and the body surface area ranged from 0.2 – 1.5 m2. In the validation cohort, there were 56 children, 48.0% being males. The mean age was 4.4 ± 2.8. The weight ranged from 5 – 40 kg, the height ranged from 54 – 152 cm and the body surface area ranged from 0.3 – 1.3 m2. The outcome of the validation was good. The chest tubes functioned well and there were no chest tube-associated complications. The formulae obtained were S (FG) = A + 16, L (cm) = 0.3A + 3.5, S (FG) = 6B + 16, L (cm) = 3.5B + 3, where S is the size of the chest tube, A is the age in years, L is the length of insertion and B is the body surface area. Conclusion: A formula can be developed to guide in determining the most appropriate chest tube size and length of insertion in children, using the age and body surface area.

Introduction: The T-cell subset (CD4+Tregs) play a significant role in immunoregulation, by active suppression of the immune system, through cell-to-cell contact and the secretion of IL10. The frequencies of these cell subpopulations were investigated in the mother. Methods: The study recruited 61 mothers out of this number, 31 mothers with plasmodium parasitized placentas and 30 mothers without plasmodium infection. Placental malaria positivity was determined by PCR and microscopy. Peripheral mononuclear cells (PBMCs) were isolated from peripheral blood, cultured in the presence of VAR2CSA antigen, and stained with antibodies (CD3, CD4, CD25, and IL-10), before cytometry analysis. Results: The CD4+CD25+ T cell frequencies were significantly higher in all the participants (p<0.0001), and comparable across gravida. These cell populations were similar when compared between primigravid and secumgravida mothers (p=0.77), and between multigravida and secumgravida mothers (p=0.84). Primigravid mothers with placental malaria had significantly higher frequencies of CD4+CD25+ T cell population (p=0.04). The frequencies of CD4+IL10 were significantly high in both primigravid and multigravid mothers who were placental malaria positive (p=0.03) and (p=0.04) respectively. Conclusion: Induced Tregs (CD4+IL10) cells could play a role in placental malaria susceptibility due to an increase in their populations in mothers with plasmodium-infected placentas.

Serpin E1/PAI-1, N-terminal pro-brain natriuretic peptide (NTpro-BNP) and neuropilin-1 are markers which have been associated with endothelial dysfunction. However, data on the levels of these markers in PE is limited. The limited data on the pathophysiology of PE in relation to these markers necessitated the study. This was a multicentre case-control study conducted at the Obstetrics and Gynaecology Department of the Tamale Teaching Hospital, the Bawku Presbyterian Hospital and the Bolgatanga Regional Hospital. Out of 520 consenting pregnant women, 127 pregnant women met the inclusion criteria (53 with PE and 74 controls) and were included in this study. Venous, placental, cord and peripheral blood were collected for biomarker assay, haematological parameters and placental parasite determination. Placental tissue sections were obtained for placental malaria and histopathological lesions associated with hypoperfusion. Maternal heart rate and foetal umbilical artery Doppler impedance indices; resistance index (RI) and systolic diastolic (SD) ratio were determined to confirm utero-placental hypoperfusion. Significantly higher proportions of foeto-maternal complications; eclampsia, low birth weight (LBW), neonatal intensive care unit admissions (NICU), intrauterine growth restriction (IUGR), caesarian deliveries and early gestational age at delivery were associated with PE. Women with PE had lower concentrations of platelet (p = 0.02) whereas red cell distribution width (RDW) was markedly elevated (p = 0.01). NTPro-BNP concentration was markedly elevated (p = 0.01) in women with PE whereas neuropilin-1 concentration was lower (p = 0.03) compared to the non-PE group. Maternal heart rate was elevated in women with PE and Doppler resistance indices (RI and SD) were significantly elevated in foetuses of PE women than foetuses of the controls. Placental mal-perfusion lesions were higher in women with PE compared to the non-PE group. Women with PE had increased risk of adverse foeto-maternal complications, significantly associated with placental mal-perfusion lesions, had reduced platelet concentration and elevated RDW-CV levels. NTPro-BNP, RI and SD are elevated in women with PE whereas neuropilin-1 concentration is reduced. Significant changes in these pathological variables in PE women is indicative of significant derangement in endothelial function culminating in adverse maternal and perinatal outcomes of pregnancy.

