Justice Sylverken - Academia.edu (original) (raw)

Papers by Justice Sylverken

Research paper thumbnail of Case Report on Multiple Pathologies in an Adolescent Sickle Cell Disease Patient in Ghana

International Clinical Pathology Journal, 2016

International Clinical Pathology Journal

Research paper thumbnail of Human candidate gene polymorphisms and risk of severe malaria in children in Kilifi, Kenya: a case-control association study

The Lancet Haematology, 2018

Background Human genetic factors are important determinants of malaria risk. We investigated asso... more Background Human genetic factors are important determinants of malaria risk. We investigated associations between multiple candidate polymorphisms-many related to the structure or function of red blood cells-and risk for severe Plasmodium falciparum malaria and its specific phenotypes, including cerebral malaria, severe malaria anaemia, and respiratory distress. Methods We did a case-control study in Kilifi County, Kenya. We recruited as cases children presenting with severe malaria to the high-dependency ward of Kilifi County Hospital. We included as controls infants born in the local community between Aug 1, 2006, and Sept 30, 2010, who were part of a genetics study. We tested for associations between a range of candidate malaria-protective genes and risk for severe malaria and its specific phenotypes. We used a permutation approach to account for multiple comparisons between polymorphisms and severe malaria. We judged p values less than 0•005 significant for the primary analysis of the association between candidate genes and severe malaria.

Research paper thumbnail of Role of Diagnostic Testing in Schistosomiasis Control Programs in Rural Ghana

Journal of Bacteriology & Parasitology, 2011

Background: Schistosomiasis affects an estimated 200-300 million people worldwide. Construction o... more Background: Schistosomiasis affects an estimated 200-300 million people worldwide. Construction of dams has contributed to the high prevalence of urinary schistosomiasis in Ghana. To assist rural villages downstream from the Barekese dam in schistosomiasis control programs, this study evaluated possible detection methods of schistosomiasis. Methods: A cross-sectional survey of volunteers was conducted in a rural setting of Ghana. Five hundred and thirty four (534) volunteers provided symptom information and urine samples for urinalysis. Microscopic egg count of 341 random samples was used to determine prevalence of disease and to analyze effectiveness of urinalysis and symptom information for diagnosing schistosomiasis. Results: Schistosomiasis prevalence was 41.1 % for the village. The highest prevalence was in the 10-14 age groups (71.1 %). Sensitivity and specificity for hematuria was 76.1 and 77.7 % respectively, and proteinuria was 58.2 & 68.7 % respectively. The positive predictive value was highest for hematuria (71.1 %). The highest negative predictive value was among positive proteinuria or hematuria (84.0 %). From urinary symptom information, reporting pain and dark urine yielded the highest positive predictive value (72.0 %). Reporting pain, difficulty, or dark urine yielded the highest negative predictive value (75.8 %). Discussion: The positive and negative predictive values of urine analysis and symptom information may be an inexpensive tool for diagnosing schistosomiasis in areas of high prevalence.

Research paper thumbnail of Social constructs, late recognition and decision making for managing fast breathing in children

Children and Youth Services Review, 2020

Acute Respiratory Infection (ARI) is one of the topmost childhood killers ahead of diarrhoea and ... more Acute Respiratory Infection (ARI) is one of the topmost childhood killers ahead of diarrhoea and malnutrition in children. This exploratory qualitative study sought to examine the influence of maternal social constructs on the recognition and care seeking for fast breathing in children to inform the development of an intervention aimed at addressing fast breathing and acute respiratory infection related illness among children in Ghana. Method: Focus group discussions with 23 mothers with children aged 6 weeks-12 weeks old was conducted. The study used an abbreviated grounded theory and thus the full iterative cycle was not performed during the interview and data analysis. Results: Fast breathing is locally called 'oteeso'(difficulty in breathing), and 'mframa-ko-ne-mu'(air has entered the child). Evil spirit, heredity, and exposure to windy weather were mentioned as the causes. Herbs and herbal preparations are perceived to be more effective in managing fast breathing. Mothers have varying construction of causes, presentation and treatment options for fast breathing, and these have implications in control and prevention. Conclusion: Understanding the local construction of illness beliefs is key to designing interventions aimed at empowering mothers to seek early care for their children on respiratory related illness.

Research paper thumbnail of Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries

JAMA Pediatrics, 2022

; for the African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Colla... more ; for the African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents IMPORTANCE Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. OBJECTIVE To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa.

