Ghanaian Children Research Articles

Anemia, micronutrient deficiencies, malaria, hemoglobinopathies and malnutrition in young children and non-pregnant women in Ghana: Findings from a national survey.

Nationally representative data on the micronutrient status of Ghanaian women and children are very scarce. We aimed to document the current national prevalence of micronutrient deficiencies, anemia, malaria, inflammation, α-thalassemia, sickle cell disease and trait, and under- and over-nutrition in Ghana. In 2017, a two-stage cross-sectional design was applied to enroll pre-school children (6-59 months) and non-pregnant women (15-49 years) from three strata in Ghana: Northern, Middle and Southern Belt. Household and individual questionnaire data were collected along with blood samples. In total, 2123 households completed the household interviews, 1165 children and 973 women provided blood samples. Nationally, 35.6% (95%CI: 31.7,39.6) of children had anemia, 21.5% (18.4,25.0) had iron deficiency, 12.2% (10.1,14.7) had iron deficiency anemia, and 20.8% (18.1,23.9) had vitamin A deficiency; 20.3%(15.2,26.6) tested positive for malaria, 13.9% (11.1,17.3) for sickle trait plus disease, and 30.7% (27.5,34.2) for α-thalassemia. Anemia and micronutrient deficiencies were more prevalent in rural areas, poor households and in the Northern Belt. Stunting and wasting affected 21.4% (18.0,25.2) and 7.0% (5.1,9.5) of children, respectively. Stunting was more common in rural areas and in poor households. Among non-pregnant women, 21.7% (18.7,25.1) were anemic, 13.7% (11.2,16.6) iron deficient, 8.9% (6.7,11.7) had iron deficiency anemia, and 1.5% (0.8,2.9) were vitamin A deficient, 53.8% (47.6,60.0) were folate deficient, and 6.9% (4.8,9.8) were vitamin B12 deficient. Malaria parasitemia in women [8.4% (5.7,12.2)] was lower than in children, but the prevalence of sickle cell disease or trait and α-thalassemia were similar. Overweight [24.7% (21.0,28.8)] and obesity [14.3% (11.5,17.7)] were more common in wealthier, older, and urban women. Our findings demonstrate that anemia and several micronutrient deficiencies are highly present in Ghana calling for the strengthening of Ghana's food fortification program while overweight and obesity in women are constantly increasing and need to be addressed urgently through governmental policies and programs.

Deontological Perspective of the Free Secondary Education Policy in Ghana

The Free Senior High School (aka. FSHS) policy of the Ghana government has attracted views from both critics and supporters. The objective for this investigation was to examine the deontological ethics of the FSHS educational policy leadership within the framework of utilitarianism-it is as a “duty” and for “public good”. Critics are questioning the policy leadership, intentionality, feasibility, and sustainability. Supporters are also defending the FSHS as a timely social intervention, for equitable access, and the ability of the national economy to afford by re-strategizing government priorities, national indebtedness, and the entire school management system. The research design was exploratory mixed method using a sample study (N=55) that came from six schools (students, head teachers, teachers, and parents) in one region. Data were analysed under the themes: perceptions, benefits, and challenges. Responses showed that the FSHS seems to be a natural progression from the FCUBE policy that is hailed as successful by the international donors. Respondents confirmed the benefits derived from the FSHS policy as altruistic. The discussions followed the theory of ethical deontology, policy leadership implications, democratization of education in Ghana, and the utilitarian concept for future national development. Recommendations include the Government of Ghana (GoG) should ensure “fitness” and “rightness” to align with national priorities in the economy. Secondly, GoG should fight against corruption and “noise” in the FSHS implementation system. Thirdly, the GoG should consider cost sharing and decentralization of education provision in Ghana. Policy makers (legistrators) should ensure that the education system recognizes Ghanaian children as deserving better quality and the incommensurability of values of Education for All.

