Papers by Alex Osei-Akoto
Hemoglobin
Abstract Sickle cell disease is a genetic disease with a predisposition to infections caused by e... more Abstract Sickle cell disease is a genetic disease with a predisposition to infections caused by encapsulated organisms, especially Streptococcus pneumoniae. Pneumococcal vaccines and prophylactic penicillin have reduced the rate of this infection and mortality in sickle cell disease. However, implementation of these interventions is limited in Africa. The objectives of the study were to assess health care providers’ behaviors with the implementation of pneumococcal vaccination and penicillin prophylaxis and to identify barriers to their use. A 25-item online questionnaire was administered through SickleinAfrica: a network of researchers, and healthcare providers, in Ghana, Nigeria, and Tanzania, working to improve health outcomes of sickle cell disease in Africa. Data was collected and managed using the Research Electronic Data Capture (REDCap), tools and data analysis was done using STATA version 13 and R statistical software. Eighty-two medical practitioners responded to the questionnaire. Only 54.0 and 48.7% of respondents indicated the availability of published guidelines on sickle cell disease management and pneumococcal vaccine use, respectively, at their facilities. The majority (54.0%) perceived that the vaccines are effective but over 20.0% were uncertain of their usefulness. All respondents from Ghana and Tanzania affirmed the availability of guidelines for penicillin prophylaxis in contrast to 44.1% in Nigeria. Eighty-five percent of respondents affirmed the need for penicillin prophylaxis but 15.0% had a contrary opinion for reasons including the rarity of isolation of Streptococcus pneumoniae in African studies, and therefore, the uncertainty of its benefit. Lack of published guidelines on the management of sickle cell disease and doubts about the necessity of prophylactic measures are potential barriers to the implementation of effective interventions.
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.
African Journal of Current Medical Research, 2022
BackgroundSickle cell disease (SCD) is the commonest monogenic haemolytic disorder in Africa. It ... more BackgroundSickle cell disease (SCD) is the commonest monogenic haemolytic disorder in Africa. It continues to be a major public health burden. Newborn screening of SCD has been implemented in Kumasi, Ghana, since 1995 and SCD patients identified have been enrolled into the paediatric SCD clinic. The Sickle Pan African Research Consortium (SPARCo) which commenced in 2017 comprises of the Hub in Tanzania with two collaborating sites in Ghana and Nigeria has established a SCD patient consented database. Despite strides made in managing SCD, a significant proportion of patients are hospitalized from the various complications of the disease. This study set out to describe the main causes and outcomes of hospitalizations among paediatric patients with SCD at the Komfo Anokye Teaching Hospital (KATH) in Kumasi. MethodsProspectively, all patients in the database who were hospitalized over the 12-month period between April 2019 and March 2020 at the Paediatric Emergency Unit of KATH were fol...
This is an Open Access article distributed under the terms of the Creative Commons Attribution Li... more This is an Open Access article distributed under the terms of the Creative Commons Attribution License
Haematologica, 2021
Studies on red blood cell (RBC) antibodies in Africa routinely use standard test cells from donor... more Studies on red blood cell (RBC) antibodies in Africa routinely use standard test cells from donors of Caucasian descent. There are no systematic data on alloimmunization against antigens that are almost exclusively present in Africans. We studied the prevalence of antibodies in transfused Ghanaian patients with sickle cell disease (SCD) using standard test cells (representing predominantly antigens more common in Caucasians (Caucasian antigens) and cells expressing antigens more common among Africans (African antigens). Antibodies were present in 16% of 221 patients; 31% of these were directed against African antigens that were not detected with standard test cells. Our findings are not only relevant for an African setting, but also for Western blood banks that are developing strategies to recruit more African donors. Transfusions in patients with SCD are associated with high rates of red blood cell (RBC) alloimmunization against multiple antigens. Alloantibody screening is performed with standard reagent test cells, mostly from donors of Caucasian descent that lack antigens that are more prevalent in Africans. Alloimmunisation involving antigens that are almost exclusively present in Africans has not been studied systematically in a setting where both patients and donors are Africans. We determined the prevalence