Research paper thumbnail of Mortality pattern within twenty-four hours of admission to a pediatric emergency room in a teaching hospital in Ghana

African Journal of Current Medical Research, 2022

BackgroundChildhood mortality in sub-Saharan Africa still remains high despite a reduction in glo... more BackgroundChildhood mortality in sub-Saharan Africa still remains high despite a reduction in global trends. Although several strategies have been instituted to help reduce this, the progress is slow which can affect the achievement of the Sustainable Development Goal 3 (SDG). Majority of these deaths occur within the first twenty-four hours of admission due to delay in seeking medical care and inability to identify and adequately resuscitate the critically ill patients. The aim of the study was to describe the pattern of mortality within the first twenty-four hours in children presenting to the Paediatric Emergency Unit (PEU) of Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. Methods This was a retrospective review of mortalities in children aged 2 months to 13 years admitted to PEU from January to December 2020. The bio-data, duration of illness, diagnoses, duration of hospital stay and admission outcome were extracted from their health records and analysed. Results Ther...

Research paper thumbnail of Hypoxia and mortality outcomes in children presenting with pneumonia to a tertiary Hospital: A Retrospective review of records

African Journal of Current Medical Research, 2022

BackgroundChildhood pneumonia is a leading cause of hospitalisation and death in Low- and Middle-... more BackgroundChildhood pneumonia is a leading cause of hospitalisation and death in Low- and Middle-Income Countries (LMIC). Despite remarkable achievements in global mortality trends in children under 5 nearly 700 000 children die annually from pneumonia. In Ghana, an estimated 4,700 children under 5 died from pneumonia in 2017. Hypoxia is a known predictor of death among children hospitalised with pneumonia. Few studies in Ghana have described the predictors of mortality among children with pneumonia. This study aimed to determine the factors associated with mortality among children hospitalized for pneumonia to the Paediatric Emergency Unit (PEU) of Komfo Anokye Teaching Hospital (KATH). MethodsMedical records of children admitted to the PEU of KATH from January 2016 to December 2020 were reviewed. Data was cleaned and exported to STATA version 16 for analysis. Outcomes measures of interest were survival and mortality. Results Records for 482 children hospitalised with pneumonia to ...

Research paper thumbnail of RESEARCH Open Access Exploring the relationship between chronic undernutrition and asymptomatic malaria in

Background: A moderate association has been found between asymptomatic parasitaemia and undernutr... more Background: A moderate association has been found between asymptomatic parasitaemia and undernutrition. However, additional investigation using the gold standard for asymptomatic parasitaemia confirmation, polymerase chain reaction (PCR), is needed to validate this association. Anthropometric measurements and blood samples from children less than five years of age in a rural Ghanaian community were used to determine if an association exists between chronic undernutrition and PCR-confirmed cases of asymptomatic malaria. Methods: This was a descriptive cross-sectional study of 214 children less than five years of age from a community near Kumasi, Ghana. Blood samples and anthropometric measurements from these children were collected during physical examinations conducted in January 2007 by partners of the Barekuma Collaborative Community Development Programme. Results: Findings from the logistic model predicting the odds of asymptomatic malaria indicate that children who experienced m...

Research paper thumbnail of Haematological indices, nutritional assessment and mortality outcome of children presenting with severe malaria to a tertiary hospital in Ghana

Journal of Pediatric Neurosciences, 2013

Background: Severe malaria in children remains the commonest clinical disease in the paediatric e... more Background: Severe malaria in children remains the commonest clinical disease in the paediatric emergency units of most hospitals in sub-Saharan Africa. Anaemia and nutritional deficiency are associated with severe malaria. The aim of the study was to describe the haematological indices, nutritional status and mortality among children admitted in a tertiary hospital in Ghana with severe malaria. Methods: We conducted a prospective cross-sectional study documenting the haematological, nutritional indices and mortality outcomes of children less than five years reporting to the Komfo Anokye Teaching Hospital with severe malaria. Results: The study recruited four-hundred-and-eight (408) children between April, 2005 and July, 2006. There were 231 males (57%). The median age was 21 months, (1QR: 4-54months). 36 (8.8%) patients had weight-for-age z-score -2, 3.3% (RR=1.7, 95%CI: 1.1-2.6, P=0.038). Conclusion: Malaria in children under five remains a principal cause of morbidity and mortali...