Diagnostic Accuracy of Body Mass Index in Defining Childhood Obesity: Analysis of Cross-Sectional Data from Ghanaian Children

Background: Screening methods for childhood obesity are based largely on the published body mass index (BMI) criteria. Nonetheless, their accuracy in African children is largely unknown. The diagnostic accuracies of the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the International Obesity Taskforce (IOTF) BMI-based criteria in defining obesity using deuterium dilution as a criterion method in a sample of Ghanaian children are presented. Methods: Data on anthropometric indices and percent body fat were collected from 183 children aged 8–11 years. The sensitivity, specificity, and predictive values were calculated. The overall performance of the BMI criteria was evaluated using the receiver operating characteristics area under the curve (AUC). Results: Overall sensitivity of WHO, CDC, and IOTF were 59.4% (40.6–76.3), 53.1% (34.7–70.9), and 46.9% (29.1–65.3) respectively. The overall specificity was high, ranging from 98.7% by WHO to 100.0% by IOTF. The AUC were 0.936 (0.865–1.000), 0.924 (0.852–0.995), and 0.945 (0.879–1.000) by the WHO, CDC, and IOTF criteria respectively for the overall sample. Prevalence of obesity by the WHO, CDC, IOTF, and deuterium oxide-derived percent body fat were 11.5%, 10.4%, 8.2%, and 17.5% respectively, with significant positive correlations between the BMI z-scores and percent body fat. Conclusions: The BMI-based criteria were largely specific but with moderate sensitivity in detecting excess body fat in Ghanaian children. To improve diagnostic accuracy, direct measurement of body fat and other health risk factors should be considered in addition to BMI.

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

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 < 10 g/dL) at presentation. Hemoglobin increased after Day 7 correlating with increased erythropoiesis through adequate erythropoietin stimulation. 22 children (24%) remained anemic until Day 28. Post-artesunate delayed hemolysis was detected in 7 children (5%) with only minor differences in the dynamics of once-infected erythrocytes. Hyperparasitemia and hemoglobin at presentation were associated with anemia on Day 14. On Day 28 only lower hemoglobin at presentation was associated with anemia. Most children showed an adequate erythropoiesis and recovered from anemia within one month. Post-artesunate delayed hemolysis (PADH) and hyperparasitemia are associated with early malarial anemia and pre-existing anemia is the main determinant for prolonged anemia.

Long-term immunity against yellow fever in children vaccinated during infancy: a longitudinal cohort study

SummaryBackgroundA single dose of vaccine against yellow fever is routinely administered to infants aged 9–12 months under the Expanded Programme on Immunization, but the long-term outcome of vaccination in this age group is unknown. We aimed to evaluate the long-term persistence of neutralising antibodies to yellow fever virus following routine vaccination in infancy.MethodsWe did a longitudinal cohort study, using a microneutralisation assay to measure protective antibodies against yellow fever in Malian and Ghanaian children vaccinated around age 9 months and followed up for 4·5 years (Mali), or 2·3 and 6·0 years (Ghana). Healthy children with available day-0 sera, a complete follow-up history, and no record of yellow fever revaccination were included; children seropositive for yellow fever at baseline were excluded. We standardised antibody concentrations with reference to the yellow fever WHO International Standard.FindingsWe included 587 Malian and 436 Ghanaian children vaccinated between June 5, 2009, and Dec 26, 2012. In the Malian group, 296 (50·4%, 95% CI 46·4–54·5) were seropositive (antibody concentration ≥0·5 IU/mL) 4·5 years after vaccination. Among the Ghanaian children, 121 (27·8%, 23·5–32·0) were seropositive after 2·3 years. These results show a large decrease from the proportions of seropositive infants 28 days after vaccination, 96·7% in Mali and 72·7% in Ghana, reported by a previous study of both study populations. The number of seropositive children increased to 188 (43·1%, 95% CI 38·5–47·8) in the Ghanaian group 6·0 years after vaccination, but this result might be confounded by unrecorded revaccination or natural infection with wild yellow fever virus during a 2011–12 outbreak in northern Ghana.InterpretationRapid waning of immunity during the early years after vaccination of 9-month-old infants argues for a revision of the single-dose recommendation for this target population in endemic countries. The short duration of immunity in many vaccinees suggests that booster vaccination is necessary to meet the 80% population immunity threshold for prevention of yellow fever outbreaks.FundingWellcome Trust.