This chapter evaluated the aetiology of anaemia in pregnant women in Northern Ghana. Maternal anaemia has significant adverse effects on both mothers and infants. The risk of death among pregnant women with severe anaemia has been reported to be twice that of mothers without severe anaemia. This hospital-based cross-sectional case-control study was conducted in the Obstetrics and Gynecology Department of the Regional Hospital Bolgatanga (RHB), Ghana, West Africa, from May 2013 to May 2014. A total of 400 pregnant women, comprising 253 anaemic and 147 non-anaemic pregnant women attending the antenatal clinic at the Bolgatanga Regional Hospital, Ghana, were selected for the study. Venous blood was collected and haemoglobin genotype, complete blood count and biochemical parameters [ferritin, iron, total iron binding capacity (TIBC), transferrin saturation (TfS), C-reactive protein (CRP) and bilirubin] were determined. Per the manufacturer's instructions, daily quality control checks were run on control specimens within specified limits. Thick blood films were prepared for malaria parasitemia, while early morning stool and midstream urine samples were examined for enteric and urogenital parasites, respectively. Anaemic pregnant women had a significantly lower mean HGB, HCT, MCV, and MCHC than their non-anaemic counterparts (p<0.0001). Conversely, there was a significantly higher mean WBC and RDW amongst anaemic pregnant women than non-naemic women (p<0.05). There were significantly reduced levels of HGB (p<0.0001), HCT (p<0.0001), MCV (p<0.0001), iron (0.0273), ferritin (p=0.018) and transferrin saturation (0.0391) and an increased WBC (p=0.006), RDW (p=0.0480), TIBC (p=0.0438) and positivity of CRP in the anaemic group compared to non-anaemic pregnant women. Plasmodium falciparum, Schistosoma hematobium, increased hemoglobinopathies (AS, SS, and SC), and intestinal parasite infections were associated with anaemic women. Iron deficiency is linked to a notable disruption in haematological and iron indices in pregnant women who are anaemic. Hemoglobinopathies and parasite infections further complicate this outcome.

Abstract Background Plasmodium falciparum and Hookworm infections are prevalent in West Africa and they cause iron deficiency anemia and protein malnutrition in Children. Immune response of these parasites interact and their interactions could have repercussions on vaccine development and efficacy. The current goal of hookworm eradication lies on vaccination. We evaluated the effect of P. falciparum coinfection and albendazole treatment on naturally acquired antibody profile against hookworm L3 stage larvae antigen. Methods In a longitudinal study, 40 individuals infected with Necator americanus only, 63 participants infected with N. americanus and P. falciparum, and 36 nonendemic controls (NECs) were recruited. The study was done in the Kintampo North Metropolis of Ghana. Stool and blood samples were taken for laboratory analyses. Serum samples were obtained before hookworm treatment and 3 weeks after treatment. Results The malaria‐hookworm (N. americanus and P. falciparum) coinfected subjects had significantly higher levels of IgE (β = 0.30, 95% CI = [0.12, 0.48], p = 0.023) and IgG3 (β = 0.15, 95% CI = [0.02, 0.52], p = 0.004) compared to those infected with hookworm only (N. americanus). The N. americanus groups had significantly higher levels of IgG3 (β = 0.39, 95% CI = [0.14–0.62], p = 0.002) compared to the control group. Similarly, N. americanus and P. falciparum coinfected participants had significantly higher levels of IgE (β = 0.35, 95% CI = [0.70–0.39], p = 0.002) and IgG3 (β = 0.54, 95% CI = [0.22–0.76], p = 0.002). Moreover, albendazole treatment led to a significant reduction in IgE, IgA, IgM, and IgG3 antibodies against hookworm L3 stage larvae (p < 0.05) Conclusion P. falciparum is associated with improved IgE and IgG response against hookworm L3 stage larvae. Treatment with single dose of albendazole led to reduction in naturally acquired immune response against hookworm infection. Thus, P. falciparum infection may have a boosting effect on hookworm vaccine effectiveness.