Research paper thumbnail of A typical Kawasaki syndrome in COVID-19 infection: a case report of a multisystem inflammatory syndrome in a child (MIS-C)

Ghana Medical Journal, 2021

The emergence of COVID-19 by a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) i... more The emergence of COVID-19 by a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) in 2019 has seen evolving data reporting infrequent infection in children and mostly mild disease for children who contract the infection. A severe form of COVID-19 in children recently reported in Europe and North America describes a multisystem inflammation syndrome in children (MIS-C), presenting as toxic-shock-like and Kawasaki-like syndromes. Data on MIS-C in Africa is being documented with recent reports from South Africa and Nigeria in black children, but information on MIS-C in Ghana is yet to be characterized. We report the first case of multisystem inflammatory syndrome in a child who tested PCR positive to SARS-CoV2 in a tertiary hospital in Ghana. The case describes a 10-year-old boy who reported Kawasaki-like syndrome without shock but with moderate respiratory distress requiring supportive acute care without the need for intensive care.

Research paper thumbnail of Educating caregivers to recognise the clinical signs of pneumonia in children younger than 6 months

South African Journal of Child Health, 2020

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Pneumonia re... more This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Pneumonia remains a significant contributor to preventable deaths in children under five. [1] Together, pneumonia and diarrhoea account for 30% of all deaths in this age group, which translates to a loss of two million lives each year. [2] The global death toll of pneumonia was estimated at 1.3 million in 2011, with 81% of fatalities occurring in the first two years of life. [3] More than 150 million cases of pneumonia are reported in lowand-middle-income countries per year. [4] In sub-Saharan Africa, it is the leading cause of mortality in children under five and accounts for 490 000 deaths annually. [5] Children living in low socioeconomic households or remote areas are the worst affected. In many cases, these children report to facilities only at a late stage and may have complicated pneumonia episodes, subsequently associated with poor outcomes. The burden of pneumonia on the families and general health systems in lowresource settings further worsens the existing health inequities, as pneumonia diagnosed late is more expensive to treat owing to complications. [2] Considerable gains have been made in reducing morbidity and mortality from pneumonia following the introduction of vaccines against Haemophilus influenzae, pneumococcal disease, pertussis and measles as part of the Expanded Programme on Immunisation in Ghana. [6,7] Implementing treatment protocols as included in the Integrated Management of Neonatal and Childhood Illness approach has resulted in further progress. Currently, pneumonia morbidity and mortality seem to be influenced largely by delays in diagnosis and initiation of treatment. [8,9] The World Health Organization has documented more than ten simple non-technological interventions to promote child survival and to reduce mortality from pneumonia. [2] However, these interventions focus mostly on healthcare workers, health facilities and access to essential medicines such as antibiotics, and do not help caregivers at home to detect diseases such as pneumonia early. A study of children with pneumonia, as documented by the receiving doctor at a health facility in New Delhi, India, reported that ~80% of mothers (n=161/200) identified difficulty in breathing as the most distressing sign for which they sought medical attention, despite their not previously being trained on recognising signs of pneumonia. [10] Although difficulty in breathing is a late sign of pneumonia, this finding suggests that educating mothers on identifying early signs of pneumonia may facilitate early case detection and treatment to avert complications and death. [10] Strategies to further reduce the burden of pneumonia in lowincome countries need not require advanced technologies. [2] During episodes of pneumonia, rapid breathing is a key symptom and an independent predictor for hospital death. [11] Educating caregivers, Background. Pneumonia remains the foremost cause of death in young children in sub-Saharan Africa. This phenomenon is largely driven by poor access to healthcare and delay in seeking medical care for childhood pneumonia. Objective. To assess the effectiveness of training caregivers to recognise the early clinical signs of pneumonia. Methods. The study involved a cohort of women presenting to the Child Welfare Clinic at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, between 7 July and 8 September 2016. A total of 90 women with children younger than 10 weeks were recruited. Participants were trained on identifying early signs of pneumonia using low-cost equipment. Follow-up training and assessment sessions formed part of the programme. Results. At pre-training assessment, the majority of the participants (n=83/90; 92.2%) recognised lower chest indrawing as a sign of respiratory disease requiring immediate hospital intervention. Participants' performance in determining rhythms of 50 breaths per minute (bpm) and 60 bpm improved significantly across sessions (p=0.011 and p≤0.001, respectively). After training, 87 participants (96.7%) were able to determine rapid breathing accurately compared with 73 participants (81.1%) before training (p=0.001). Conclusion. The results suggest that caregivers can be effectively trained to identify clinical signs of pneumonia in young children, even in low-resource settings. A training initiative as described in this study could be an effective public health intervention to help address the burden of pneumonia in low-resource settings.