Prevalence and patterns of mental disorders among primary school age children in Ghana: correlates with academic achievement

Background: There is limited data on the prevalence of child and adolescent mental health disorders (CAMHD) in Ghana. Recent reports suggest a decline in academic achievement in basic education. This paper sought to determine the prevalence of CAMHD in Ghanaian primary school children and to draw correlates with academic achievement.Methods: We conducted a pilot cross-sectional survey of 303 grade 3 pupils aged 7–15 years in the city of Kumasi. The Child Behaviour Checklist (CBCL) and Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) were used to assess for CAMHD in 2016, and data on performance in examinations over the prior academic year were analysed.Results: Overall, current prevalence of CAMHD was 7.25%, with depressive disorder = 1.31%, anxiety disorders = 1%, attention deficit hyperactivity disorder (ADHD) = 1.64%, conduct disorder = 1.97%, and intellectual disability = 1%. Co-morbid disorders, such as seizure disorder (1%), were also noted. There was a greater prevalence of CAMHD in public schools (11.6%) compared to private schools (0.7%), with p < 0.001. Even when adjusted for other factors, children with CAMHD had a lower average academic score by 10.5 units (p < 0.001). Thus, having a dual diagnosis was most predictive of academic underachievement.Conclusions: The results of this study document the prevalence of CAMHD in Ghana for the first time and shows correlates with academic underachievement.

Beyond the Politics of Inclusion: The Policy Environment and the Fate of Children with Disability in the Ghanaian Educational System

Abstract The 1992 constitution of Ghana and other national legislative instruments guarantee and promote free compulsory universal basic education for all Ghanaian children irrespective of their background. This has been the practice for many years. Even though these policies have chalked some successes, especially regarding school attendance and gender parity, there still remains some level of uncertainty as to whether all Ghanaian children, especially those with disabilities, benefit from these policies. Using secondary information available, the paper provides an overview of the existing legislative instruments that seek to promote the adoption of inclusive education policy in Ghana. Evidence from the literature reveals that there are restrictions within the current policy provisions which make inclusive education not possible for children living with disabilities. The paper concludes and recommends that there should be some modifications or new developments of inclusive education to enable the system to accommodate the diverse educational needs of children with disabilities.

Maternal and child factors associated with child body fatness in a Ghanaian cohort.

We aimed to identify factors (child diet, physical activity; maternal BMI) associated with body composition of Ghanaian pre-school children. Longitudinal analysis of the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana randomized trial, which enrolled 1320 pregnant women at ≤20 weeks' gestation and followed them and their infants until 6 and 18 months postpartum, respectively. At follow-up, child age 4-6 years, we collected data on body composition (by 2H dilution), physical activity and diet, extracted dietary patterns using factor analysis, and examined the association of children's percentage body fat with maternal and child factors by regression analysis. Eastern Region, Ghana. Children 4-6 years of age. The analysis included 889 children with percentage body fat and dietary data at follow-up. We identified two major dietary patterns, a snacking and a cooked foods pattern. Percentage body fat was positively associated (standardized β (se)) with maternal BMI at follow-up (0·10 (0·03); P = 0·003) and negatively associated with physical activity (-0·15 (0·05); P = 0·003, unadjusted for child gender), but not associated with the snacking (0·06 (0·03); P = 0·103) or cooked foods (-0·05 (0·07); P = 0·474) pattern. Boys were more active than girls (1470 v. 1314 mean vector magnitude counts/min; P < 0·0001) and had lower percentage body fat (13·8 v. 16·9 %; P < 0·0001). In this population, maternal overweight and child physical activity, especially among girls, may be key factors for addressing child overweight/obesity. We did not demonstrate a relationship between the dietary patterns and body fatness, which may be related to limitations of the dietary data available.

Antibody responses to yellow fever vaccine in 9 to 11-month-old Malian and Ghanaian children

ABSTRACTBackground: The World Health Organization recommends use of a single yellow fever (YF) vaccine dose for life and fractional doses in outbreaks when there are limited vaccine stocks. In endemic regions, this vaccine is given as part of routine infant immunization programs around 9 months of age. There is a need to better understand immune responses when vaccinating infants particularly in contexts where the child may be malnourished.Methods: Data from 393 Malian and Ghanaian infants who concomitantly received measles and YF vaccines at 9 to 11 months of age were retrospectively analyzed. Response to YF vaccine was examined for association with nutritional status at time of vaccination, sex, age, pre-vaccination titers and season of vaccination.Results: Neutralizing antibodies following vaccination were unaffected by season of vaccination, sex, pre-vaccination titers or nutritional status, though there was a trend to higher titers in males and children with higher height for age z-scores. Seroconversion rates differed significantly between countries (63.5 in Ghana vs. 91.0% in Mali).Conclusion: Longitudinal, prospective studies are needed to optimize the use of YF vaccine in infants in endemic settings. There may be a need for booster vaccinations and to compare various vaccine preparations to optimize the use of available vaccines.