BACKGROUND:Evidence from recent studies in Schistosoma mansoni-endemic areas show an age-associated immunity that is positively correlated with IgE titres to Schistosoma mansoni-specific tegumental allergen-like protein 1 (SmTAL1). The structural homology between SmTAL1 and the S. haematobium-specific TAL1 (ShTAL1) has been verified, yet it remains unclear whether similar age- and immune-associated trends characterize ShTAL1. This community-based intervention study was conducted to assess whether ShTAL1IgE responses post-treatment with praziquantel (PZQ) might be associated with a reduced risk to re-infection with S. haematobium.METHODOLOGY/PRINCIPAL FINDINGS:This study was conducted at Agona Abodom, Central Region, Ghana, and involved 114 participants aged 6 to 55 years. EDTA blood samples were collected at baseline and 7 weeks after PZQ treatment (Follow-up). Baseline and Follow-up titres of specific IgG1, IgG4, and IgE antibodies to the S. haematobium-specific adult worm antigen (ShAWA), the Sh-specific soluble egg antigen (ShSEA), and the Sh-specific tegumental-allergen-like 1 protein (ShTAL1) in plasma samples were measured using sandwich ELISA. Participants at both time points also provided stool and urine for helminth egg detection by microscopy. Prevalence of S. haematobium at baseline was 22.80%, and decreased to 3.50% at Follow-up. The egg reduction rate (ERR) was 99.87%. Overall plasma levels of ShTAL1-IgE increased 7 weeks post-PZQ treatment, and with increasing age; whiles S. haematobium infection prevalence and intensity decreased. For S. haematobium-infected participants who were egg-negative at Follow-up (N = 23), minimal median levels of ShTAL1-IgE were observed for all age groups prior to treatment, whilst median levels increased considerably among participants aged 12 years and older at Follow-up; and remained minimal among participants aged 11 years or less. In the univariate analysis, being aged 12 years or older implied an increased likelihood for ShTAL1-IgE positivity [12-14 years (cOR = 9.64, 95% CI = 2.09-44.51; p = 0.004); 15+ years (cOR = 14.26, 95% CI = 3.10-65.51; p = 0.001)], and this remained significant after adjusting for confounders [12-14 years (aOR = 22.34, 95% CI = 2.77-180.14; p = 0.004); ≥15 years (aOR = 51.82, 95% CI = 6.44-417.17; p < 0.001)]. Conversely, median ShTAL1-IgG4 titres were hardly detectible at Follow-up.CONCLUSIONS/SIGNIFICANCE:These findings demonstrate that increased IgE levels to ShTAL1 7 weeks after PZQ treatment could be associated with a reduced risk to re-infection, and adds to the large body of evidence suggesting a protective role of the treatment-induced ShTAL1 antigen in schistosomiasis infections. It was also quite clear from this work that apart from being persistently S. haematobium-positive, elevated ShTAL1-IgG4 levels at Follow-up could be indicative of susceptibility to re-infection. These outcomes have important implications in vaccine development, and in shifting the paradigm in mass chemotherapy programmes from a 'one-size-fits-all' approach to more sub-group-/participant-specific strategies in endemic areas.