Research paper thumbnail of Determinants of post-malarial anemia in African children treated with parenteral artesunate

Scientific Reports, 2019

The pathophysiology of malarial anemia is multifactorial and incompletely understood. We assessed... more The pathophysiology of malarial anemia is multifactorial and incompletely understood. We assessed mechanistic and risk factors for post-malarial anemia in Ghanaian and Gabonese children with severe P. falciparum malaria treated with parenteral artesunate followed by an oral artemisinin-combination therapy. We analyzed data from two independent studies in which children were followed on Days 7,14, and 28 after treatment with artesunate. Specific hematological parameters included the presence of hemoglobinopathies and erythropoietin. Presence of once-infected erythrocytes was assessed by flow cytometry in a sub-population. Of 143 children with a geometric mean parasitemia of 116,294/µL (95% CI: 95,574–141,505), 91 (88%) had anemia (Hb

Research paper thumbnail of Aetiology of viral hepatitis among jaundiced patients presenting to a tertiary hospital in Ghana

PloS one, 2018

Viral hepatitis continues to play significant role in causing morbidity and mortality in sub-Saha... more Viral hepatitis continues to play significant role in causing morbidity and mortality in sub-Saharan Africa. Apart from the few population based studies available, not many have investigated the burden of these viruses in jaundiced patients. Among the few studies, hepatitis E is the least studied among jaundiced patients. This study was aimed at describing the frequency, distribution and risk of the different hepatitis viruses among jaundiced patients reporting to the second largest teaching hospital in Ghana. From November, 2015 to April, 2016, a cross-sectional study was conducted among jaundiced patients attending the Komfo Anokye Teaching Hospital. Between 3-5 ml of blood was collected from each patient and screened for viral hepatitis agents using both serologic and molecular-based assays. In the 155 patients recruited, hepatitis B was the most prevalent [54.2% (95% CI = 46.0%-62.2%)] followed by hepatitis E [32.9% (95% CI = 25.6-40.9%)]. Most cases of hepatitis E occurred as c...

Research paper thumbnail of Respiratory Pathogens in Children 1 Month to 5 Years of Age Presenting With Undifferentiated Acute Respiratory Distress in 2 District-Level Hospitals in Ghana

Journal of the Pediatric Infectious Diseases Society, Jan 3, 2018

Ghanaian children (2176) aged <5 years who presented with undifferentiated acute respiratory d... more Ghanaian children (2176) aged <5 years who presented with undifferentiated acute respiratory distress were tested for respiratory pathogens using a BioFire FilmArray polymerase chain reaction assay. Rhinovirus and/or enterovirus was detected in 36% of the assays, respiratory syncytial virus in 11%, and parainfluenza in 7%. Respiratory syncytial virus and metapneumovirus were detected more frequently in the rainy season than in the dry season.

Research paper thumbnail of Epidemiology of paediatric poisoning reporting to a tertiary hospital in Ghana

South African Journal of Child Health, 2016

Research paper thumbnail of Intramuscular Artesunate for Severe Malaria in African Children: A Multicenter Randomized Controlled Trial

PLOS Medicine, 2016

Background Current artesunate (ARS) regimens for severe malaria are complex. Once daily intramusc... more Background Current artesunate (ARS) regimens for severe malaria are complex. Once daily intramuscular (i.m.) injection for 3 d would be simpler and more appropriate for remote health facilities than the current WHO-recommended regimen of five intravenous (i.v.) or i.m. injections over 4 d. We compared both a three-dose i.m. and a three-dose i.v. parenteral ARS regimen with the standard five-dose regimen using a non-inferiority design (with non-inferiority margins of 10%). Methods and Findings This randomized controlled trial included children (0.5-10 y) with severe malaria at seven sites in five African countries to assess whether the efficacy of simplified three-dose regimens is non-inferior to a five-dose regimen. We randomly allocated 1,047 children to receive a total dose of 12 mg/kg ARS as either a control regimen of five i.m. injections of 2.4 mg/kg (at 0, 12, 24, 48, and 72 h) (n = 348) or three injections of 4 mg/kg (at 0, 24, and 48 h)

Research paper thumbnail of Phase II, randomized trial to assess the safety and immunogenicity of the candidate malaria vaccines RTS, S/AS02 and RTS, S/AS01 when given according to different vaccination schedules in children in Ghana

Research paper thumbnail of Disease-associated QT-shortage versus quinine associated QT-prolongation: age dependent ECG-effects in Ghanaian children with severe malaria

Research paper thumbnail of Continuous positive airway pressure for children: A discussion on how to maximize compliance

Sleep Medicine Reviews, 2006

Research paper thumbnail of Correction: Randomized Controlled Trial of RTS,S/AS02 D and RTS,S/AS01 E Malaria Candidate Vaccines Given According to Different Schedules in Ghanaian Children