Longitudinal causal impacts of preschool teacher training on Ghanaian children's school readiness: Evidence for persistence and fade-out.

Preschool programs have expanded rapidly in low- and middle-income countries, but there are widespread concerns about whether they are of sufficient quality to promote children's learning and development. We conducted a large school-randomized control trial ('Quality Preschool for Ghana' - QP4G) of a one-year teacher training and coaching program, with and without parental-awareness meetings, designed to improve preschool quality and child development. We followed 3,435 children in 240 schools in the Greater Accra Region of Ghana, a country with universal pre-primary education. A previous study reported positive impacts of teacher training (but not teacher training plus parental-awareness meetings) at the end of the implementation year on some dimensions of classroom quality, teacher well-being, and children's school readiness (Wolf et al., [2019] Journal of Research on Educational Effectiveness, 12, 10-37). The present study analyzed a new round of data collected 1year after the end of implementation to assess (a) the extent of persistence in impacts on child development and (b) whether such impacts vary by select child, household, and school characteristics. We found impacts of the teacher training intervention on children's overall school readiness were sustained (d=0.13), but were only marginally statistically significant. When broken down by domain, impacts on social-emotional skills specifically persisted. Persistent negative effects of teacher training plus parental-awareness meetings varied by the literacy status of the male parent such that negative impacts were concentrated in children in households with non-literate male heads.

Population pharmacokinetics of efavirenz in HIV and TB/HIV coinfected children: the significance of genotype-guided dosing

The current WHO weight-based dosing recommendations for efavirenz result in a wide variability of drug exposure in children. Our objectives are to characterize the effects of rifampicin- and isoniazid-containing anti-TB therapy and CYP2B6 activity on efavirenz concentrations in children, using non-linear mixed-effects modelling. This is a pharmacokinetic (PK) substudy of a prospective study that examined the interactions between anti-TB therapy and efavirenz in HIV-infected children with and without TB. PK samples were obtained 4 weeks after starting efavirenz (PK1) and repeated 4 weeks after completing TB therapy (PK2) in TB/HIV coinfected patients. Drug concentrations were measured using LC-MS/MS. Composite CYP2B6 516/983/15582 genotype was determined. Population PK modelling was performed in Monolix. Simulations were performed to obtain the predicted mid-dose concentrations (C12). One hundred and five HIV-infected Ghanaian children (46 with TB/HIV) were included. The median age and weight were 7 years and 19 kg. The efavirenz concentrations over time were adequately described using a one-compartment model. Weight, composite CYP2B6 genotype and PK visit had a significant influence on the PK parameters, while TB therapy had no significant effect. Simulations showed adequate C12 for intermediate composite CYP2B6 metabolizers only. Our model showed that rifampicin- and isoniazid-containing anti-TB therapy does not influence efavirenz PK parameters. On the other hand, it describes the effect of efavirenz autoinduction after completing TB treatment. In addition, dosing efavirenz in children based only on weight results in a large variability in drug exposure. We propose dose adjustments for slow and extensive composite CYP2B6 metabolizers.

Whole genome characterization and evolutionary analysis of OP354-like P[8] Rotavirus A strains isolated from Ghanaian children with diarrhoea.

In 2010, the rare OP354-like P[8]b rotavirus subtype was detected in children less than 2 years old in Ghana. In this follow-up study, to provide insight into the evolutionary history of the genome of Ghanaian P[8]b strains RVA/Human-wt/GHA/GHDC949/2010/G9P[8] and RVA/Human-wt/GHA/GHM0094/2010/G9P[8] detected in an infant and a 7-month old child hospitalised for acute gastroenteritis, we sequenced the complete genome using both Sanger sequencing and Illumina MiSeq technology followed by phylogenetic analysis of the near-full length sequences. Both strains possessed the Wa-like/genotype 1 constellation G9P[8]b-I1-R1-C1-M1-A1-N1-T1-E1-H1. Sequence comparison and phylogenetic inference showed that both strains were identical at the lineage level throughout the 11 genome segments. Their VP7 sequences belonged to the major sub-lineage of the G9-lineage III whereas their VP4 sequences belonged to P[8]b cluster I. The VP7 and VP4 genes of the study strains were closely related to a Senegalese G9P[8]b strain detected in 2009. In the remaining nine genome segments, both strains consistently clustered together with Wa-like RVA strains possessing either P[8]a or P[8]b mostly of African RVA origin. The introduction of a P[8]b subtype VP4 gene into the stable Wa-like strain backbone may result in strains that might propagate easily in the human population, with a potential to become an important public health concern, especially because it is not certain if the monovalent rotavirus vaccine (Rotarix) used in Ghana will be efficacious against such strains. Our analysis of the full genomes of GHM0094 and GHDC949 adds to knowledge of the genetic make-up and evolutionary dynamics of P[8]b rotavirus strains.