of RBC antibodies against Caucasian and African antigens in multi-transfused patients with SCD in Ghana, where pre-transfusion antibody screening and indirect antiglobulin crossmatch are not routine. Our cross-sectional study recruited patients between July and December 2018, from two tertiary hospitals. Patients were eligible for inclusion if they were at least 2 years of age and had received at least two transfusions at least 6 weeks before study enrolment (to allow time to develop antibodies). Patients were episodically transfused with non-leucoreduced whole blood from African donors. Donors were not screened for sickle cells. Participants' demographics and transfusion history were retrieved from hospital files. Patients or caretakers provided this information, if missing from hospital files, using a standard questionnaire. Plasma and buffy coat samples, taken at enrolment, were frozen at-80°C and transported to Sanquin, Amsterdam, the Netherlands, for routine antibody testing against a standard three-cell reagent panel (Bio-Rad Laboratories AG, Cressier, Switzerland), not expressing antigens that are more common in Africans, using a low ionic strength solution (LISS) indirect anti-globulin gel column agglutination test. Using the same method, antibody identification was performed with commercial panels of reagent RBC of selected phenotypes and against eight selected cells with antigens that are very rare (<0.01% to 1%) in Caucasians but more frequent (0.5% to 32%) in Africans (i.e., MNS6 [He], MNS25 [Dantu], RH10 [V], RH20 [VS], RH30 [Go a ], RH32, RH43 [Crawford] and KEL6 [Js a ]). 1 These antigens were selected based on the availability of RBC expressing rare antigens archived in the Immunohaematology Diagnostics laboratory at Sanquin. Antibody specificities were confirmed by re-testing with two RBC expressing and two RBC not expressing the target antigens. For patients with anti-D, RHD genotyping was done on genomic DNA by Multiplex Ligation-dependent Probe Amplification (MLPA) assay according to the manufacturers' protocol
Analysis 2.4. Comparison 2 Atovaquone-proguanil (AP) versus amodiaquine, Outcome 4 Fever clearanc... more Analysis 2.4. Comparison 2 Atovaquone-proguanil (AP) versus amodiaquine, Outcome 4 Fever clearance time (mean; h). Analysis 2.5. Comparison 2 Atovaquone-proguanil (AP) versus amodiaquine, Outcome 5 Adverse events.. .. . Analysis 3.1. Comparison 3 Atovaquone-proguanil (AP) versus sulfadoxine-pyrimethamine (SP), Outcome
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...
Journal of Transcultural Nursing, 2021
Introduction People with sickle cell disease (SCD) often face stigmatization in Ghana and elsewhe... more Introduction People with sickle cell disease (SCD) often face stigmatization in Ghana and elsewhere in Africa. Research is needed to understand whether it is necessary to design an SCD stigma reduction program in the Ghanaian setting. The aim of this study was to explore the perception of stigmatization for adults with SCD in Kumasi, Ghana. Methodology Using in-depth qualitative interviews, researchers conducted a phenomenological study to investigate the perception of stigmatization for people with SCD in Kumasi, Ghana. Snowball and purposive sampling was used to identify the participants. Results Participants ( n = 12) were mostly female, Akan, and Christian. Researchers categorized three main themes: (a) Feelings of social isolation, (b) Fear of disclosure, and (c) Bullying about physical appearance. Discussion The findings highlight the need to develop effective strategies to counteract stigma. Transcultural health care providers can implement stigma reduction interventions that...
Journal of Pediatric Health Care, 2021
Sickle cell disease (SCD) stigma is a major community health issue. The challenges of caring for ... more Sickle cell disease (SCD) stigma is a major community health issue. The challenges of caring for someone with SCD can be isolating and overwhelming. We explored stigma and its related factors for caregivers of pediatric patients with SCD in Kumasi, Ghana. Methods: Guided by the Ecological Systems Theory, we used in-depth interviews with a semistructured guide to learn about the perception of stigmatization for Ghanaian caregivers of patients with SCD. Results: Overall, participants were knowledgeable about SCD. We identified three overarching themes including: 1) Blame for SCD; 2) Public misconception about SCD, and; 3) Shame for financial burden of SCD. Discussion: Findings demonstrate the need to design a SCD stigma reduction program for caregivers, their families and the community. Providers need to consider SCD stigma and interaction with multiple ecological levels including the family and community, health care system, culture, and health policy in Ghana. Findings can be used as a catalyst to explore the reduction of stigmatization in other sub-Saharan countries.