PLoS ONE, 2010

Copyright Public Library of Science. This is an open-access article distributed under the terms o... more Copyright Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Research paper thumbnail of Case Report on Multiple Pathologies in an Adolescent Sickle Cell Disease Patient in Ghana

International Clinical Pathology Journal, 2016

International Clinical Pathology Journal

Research paper thumbnail of Human candidate gene polymorphisms and risk of severe malaria in children in Kilifi, Kenya: a case-control association study

The Lancet Haematology, 2018

Background Human genetic factors are important determinants of malaria risk. We investigated asso... more Background Human genetic factors are important determinants of malaria risk. We investigated associations between multiple candidate polymorphisms-many related to the structure or function of red blood cells-and risk for severe Plasmodium falciparum malaria and its specific phenotypes, including cerebral malaria, severe malaria anaemia, and respiratory distress. Methods We did a case-control study in Kilifi County, Kenya. We recruited as cases children presenting with severe malaria to the high-dependency ward of Kilifi County Hospital. We included as controls infants born in the local community between Aug 1, 2006, and Sept 30, 2010, who were part of a genetics study. We tested for associations between a range of candidate malaria-protective genes and risk for severe malaria and its specific phenotypes. We used a permutation approach to account for multiple comparisons between polymorphisms and severe malaria. We judged p values less than 0•005 significant for the primary analysis of the association between candidate genes and severe malaria.

Research paper thumbnail of Role of Diagnostic Testing in Schistosomiasis Control Programs in Rural Ghana

Journal of Bacteriology & Parasitology, 2011

Background: Schistosomiasis affects an estimated 200-300 million people worldwide. Construction o... more Background: Schistosomiasis affects an estimated 200-300 million people worldwide. Construction of dams has contributed to the high prevalence of urinary schistosomiasis in Ghana. To assist rural villages downstream from the Barekese dam in schistosomiasis control programs, this study evaluated possible detection methods of schistosomiasis. Methods: A cross-sectional survey of volunteers was conducted in a rural setting of Ghana. Five hundred and thirty four (534) volunteers provided symptom information and urine samples for urinalysis. Microscopic egg count of 341 random samples was used to determine prevalence of disease and to analyze effectiveness of urinalysis and symptom information for diagnosing schistosomiasis. Results: Schistosomiasis prevalence was 41.1 % for the village. The highest prevalence was in the 10-14 age groups (71.1 %). Sensitivity and specificity for hematuria was 76.1 and 77.7 % respectively, and proteinuria was 58.2 & 68.7 % respectively. The positive predictive value was highest for hematuria (71.1 %). The highest negative predictive value was among positive proteinuria or hematuria (84.0 %). From urinary symptom information, reporting pain and dark urine yielded the highest positive predictive value (72.0 %). Reporting pain, difficulty, or dark urine yielded the highest negative predictive value (75.8 %). Discussion: The positive and negative predictive values of urine analysis and symptom information may be an inexpensive tool for diagnosing schistosomiasis in areas of high prevalence.

Research paper thumbnail of Social constructs, late recognition and decision making for managing fast breathing in children

Children and Youth Services Review, 2020

Acute Respiratory Infection (ARI) is one of the topmost childhood killers ahead of diarrhoea and ... more Acute Respiratory Infection (ARI) is one of the topmost childhood killers ahead of diarrhoea and malnutrition in children. This exploratory qualitative study sought to examine the influence of maternal social constructs on the recognition and care seeking for fast breathing in children to inform the development of an intervention aimed at addressing fast breathing and acute respiratory infection related illness among children in Ghana. Method: Focus group discussions with 23 mothers with children aged 6 weeks-12 weeks old was conducted. The study used an abbreviated grounded theory and thus the full iterative cycle was not performed during the interview and data analysis. Results: Fast breathing is locally called 'oteeso'(difficulty in breathing), and 'mframa-ko-ne-mu'(air has entered the child). Evil spirit, heredity, and exposure to windy weather were mentioned as the causes. Herbs and herbal preparations are perceived to be more effective in managing fast breathing. Mothers have varying construction of causes, presentation and treatment options for fast breathing, and these have implications in control and prevention. Conclusion: Understanding the local construction of illness beliefs is key to designing interventions aimed at empowering mothers to seek early care for their children on respiratory related illness.

Research paper thumbnail of Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries

JAMA Pediatrics, 2022

; for the African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Colla... more ; for the African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents IMPORTANCE Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. OBJECTIVE To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa.