Ecological zone and symptoms of acute respiratory infection among children under five in Ghana: 1993-2014.

Since 1993, evidence suggest that a significant portion of Ghanaian under-five children have suffered from Acute Respiratory Infection (ARI). This study sought to examine the prevalence of ARI symptoms among under-fives across ecological zones as well as childhood and maternal factors associated with ARI between 1993 and 2014. We used data from Ghana Demographic and Health Surveys (1993–2014). The study sample included women of reproductive age who had under-five children experiencing a cough accompanied with short rapid breaths in the last two weeks preceding each of the surveys. Data were extracted and analysed using STATA version 14.2. Both bivariate and multivariate analyses were done to establish the association between the explanatory and outcome variable. Among Coastal dwellers, the prevalence of reported ARI increased from 18.7% in 1993 to 36.5% in 2014. Increment occurred between 1993 (45.2%) and 2014 (47.3%) within the Middle zone. Between 1993 and 2014, reported ARI reduced from 36.1% to 16.2% among Savanna dwellers. In addition to ecological zone, place of residence, and survey year were associated with symptoms of childhood ARIs. The multivariate results showed that children whose mothers lived in rural areas [AOR = 1.54, CI = 1.21–1.97] and those born in survey wave 1998 [AOR = 1.59, CI = 1.24–2.04] had higher odds of reporting symptoms of ARI. The study findings have demonstrated the need for public health education and sensitization on ARI to be more specific and target women with children under-five who live in the Middle zone compared to those who live in other ecological zones.

Association between school-level attributes and weight status of Ghanaian primary school children

BackgroundLittle is known about the impact of the school environmental context on the emerging trend of childhood obesity in Africa. We examined the association of the schools’ contextual factors with body mass index (BMI), abdominal obesity and overweight (including obesity) in urban Ghana.MethodUsing cross-sectional data from 543 school children aged 8–11 years attending 14 primary schools, we applied multilevel logistic regressions and linear regression models to investigate the association of child- and school level attributes with overweight, abdominal obesity, and BMI.ResultsWe observed significant variance of the random effects of schools in BMI (2.65, p < 0.05), abdominal obesity (0.85, p < 0.05), and overweight (1.41, p < 0.05), with school contextual levels accounting for 19.7, 20.6, and 30.0% of the total variability observed in BMI, abdominal obesity and overweight respectively. Attending high socioeconomic (SES) level school, private school and school with increased after-school recreational facilities were associated with higher BMI. Children were more likely to be overweight if they attended a high SES level school, had access to healthful foods at school, and after-school recreational facilities. With regards to abdominal obesity, attending a school with increased physical activity facilities decreased the odds of abdominal obesity; however the odds increased if they attended a school with access to after-school recreational facilities.ConclusionA number of school-level factors were associated with BMI, overweight and abdominal obesity of children in the present study. Our results provide support for improved school environment to reduce overweight.

Exposure to a slightly sweet lipid-based nutrient supplement during early life does not increase the level of sweet taste most preferred among 4- to 6-year-old Ghanaian children: follow-up of a randomized controlled trial