PLOS ONE, 2020
Background Plasmodium infection among children is a serious public health problem. Asymptomatic m... more Background Plasmodium infection among children is a serious public health problem. Asymptomatic malaria infection among humans serves as a significant reservoir for transmitting Plasmodium to uninfected Anopheles mosquitoes, fueling malaria endemicity and asymptomatic malaria may progress to clinical malaria. Therefore, prompt and accurate diagnosis of malaria infection is crucial for the management and control of malaria, especially in endemic areas. This study assessed the point prevalence of asymptomatic malaria infection and evaluated the performance of malaria Rapid Diagnostic Tests (RDT), light microscopy and nested PCR (nPCR) for the diagnosis of asymptomatic malaria infection in a paediatric population in the Atwima Nwabiagya North district, Ghana. Methods This cross-sectional study enrolled 500 asymptomatic children aged � 5 years. After consent was obtained from a parent, blood samples were collected from each participant to
Journal of Clinical Oncology, 2015
e21007 Background: Hodgkin lymphoma (HL) is a distinct primary solid tumour of the immune system ... more e21007 Background: Hodgkin lymphoma (HL) is a distinct primary solid tumour of the immune system with varied histopathologic subtypes. The epidemiology of HL suggests an infectious etiology with Ep...
The Lancet Haematology, 2020
African Journal of Current Medical Research, 2019
Pneumonia is the highest cause of death in children under five (5) especially in sub-Saharan Afri... more Pneumonia is the highest cause of death in children under five (5) especially in sub-Saharan Africa. It accounts for 16 % of all deaths in Africa, deadlier than Malaria. Sub-Saharan Africa carries about half of the burden of the world’s under-five deaths. Progress in the fight against pneumonia has slacked behind that of the others. Pneumonia mortality rates in children have fallen by just 50 per cent compared to an 85 per cent decline in measles deaths, and 60 per cent in deaths from malaria, AIDS and tetanus in the last 15 years. The global funding to address the burden of pneumonia in children is low and this is potentially hindering the effort to reduce the mortalities associated with the disease.
Pediatric Emergency Care, 2019
Emergently ill infants and children are often inadequately recognized and stabilized by health ca... more Emergently ill infants and children are often inadequately recognized and stabilized by health care facilities in low-and middle-income countries. Limited reports have shown that process improvements and prioritization of emergency care for children presenting to the hospital can improve pediatric hospital mortality. A dedicated pediatric emergency unit (PEU) was established for nontrauma emergencies at a busy teaching and referral hospital in Kumasi, Ghana, in response to high inpatient mortality early during hospitalization. The PEU was designed to identify and separate critically ill children from more stable children on admission. Locally available hospital resources were reallocated from other areas of the hospital to prioritize staffing and supplies for the PEU. A multiyear data set of nonnewborn inpatient mortality was analyzed with a change point model to find the point at which mortality changed the most within the Department of Child Health or the maximum likelihood estimate. Relative risk of mortality for the periods 1 and 2 years immediately before and after the implementation of the PEU and each individual year compared with its preceding year was analyzed to further establish a temporal correlation of changes in mortality rates to the PEU implementation. Individual years were also analyzed against preimplementation data to establish the durability of mortality improvements. Patient mortality decreased over the analyzed period with the maximum change point strongly associated with implementation of the PEU. Relative risk values of mortality 1 year and 2 years immediately before and after implementation of the PEU were 0.70 (0.62-0.78) and 0.69 (0.64-0.74) respectively, representing a one-third reduction in mortality. The only other mortality improvements seen in the year-to-year analysis were between July 2004-June 2005 compared with July 2005-June 2006 with a relative risk of 0.86 (0.77-0.96). Prioritizing and redirecting limited resources toward pediatric emergency care in low-and middle-income country hospitals is associated with reductions in inpatient mortality that are both immediate and sustained.
BMJ Open, 2017
IntroductionSickle cell disease is highly prevalent in Africa with a significant public health bu... more IntroductionSickle cell disease is highly prevalent in Africa with a significant public health burden. Nonetheless, morbidity and mortality in sickle cell disease that result from the progression of organ damage is not well understood. The Organ Damage in Sickle Cell Disease Study (ORDISS) is designed as a longitudinal cohort study to provide critical insight into cellular and molecular pathogenesis of chronic organ damage for the development of future innovative treatment.Methods and analysisORDISS aims to recruit children aged 0–15 years who attend the Kumasi Centre for Sickle Cell Disease based at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Consent is obtained to collect blood and urine samples from the children during specified clinic visits and hospitalisations for acute events, to identify candidate and genetic markers of specific organ dysfunction and end-organ damage, over a 3 year period. In addition, data concerning clinical history and complications associated wi...