OBJECTIVE:The study evaluated the socio-demographic characteristics, obstetric variables and foeto-maternal complications associated with low birth weight (LBW) in order to provide better treatment and management options. METHODS:The prospective study conducted from February, 2019 to June, 2020 recruited 312 primigravid pregnant women who reported for antenatal care in three tertiary referral hospitals in northern Ghana. Their socio-demographic, obstetric and adverse foeto-maternal outcome information were obtained with a well-structured questionnaire according to the World Health Organisation (WHO) guidelines. Participants' blood samples were collected for haematological tests. Odds ratio [OR, 95% confidence interval (CI)] for the association between socio-demographic, obstetric characteristics, foeto-maternal complications and haematological tests in relation to LBW were assessed using logistic regression model. RESULTS:This study reported a LBW prevalence of 13.5%. Increasing maternal systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 1st visit, before and after delivery significantly increased the odds of LBW. Preterm delivery (PTD<37 weeks) (COR = 9.92, 95% CI (4.87-2020), p<0.001), preeclampsia (PE) (COR = 5.94, 95% CI (2.96-11.94), p<0.001), blood transfusion (COR = 14.11, 95% CI (2.50-79.65), p = 0.003), caesarian delivery (COR = 3.86, 95% CI (1.96-7.58), p<0.001) and male sex neonates (COR = 2.25, 95%CI (1.14-4.47), P = 0.020) presented with increased odds of LBW. Increasing gestational age at delivery presented with 28% reduced odds of LBW (COR = 0.72, 95% CI (1.12-4.40), P = 0.023). Upon controlling for potential confounders in multivariate logistic regression, only gestational age at delivery (AOR = 0.67, 95% CI (0.47-0.96), P = 0.030) remained significantly associated with reduced odds of LBW. CONCLUSION:This study found that high blood pressure at 1st visit, before and after delivery results in increased chances of delivering a baby with LBW. Furthermore, PTD<37 weeks, having PE in current pregnancy, and male sex potentiate the risk of LBW. On the other hand, increasing gestational age reduces the risk of LBW. Thus, we recommend that midwives should intensify education to pregnant women on the benefits of regular ANC visits to aid in the early detection of adverse foeto-maternal complications. We also recommend proper clinical management of pregnancies associated with an elevated blood pressure at registration. Also, maternal intrapartum blood pressure measurement could be used to predict LBW in low resourced settings.

Background Asymptomatic malaria infections can serve as potential reservoirs for malaria transmission. The density of parasites contained in these infections range from microscopic to submicroscopic densities, making the accurate detection of asymptomatic parasite carriage highly dependent on the sensitivity of the tools used for the diagnosis. This study sought to evaluate the sensitivities of a variety of molecular and serological diagnostic tools at determining the prevalence of asymptomatic Plasmodium falciparum parasite infections in two communities with varying malaria parasite prevalence. Methods Whole blood was collected from 194 afebrile participants aged between 6 and 70 years old living in a high (Obom) and a low (Asutsuare) malaria transmission setting of Ghana. Thick and thin blood smears, HRP2 based malaria rapid diagnostic test (RDT) and filter paper dried blood spots (DBS) were prepared from each blood sample. Genomic DNA was extracted from the remaining blood and used in Plasmodium specific photo-induced electron transfer polymerase chain reaction (PET-PCR) and Nested PCR, whilst the HRP2 antigen content of the DBS was estimated using a bead immunoassay. A comparison of malaria parasite prevalence as determined by each method was performed. Results Parasite prevalence in the high transmission site of Obom was estimated at 71.4%, 61.9%, 60%, 37.8% and 19.1% by Nested PCR, the HRP2 bead assay, PET-PCR, HRP2-RDT and microscopy respectively. Parasite prevalence in the low transmission site of Asutsuare was estimated at 50.1%, 11.2%, 5.6%, 0% and 2.2% by Nested PCR, the HRP2 bead assay, PET-PCR, RDT and microscopy, respectively. The diagnostic performance of Nested PCR, PET-PCR and the HRP2 bead assay was similar in Obom but in Asutsuare, Nested PCR had a significantly higher sensitivity than PET-PCR and the HRP2 bead assay, which had similar sensitivity. Conclusions Nested PCR exhibited the highest sensitivity by identifying the highest prevalence of asymptomatic P. falciparum in both the high and low parasite prevalence settings. However, parasite prevalence estimated by the HRP2 bead assay and PET-PCR had the highest level of inter-rater agreement relative to all the other tools tested and have the advantage of requiring fewer processing steps relative to Nested PCR and producing quantitative results.