ABSTRACTBackgroundThe impact of feeding a slightly sweet nutrient supplement early in life on later sweet taste preference is unknown.ObjectiveWe tested the hypothesis that the level of sucrose most preferred by 4–6-y-old children exposed to a slightly sweet lipid-based nutrient supplement (LNS) early in life would not be higher than that of children never exposed to LNS.DesignWe followed up children born to women (n = 1,320) who participated in a randomized trial in Ghana. In one group, LNS was provided to women on a daily basis during pregnancy and the first 6 mo postpartum and to their infants from age 6 to 18 mo (LNS group). The control groups received daily iron and folic acid or multiple micronutrients during pregnancy and the first 6 mo postpartum, with no infant supplementation (non-LNS group). At age 4–6 y, we randomly selected a subsample of children (n = 775) to assess the concentration of sucrose most preferred using the Monell 2-series, forced-choice, paired-comparison tracking procedure. We compared LNS with non-LNS group differences using a noninferiority margin of 5% weight/volume (wt/vol).ResultsOf the 624 children tested, most (61%) provided reliable responses. Among all children, the mean ± SD sucrose solution most preferred (% wt/vol) was 14.6 ± 8.6 (LNS group 14.9 ± 8.7; non-LNS group 14.2 ± 8.4). However, among children with reliable responses, it was 17.0 ± 10.2 (LNS group 17.5 ± 10.4; non-LNS group 16.5 ± 10.0). The upper level of the 95% CI of the difference between groups did not exceed the noninferiority margin in either the full sample or those with reliable responses, indicating that the LNS group did not have a higher sweet preference than the non-LNS group.ConclusionExposure to a slightly sweet nutrient supplement early in life did not increase the level of sweet taste most preferred during childhood. This trial was registered at clinicaltrials.gov as NCT00970866.

Prevalence and correlates of overweight and obesity among school children in an urban district in Ghana

BackgroundThere is limited data on risk factors associated with childhood overweight and obesity in Ghanaian school children. Therefore, the aim of this study was to assess the prevalence of overweight and obesity and associated risk factors in Ghanaian school children.MethodsData for this study were obtained from a cross-sectional survey of 543 children aged 8 and 11 years, attending private and public primary schools in the Adentan Municipality of Greater Accra Region, Ghana. Anthropometric, dietary, physical activity, sedentary behaviours, sleep duration and socio-demographic data were collected. BMI-for-age Z-scores were used to classify children as overweight/obesity. Multivariable logistic regressions were used to assess the determinants of overweight and obesity.ResultsThe overall prevalence of overweight/obesity was 16.4%. Children living in middle (OR = 1.88; 95% CI = 1.01–3.50) and high socioeconomic status (SES) households (2.58; 1.41–4.70) had increased odds of being overweight or obese compared to those living in low SES household. Attending private school (2.44; 1.39–4.29) and watching television for more than 2 h each day (1.72; 1.05–2.82) were significantly associated with increased likelihood of overweight and obesity. Children who slept for more than 9 h a night (0.53; 0.31–0.88) and walked or cycled to school (0.51; 0.31–0.82) had lower odds of being overweight or obese.ConclusionsA number of modifiable risk factors were associated with overweight and obesity in this study. Public health strategies to prevent childhood obesity should target reduction in television watching time, promoting active transport to and from school, and increasing sleep duration.

Complications of Falciparum Malaria Infections among Ghanaian Children; from the Healthcare Personnel’s Perspective

Background and Aim: Malaria is known to be the most widespread tropical disease and a chief cause of morbidity and mortality in Africa. This study was conducted to determine some common complications of falciparum malaria in children, from the perspective of healthcare personnel in Kumasi, Ghana.&#x0D; Materials and Methods: This questionnaire-based cross-sectional study was carried out at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. The study population included health care professionals working at the children`s unit of the hospital. About 80 healthcare personnel were recruited to partake in the survey for eliciting views on malaria. Questionnaires were used to capture some symptoms and complications of malaria from the health workers’ point of view.&#x0D; Results: More than half of the healthcare personnel were males (52.5%), and majority of the participants were medical officers. The study participants elaborated on some common malaria symptoms among children. Fever recorded the highest frequency, represented by 98.8%, followed by general malaise (97.4%), nausea and vomiting (93.8%), chills (78.8%) and headaches (72.5%). Prostration (45.0%), hyperpyrexia (38.75%) and hypoglycemia (13.75%) were the most frequently reported complications by the respondents. Majority of the participants reported cerebral malaria (30.0%), severe anemia (23.75%), acute respiratory distress (17.5%) and repeated generalized convulsions (16.25%) to be the most lethal feature of complicated malaria infection in children. The overwhelming majority of the respondents (90.0%) use the WHO 2014 standard (page2) as guide for determining complicated malaria.&#x0D; Conclusion: Prostration with hyperpyrexia and hypoglycemia were the most common features of falciparum malaria from the perspective of healthcare personnel in Kumasi, Ghana.

The role of executive function and social-emotional skills in the development of literacy and numeracy during preschool: a cross-lagged longitudinal study.