Journal of Cancer Prevention & Current Research, 2015
Introduction: Childhood cancers are increasing in incidence worldwide with geographic differences... more Introduction: Childhood cancers are increasing in incidence worldwide with geographic differences having an impact on the types of cancers seen. The main aim of this study was to assess the trends in yearly proportions and number of cases seen, to determine age and gender proportions of the types of cancers and types of childhood cancers diagnosed at the cancer unit from 2012 through 2014. The purpose of this study is to set the baseline framework for future research to improve knowledge, clinical care and advocacy programmes for the newly established paediatric cancer unit in KATH in Kumasi, Ghana. Methods: A retrospective study was conducted to review secondary data from the paediatric cancer registry of all patients aged 0-15 years diagnosed with cancer by fine needle aspiration cytology and tissue biopsy at the paediatric cancer unit from 2012-2014. Demographic, anthropometric and clinical data stored in excel was exported to Stata and analysed. Simple descriptive statistics was used and presented in tables. Results: Out of 309 cases, 187(60.5%, 95%CI: 54.8-66.0) were males. Burkitt's lymphoma (126, 40.8%) was the most common cancer seen followed by Acute Lymphoblastic Leukaemia (31, 10%), Wilm's Tumour (28, 9.1%), other Non-Hodgkin's Lymphoma (28, 9.1%), and retinoblastoma (22, 7.1%). Hodgkin's Lymphoma was the commonest cancer in the age group 10-15 years, Burkitt 's lymphoma in the 5-10 year age group and Acute Lymphoblastic Leukaemia in the under 5 years group. Conclusion and Recommendations: There is an observable trend in the progressive increment in the number of cancer cases presenting to the unit over the three years period. Except for the lymphomas, CNS cancers and osteosarcomas which were commoner in the 5-9 years age group, most of the other childhood cancers; leukaemias, renal cancers, soft tissue sarcomas and neuroblatomas were predominant in the 0-4 year age group. Except for a few rare cancers, majority of the common cancers affected more males than females in the paediatric population studied. The Male: Female ratio of all the cases was 1.5:1. The lymphomas were the commonest cancers diagnosed with Burkitt's lymphoma being the highest among the 5-9 years group. The acute lymphoblastic leukaemias were next to the lymphomas in KATH. Based on these findings, further studies need to be conducted into the specific clinical patterns particularly, the lymphomas and leukaemias for better case management.
Open Journal of Blood Diseases, 2014
Objective: In order to manage the varied pathophysiological features of sickle cell disease (SCD)... more Objective: In order to manage the varied pathophysiological features of sickle cell disease (SCD), an array of drugs has to be used. The specific drugs used, however, depend on the locality. This study was aimed at finding out the drug regimen prescribed by clinicians to sickle cell disease patients who attended a Sickle Cell Clinic in Kumasi, Ghana. Method: The setting for the study is the Sickle Cell Clinic at the Komfo Anokye Teaching Hospital, Ghana, and a questionnaire was used as the study instrument. Information on drug prescription on each day of clinic visit was extracted from the medical records of the patients. Results: The drugs prescribed were "routine drugs" for SCD patients, analgesics, narcotics, anti-malarials, antibiotics, haematinics and miscellaneous drugs. The top ten commonly prescribed drugs were folic acid, diclofenac, ibuprofen, B-complex, routine drugs, artesunate/amodiaquin, paracetamol, penicillin V, amoxiclav and zincovit. Conclusion: Within the year, the drugs prescribed included those that could prevent vitamin and zinc deficiency due to continuing haemolysis, those that could mitigate the pain and inflammation from vaso-occlusion and reperfusion injury, as well as antibiotics to combat infections. Being a malarial-endemic region, prophylaxis with daraprim and symptomatic malaria fever therapy were common practices. This study has thus shown that the well-being of SCD patients in our typical tropical terrain, depends on haematinic vitamin/mineral supplements, anti-malarials, analgesics-anti-inflammatory, antipyretics and antibiotics.