Research paper thumbnail of Mortality pattern within twenty-four hours of admission to a pediatric emergency room in a teaching hospital in Ghana

African Journal of Current Medical Research, 2022

BackgroundChildhood mortality in sub-Saharan Africa still remains high despite a reduction in glo... more BackgroundChildhood mortality in sub-Saharan Africa still remains high despite a reduction in global trends. Although several strategies have been instituted to help reduce this, the progress is slow which can affect the achievement of the Sustainable Development Goal 3 (SDG). Majority of these deaths occur within the first twenty-four hours of admission due to delay in seeking medical care and inability to identify and adequately resuscitate the critically ill patients. The aim of the study was to describe the pattern of mortality within the first twenty-four hours in children presenting to the Paediatric Emergency Unit (PEU) of Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. Methods This was a retrospective review of mortalities in children aged 2 months to 13 years admitted to PEU from January to December 2020. The bio-data, duration of illness, diagnoses, duration of hospital stay and admission outcome were extracted from their health records and analysed. Results Ther...

Research paper thumbnail of Hypoxia and mortality outcomes in children presenting with pneumonia to a tertiary Hospital: A Retrospective review of records

African Journal of Current Medical Research, 2022

BackgroundChildhood pneumonia is a leading cause of hospitalisation and death in Low- and Middle-... more BackgroundChildhood pneumonia is a leading cause of hospitalisation and death in Low- and Middle-Income Countries (LMIC). Despite remarkable achievements in global mortality trends in children under 5 nearly 700 000 children die annually from pneumonia. In Ghana, an estimated 4,700 children under 5 died from pneumonia in 2017. Hypoxia is a known predictor of death among children hospitalised with pneumonia. Few studies in Ghana have described the predictors of mortality among children with pneumonia. This study aimed to determine the factors associated with mortality among children hospitalized for pneumonia to the Paediatric Emergency Unit (PEU) of Komfo Anokye Teaching Hospital (KATH). MethodsMedical records of children admitted to the PEU of KATH from January 2016 to December 2020 were reviewed. Data was cleaned and exported to STATA version 16 for analysis. Outcomes measures of interest were survival and mortality. Results Records for 482 children hospitalised with pneumonia to ...

Research paper thumbnail of RESEARCH Open Access Exploring the relationship between chronic undernutrition and asymptomatic malaria in

Background: A moderate association has been found between asymptomatic parasitaemia and undernutr... more Background: A moderate association has been found between asymptomatic parasitaemia and undernutrition. However, additional investigation using the gold standard for asymptomatic parasitaemia confirmation, polymerase chain reaction (PCR), is needed to validate this association. Anthropometric measurements and blood samples from children less than five years of age in a rural Ghanaian community were used to determine if an association exists between chronic undernutrition and PCR-confirmed cases of asymptomatic malaria. Methods: This was a descriptive cross-sectional study of 214 children less than five years of age from a community near Kumasi, Ghana. Blood samples and anthropometric measurements from these children were collected during physical examinations conducted in January 2007 by partners of the Barekuma Collaborative Community Development Programme. Results: Findings from the logistic model predicting the odds of asymptomatic malaria indicate that children who experienced m...

Research paper thumbnail of Haematological indices, nutritional assessment and mortality outcome of children presenting with severe malaria to a tertiary hospital in Ghana

Journal of Pediatric Neurosciences, 2013

Background: Severe malaria in children remains the commonest clinical disease in the paediatric e... more Background: Severe malaria in children remains the commonest clinical disease in the paediatric emergency units of most hospitals in sub-Saharan Africa. Anaemia and nutritional deficiency are associated with severe malaria. The aim of the study was to describe the haematological indices, nutritional status and mortality among children admitted in a tertiary hospital in Ghana with severe malaria. Methods: We conducted a prospective cross-sectional study documenting the haematological, nutritional indices and mortality outcomes of children less than five years reporting to the Komfo Anokye Teaching Hospital with severe malaria. Results: The study recruited four-hundred-and-eight (408) children between April, 2005 and July, 2006. There were 231 males (57%). The median age was 21 months, (1QR: 4-54months). 36 (8.8%) patients had weight-for-age z-score -2, 3.3% (RR=1.7, 95%CI: 1.1-2.6, P=0.038). Conclusion: Malaria in children under five remains a principal cause of morbidity and mortali...