The majority of evidence on the interplay between academic and non-academic skills comes from high-income countries. The aim of this study was to examine the bidirectional associations between Ghanaian children's executive function, social-emotional, literacy, and numeracy skills longitudinally. Children (N=3,862; M age=5.2years at time 1) were assessed using direct assessment at three time points over the course of two school years. Controlling for earlier levels of the same skill, early executive function predicted higher subsequent literacy and numeracy skills, and early literacy and numeracy skills predicted higher subsequent executive function, indicating that the development of executive function and academic skills is inter-related and complementary over time. Early literacy and numeracy predicted subsequent social-emotional skills, but early social-emotional skills did not predict subsequent literacy and numeracy skills. The findings provide longitudinal evidence on children's learning and development in West Africa and contribute to a global understanding of the relations between various developmental skills over time.

Decline of Yellow Fever Long-Term Immunity in Children Vaccinated During Infancy

Background: The vaccine against yellow fever is routinely administered to infants aged 9-12 months under the Expanded Programme on Immunization, but the long-term outcome of vaccination in this age group is unknown. This information is critical in the context of current guidelines recommending a single dose of the vaccine for life. Methodology: We used a microneutralization assay to measure protective antibodies against yellow fever in 587 Malian and 436 Ghanaian children vaccinated around age 9 months and followed for 4·5 years (Mali), or 2·3 and 6 years (Ghana). We standardized antibody concentrations with reference to the yellow fever WHO International Standard. Findings: In the Malian group, 50·4% of children (95% CI 46·4-54·5) were seropositive (antibody concentration =0·5 IU/ml) 4·5 years after vaccination. Among the Ghanaian children, only 27·8% (95% CI 23·5-32·0) were seropositive after 2·3 years. This represented a sharp drop from the rates reported for both populations 28 days postvaccination. Seropositivity increased to 43·1% (95% CI 38·5-47·8) in the Ghanaian group 6 years after vaccination, but this result is confounded by possible secondary exposure to yellow fever virus. Interpretation: Rapid waning of immunity during the early years after vaccination of 9-month-old infants argues for a revision of the single-dose recommendation for this target population in endemic countries. In addition, the short duration of immunity in many vaccinees suggests that booster vaccination is necessary to meet the 80% population immunity threshold for prevention of yellow fever outbreaks. Funding Statement: Wellcome Trust Foundation. Declaration of Interests: SOS received grants from PATH during the conduct of the present study. SOS is the Minister of Health and Public Hygiene of the Republic of Mali but was not at the time of the collection of the samples used in this study. NB and CK received grants from the Bill and Melinda Gates Foundation during the conduct of this study. CD, JF, POA, and JEM declare no conflicts of interest. Ethics Approval Statement: The study protocol was approved by the ethics committees for studies involving human subjects at the Navrongo Health Research Centre, Navrongo, Ghana, and the National Institute for Research in Public Health (INRSP), Bamako, Mali. All the procedures complied with the Declaration of Helsinki. Informed consent was provided in writing by the participants’ parents or legal guardians in accordance with international ethical guidelines for epidemiological studies and with applicable local ethical guidance and requirements.

Microchimerism in Ghanaian children recipients of whole blood transfusion for severe anaemia.

Transfusion-acquired microchimerism (TA-Mc) has been reported in major trauma but not in young children despite relative immunodeficiency who, in sub-Saharan Africa, often suffer severe anaemia related to haemoglobinopathies or primary malaria infections. We examined the hypothesis that such massive red cell destructions might provide conditions favourable to TA-Mc, particularly when exposed to massive amounts of parasite antigens. Twenty-seven female children <5 years transfused with male whole blood for severe anaemia (13 with acute malaria and 14 with other causes) were retrospectively identified, and a blood sample was collected >6 months post-transfusion. Four whole blood samples from paediatric females transfused with blood from female donors and five secondary school female students never pregnant, never transfused were used as negative controls. Nineteen patients (70%) carried male Mc with four (15%) having high levels of Mc (>100 genome equivalent of male cells/million of host cells) compared to three controls (37·5%). There was no difference in frequency or quantity of male Mc between paediatric patients with severe malaria and paediatric patients with other causes of severe anaemia. TA-Mc was not correlated with patient age, duration of whole blood storage or lymphocyte load transfused. After a median of 7 months post-transfusion, acute malaria did not increase the frequency of TA-Mc. One negative control appeared to carry low-level male cells. Transfusion-acquired microchimerism appears frequent in young children transfused with whole blood for severe anaemia.