Journal of Internal Medicine Research, 2014
ABSTRACT Sickle cell disease persons are prone to develop nephropathy due to the hemoglobinopathy... more ABSTRACT Sickle cell disease persons are prone to develop nephropathy due to the hemoglobinopathy, infection or drug therapy. Any indication of nephropathy or urinary tract abnormality can be ascertained, using urine analysis. In this study, spot urine samples were collected from 294 SCD subjects, aged 5 to 20 years, for macroscopic and microscopic examinations. Parameters examined included urine appearance; color and cloudiness, dipstick-identifiable parameters, such as presence of bilirubin, uro-bilinogen, blood, protein, glucose and ketones. Other parameters were presence of pus cells and epithelial cells, red blood cells, white cells, yeast cells and others. The urine color ranged from straw-colored, through amber to reddish-brown or coke-like, and cloudiness was evident in 42 of the urine samples. Blood, protein and red cells were seen in 10, 14 and 12 respectively of the subjects. The dipstick nitrite test, supported by microscopic examination showed 13 cases of bacteriuria. Twenty one subjects, 19 females and 2 males had yeast in the urine. In addition, 5 of them had ketone bodies, and there was one case of glucosuria. Overall, 117 (37.6% of sampled population) showed from one or more markers of possible urinary tract abnormality. Our results showed 36.1% of the subjects had markers of urinary tract disease, of which 15.3% could be, attributable to renal pelvis, sup-porting the fact that the sickling hemoglobinopathy is associated with various urinary tract abnormalities. The SS genotype had the higher frequency of occurrence of the markers, corroborating the inter-genotype differences in extent of nephropathy. Sickle cell disease persons are prone to develop nephropathy due to the hemoglobinopathy, infection or drug therapy. Any indication of nephropathy can be ascertained, using urine analysis. Urinalysis is a commonly performed laboratory procedure that can provide valuable information on the func-tion of the kidney [1, 2]. It is the simplest and least expensive and non-invasive way of screening healthy subjects [3]. There are various modes of collection of urine samples for urinalysis, including 24-hour, overnight and spot collections. For its simplicity and ease of compliance by participants, majority of whom were children, we used the spot collections. RBCs, WBCs, bacteria and casts are detected on micro-scopic examination of urine, while glucose, ketones, bilirubin, protein and blood can be detected, using one of several test strips, which are dipped in urine and examined for color changes [4]. In SCD, the obliteration of the vasa recta interferes with counter-current exchange, which is clinically seen as an ina-bility to concentrate urine [5]. Additionally, other functions that are primarily performed in the medulla, including distal hydrogen and potassium ions secretion, are also impaired, so such patients are unable to lower the urine pH to &lt;5 [5]. In contrast to distal defects, proximal tubular function appears supernormal, as evidenced by increased reabsorption of phosphate and increased secretion of uric acid [5]. There can also be abnormal proximal tubular function, partly related to chronic use of analgesics, resulting in increased clearance of creatinine and possibly other markers of glomerular filtration rate (GFR) [6, 7]. Sickling of red cells in the nephrons results in increased viscosity [8], leading to microthrombi formation and ischemic necrosis, which in turn, causes structural dam-age in kidney, accounting for hematuria, which could be both gross and microscopic [5, 8]. In this study we used spot urine samples provided by SCD persons who had reported to the SCC due to ill-health or for routine visits. The rationale was to ascertain whether any of the measureable indicators on the spot urine samples could be of diagnostic significance. This could also help identify the subset of SCD patients who would be at risk of developing renal disease later in life. No such study has been undertaken on these subjects in our Sickle Cell Clinic.
Journal of Investigational Biochemistry, 2013
Background: Some acute and chronic presentations of sickle cell disease (SCD) are splenomegaly, a... more Background: Some acute and chronic presentations of sickle cell disease (SCD) are splenomegaly, acute chest syndrome (ACS), priapism and leg ulceration. Hematological and biochemical parameters are used for diagnosis and prognosis. Method: In this cross-sectional study, carried out over a 12-month period, involving 291 patients, some conventional hematological and biochemical parameters, and two nonconventional determinations, aspartate aminotranferase: alanine aminotransferase (AST:ALT) ratio and urine color, were used to characterize the patients with some selected clinical presentations. Results: For these subjects studied (n = 21), the mean values of hemoglobin (Hb), red blood cells (RBC), white blood cells, (WBC), reticulocytes, platelets and fetal hemoglobin (HbF) were 6.6 g/dl, 2.28×10 12 /L; 16.3 ×10 9 /L, 27.1%, 310.1×10 9 /L and 1.84%, respectively. The mean AST:ALT ratio was 2.058 and the urine color, 2.381. These values were compared to 5 non-anemic counterparts, who had the following mean values of the parameters; Hb = 11.9 g/dl; RBC = 4.13×10 12 /L WBC = 7.2×10 9 /L; reticulocytes = 5.2%; platelets = 282.4×10 9 /L; HbF = 1.48%. A Mann-Whitney non parametric two-tailed test showed several of the differences between the patients with complications and the non-anemic, were statistically significant (p < 0.05). The subjects with the complications were moderately anemic, having elevated levels of lactate dehydrogenase, total bilirubin, indirect bilirubin and AST:ALT ratio. Conclusion: The four clinical presentations were characterized by anemia, accompanied by high levels of conventional markers, like reticulocytes, lactate dehydrogenase (LDH) and bilirubin, together with an elevated AST:ALT ratio, a non-conventional marker.
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Papers by Alex Osei-Akoto