Research paper thumbnail of A typical Kawasaki syndrome in COVID-19 infection: a case report of a multisystem inflammatory syndrome in a child (MIS-C)

Ghana Medical Journal, 2021

The emergence of COVID-19 by a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) i... more The emergence of COVID-19 by a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) in 2019 has seen evolving data reporting infrequent infection in children and mostly mild disease for children who contract the infection. A severe form of COVID-19 in children recently reported in Europe and North America describes a multisystem inflammation syndrome in children (MIS-C), presenting as toxic-shock-like and Kawasaki-like syndromes. Data on MIS-C in Africa is being documented with recent reports from South Africa and Nigeria in black children, but information on MIS-C in Ghana is yet to be characterized. We report the first case of multisystem inflammatory syndrome in a child who tested PCR positive to SARS-CoV2 in a tertiary hospital in Ghana. The case describes a 10-year-old boy who reported Kawasaki-like syndrome without shock but with moderate respiratory distress requiring supportive acute care without the need for intensive care.

Research paper thumbnail of Educating caregivers to recognise the clinical signs of pneumonia in children younger than 6 months

South African Journal of Child Health, 2020

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Pneumonia re... more This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Pneumonia remains a significant contributor to preventable deaths in children under five. [1] Together, pneumonia and diarrhoea account for 30% of all deaths in this age group, which translates to a loss of two million lives each year. [2] The global death toll of pneumonia was estimated at 1.3 million in 2011, with 81% of fatalities occurring in the first two years of life. [3] More than 150 million cases of pneumonia are reported in lowand-middle-income countries per year. [4] In sub-Saharan Africa, it is the leading cause of mortality in children under five and accounts for 490 000 deaths annually. [5] Children living in low socioeconomic households or remote areas are the worst affected. In many cases, these children report to facilities only at a late stage and may have complicated pneumonia episodes, subsequently associated with poor outcomes. The burden of pneumonia on the families and general health systems in lowresource settings further worsens the existing health inequities, as pneumonia diagnosed late is more expensive to treat owing to complications. [2] Considerable gains have been made in reducing morbidity and mortality from pneumonia following the introduction of vaccines against Haemophilus influenzae, pneumococcal disease, pertussis and measles as part of the Expanded Programme on Immunisation in Ghana. [6,7] Implementing treatment protocols as included in the Integrated Management of Neonatal and Childhood Illness approach has resulted in further progress. Currently, pneumonia morbidity and mortality seem to be influenced largely by delays in diagnosis and initiation of treatment. [8,9] The World Health Organization has documented more than ten simple non-technological interventions to promote child survival and to reduce mortality from pneumonia. [2] However, these interventions focus mostly on healthcare workers, health facilities and access to essential medicines such as antibiotics, and do not help caregivers at home to detect diseases such as pneumonia early. A study of children with pneumonia, as documented by the receiving doctor at a health facility in New Delhi, India, reported that ~80% of mothers (n=161/200) identified difficulty in breathing as the most distressing sign for which they sought medical attention, despite their not previously being trained on recognising signs of pneumonia. [10] Although difficulty in breathing is a late sign of pneumonia, this finding suggests that educating mothers on identifying early signs of pneumonia may facilitate early case detection and treatment to avert complications and death. [10] Strategies to further reduce the burden of pneumonia in lowincome countries need not require advanced technologies. [2] During episodes of pneumonia, rapid breathing is a key symptom and an independent predictor for hospital death. [11] Educating caregivers, Background. Pneumonia remains the foremost cause of death in young children in sub-Saharan Africa. This phenomenon is largely driven by poor access to healthcare and delay in seeking medical care for childhood pneumonia. Objective. To assess the effectiveness of training caregivers to recognise the early clinical signs of pneumonia. Methods. The study involved a cohort of women presenting to the Child Welfare Clinic at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, between 7 July and 8 September 2016. A total of 90 women with children younger than 10 weeks were recruited. Participants were trained on identifying early signs of pneumonia using low-cost equipment. Follow-up training and assessment sessions formed part of the programme. Results. At pre-training assessment, the majority of the participants (n=83/90; 92.2%) recognised lower chest indrawing as a sign of respiratory disease requiring immediate hospital intervention. Participants' performance in determining rhythms of 50 breaths per minute (bpm) and 60 bpm improved significantly across sessions (p=0.011 and p≤0.001, respectively). After training, 87 participants (96.7%) were able to determine rapid breathing accurately compared with 73 participants (81.1%) before training (p=0.001). Conclusion. The results suggest that caregivers can be effectively trained to identify clinical signs of pneumonia in young children, even in low-resource settings. A training initiative as described in this study could be an effective public health intervention to help address the burden of pneumonia in low-resource settings.