The RTS,S/AS01E vaccine targets the circumsporozoite protein (CSP) of the Plasmodium falciparum (P. falciparum) parasite. Protein microarrays were used to measure levels of IgG against 1000 P. falciparum antigens in 2138 infants (age 6–12 weeks) and children (age 5–17 months) from 6 African sites of the phase III trial, sampled before and at 4 longitudinal visits after vaccination. One month postvaccination, IgG responses to 17% of all probed antigens showed differences between RTS,S/AS01E and comparator vaccination groups, whereas no prevaccination differences were found. A small subset of antigens presented IgG levels reaching 4- to 8-fold increases in the RTS,S/AS01E group, comparable in magnitude to anti-CSP IgG levels (~11-fold increase). They were strongly cross-correlated and correlated with anti-CSP levels, waning similarly over time and reincreasing with the booster dose. Such an intriguing phenomenon may be due to cross-reactivity of anti-CSP antibodies with these antigens. RTS,S/AS01E vaccinees with strong off-target IgG responses had an estimated lower clinical malaria incidence after adjusting for age group, site, and postvaccination anti-CSP levels. RTS,S/AS01E-induced IgG may bind strongly not only to CSP, but also to unrelated malaria antigens, and this seems to either confer, or at least be a marker of, increased protection from clinical malaria.

Background:One major issue that has set back the gains of the numerous malaria control interventions that national malaria control programs have implemented is asymptomatic malaria. Certain host genetic factors are known to influence symptomatic malaria; however, not much is known about how host genetics influences the acquisition of asymptomatic malaria. Methods:Genomic DNA was extracted from whole blood collected from 60 symptomatic and 149 nonfebrile (asymptomatic, N = 109, and uninfected, N = 40) volunteers aged between 2 and 69 years from a high (Obom) and a low (Asutsuare) malaria transmission setting in Southern Ghana. Restriction fragment length polymorphism (RFLP) was used to determine polymorphisms at the MBL2 54, TNF-α 308, NOS2 954, and G6PD 202/376 gene loci. Results:Polymorphisms at the MBL2 54 and TNF-α 308 loci were significantly different amongst the three categories of volunteers in both Asutsuare (p = 0.006) and Obom (p=0.05). In Asutsuare, a low malaria transmission area, the allele G has significantly higher odds (3.15) of supporting asymptomatic malaria as against symptomatic malaria. There were significantly higher odds of TNF-α genotype GA being associated with symptomatic malaria as against asymptomatic malaria in both sites, Obom (p=0.027) and Asutsuare (p=0.027). The allele B of the G6PD gene was more prevalent in symptomatic rather than asymptomatic parasite-infected individuals in both Obom (p=0.001) and Asutsuare (p=0.003). Conclusion:Individuals in Southern Ghana carrying the TNF-α 308 GA genotype are more likely to exhibit symptoms of malaria when infected with the malaria parasite as opposed to harboring an asymptomatic infection. Also, the B allele of the G6PD gene is likely to prevent a P. falciparum-infected person from exhibiting symptoms and thereby promote asymptomatic parasite carriage.

Cerebral malaria (CM) is a severe neurological complication of malaria caused by the Plasmodium falciparum parasite. It is one of the leading causes of death in children under 5 years of age in Sub-Saharan Africa. CM is associated with blood-brain barrier disruption and long-term neurological sequelae in survivors of CM. Despite the vast amount of research on cerebral malaria, the cause of neurological sequelae observed in CM patients is poorly understood. In this article, the potential roles of glial cells, astrocytes, and microglia, in cerebral malaria pathogenesis are reviewed. The possible mechanisms by which glial cells contribute to neurological damage in CM patients are also examined.

The recent World Malaria report shows that progress in malaria elimination has stalled. Current data acquisition by NMCPs depend on passive case detection and clinical reports focused mainly on Plasmodium falciparum (Pf). In recent times, several countries in sub-Saharan Africa have reported cases of Plasmodium vivax (Pv) with a considerable number being Duffy negative. The burden of Pv and Plasmodium ovale (Po) appear to be more than acknowledged. Similarly, the contribution of asymptomatic malaria in transmission is hardly considered by NMCPs in Africa. Inclusion of these as targets in malaria elimination agenda is necessary to achieve elimination goal, as these harbor hypnozoites. The Pan African Vivax and Ovale Network (PAVON) is a new consortium of African Scientists working in Africa on the transmission profile of Pv and Po. The group collaborates with African NMCPs to train in Plasmodium molecular diagnostics, microscopy, and interpretation of molecular data from active surveys to translate into policy. Details of the mission, rational and modus operandi of the group are outlined.