Research paper thumbnail of Determinants of post-malarial anemia in African children treated with parenteral artesunate

Scientific Reports, 2019

The pathophysiology of malarial anemia is multifactorial and incompletely understood. We assessed... more The pathophysiology of malarial anemia is multifactorial and incompletely understood. We assessed mechanistic and risk factors for post-malarial anemia in Ghanaian and Gabonese children with severe P. falciparum malaria treated with parenteral artesunate followed by an oral artemisinin-combination therapy. We analyzed data from two independent studies in which children were followed on Days 7,14, and 28 after treatment with artesunate. Specific hematological parameters included the presence of hemoglobinopathies and erythropoietin. Presence of once-infected erythrocytes was assessed by flow cytometry in a sub-population. Of 143 children with a geometric mean parasitemia of 116,294/µL (95% CI: 95,574–141,505), 91 (88%) had anemia (Hb

Research paper thumbnail of Aetiology of viral hepatitis among jaundiced patients presenting to a tertiary hospital in Ghana

PloS one, 2018

Viral hepatitis continues to play significant role in causing morbidity and mortality in sub-Saha... more Viral hepatitis continues to play significant role in causing morbidity and mortality in sub-Saharan Africa. Apart from the few population based studies available, not many have investigated the burden of these viruses in jaundiced patients. Among the few studies, hepatitis E is the least studied among jaundiced patients. This study was aimed at describing the frequency, distribution and risk of the different hepatitis viruses among jaundiced patients reporting to the second largest teaching hospital in Ghana. From November, 2015 to April, 2016, a cross-sectional study was conducted among jaundiced patients attending the Komfo Anokye Teaching Hospital. Between 3-5 ml of blood was collected from each patient and screened for viral hepatitis agents using both serologic and molecular-based assays. In the 155 patients recruited, hepatitis B was the most prevalent [54.2% (95% CI = 46.0%-62.2%)] followed by hepatitis E [32.9% (95% CI = 25.6-40.9%)]. Most cases of hepatitis E occurred as c...

Research paper thumbnail of Respiratory Pathogens in Children 1 Month to 5 Years of Age Presenting With Undifferentiated Acute Respiratory Distress in 2 District-Level Hospitals in Ghana

Journal of the Pediatric Infectious Diseases Society, Jan 3, 2018

Ghanaian children (2176) aged <5 years who presented with undifferentiated acute respiratory d... more Ghanaian children (2176) aged <5 years who presented with undifferentiated acute respiratory distress were tested for respiratory pathogens using a BioFire FilmArray polymerase chain reaction assay. Rhinovirus and/or enterovirus was detected in 36% of the assays, respiratory syncytial virus in 11%, and parainfluenza in 7%. Respiratory syncytial virus and metapneumovirus were detected more frequently in the rainy season than in the dry season.

Research paper thumbnail of Epidemiology of paediatric poisoning reporting to a tertiary hospital in Ghana

South African Journal of Child Health, 2016

Research paper thumbnail of Intramuscular Artesunate for Severe Malaria in African Children: A Multicenter Randomized Controlled Trial

PLOS Medicine, 2016

Background Current artesunate (ARS) regimens for severe malaria are complex. Once daily intramusc... more Background Current artesunate (ARS) regimens for severe malaria are complex. Once daily intramuscular (i.m.) injection for 3 d would be simpler and more appropriate for remote health facilities than the current WHO-recommended regimen of five intravenous (i.v.) or i.m. injections over 4 d. We compared both a three-dose i.m. and a three-dose i.v. parenteral ARS regimen with the standard five-dose regimen using a non-inferiority design (with non-inferiority margins of 10%). Methods and Findings This randomized controlled trial included children (0.5-10 y) with severe malaria at seven sites in five African countries to assess whether the efficacy of simplified three-dose regimens is non-inferior to a five-dose regimen. We randomly allocated 1,047 children to receive a total dose of 12 mg/kg ARS as either a control regimen of five i.m. injections of 2.4 mg/kg (at 0, 12, 24, 48, and 72 h) (n = 348) or three injections of 4 mg/kg (at 0, 24, and 48 h)

Research paper thumbnail of Phase II, randomized trial to assess the safety and immunogenicity of the candidate malaria vaccines RTS, S/AS02 and RTS, S/AS01 when given according to different vaccination schedules in children in Ghana

Research paper thumbnail of Disease-associated QT-shortage versus quinine associated QT-prolongation: age dependent ECG-effects in Ghanaian children with severe malaria

Research paper thumbnail of Continuous positive airway pressure for children: A discussion on how to maximize compliance

Sleep Medicine Reviews, 2006

Research paper thumbnail of Correction: Randomized Controlled Trial of RTS,S/AS02 D and RTS,S/AS01 E Malaria Candidate Vaccines Given According to Different Schedules in Ghanaian Children

PLoS ONE, 2010

Copyright Public Library of Science. This is an open-access article distributed under the terms o... more Copyright Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.