Molecular characterization of haemagglutinin genes of influenza B viruses circulating in Ghana during 2016 and 2017.

Recent reports of haemagglutinin antigen (HA) mismatch between vaccine composition strains and circulating strains, have led to renewed interest in influenza B viruses. Additionally, there are concerns about resistance to neuraminidase inhibitors in new influenza B isolates. To assess the potential impact in Ghana, we characterized the lineages of influenza B viruses that circulated in Ghana between 2016 and 2017 from different regions of the country: Southern, Northern and Central Ghana. Eight representative specimens from the three regions that were positive for influenza B virus by real-time RT-PCR were sequenced and compared to reference genomes from each lineage. A total of eleven amino acids substitutions were detected in the B/Victoria lineage and six in the B/Yamagata lineage. The strains of influenza B viruses were closely related to influenza B/Brisbane/60/2008 and influenza B/Phuket/3073/2013 for the Victoria and Yamagata lineages, respectively. Three main amino acid substitutions (P31S, I117V and R151K) were found in B/Victoria lineages circulating between 2016 and 2017, while one strain of B/Victoria possessed a unique glycosylation site at amino acid position 51 in the HA2 subunit. Two main substitutions (L172Q and M251V) were detected in the HA gene of the B/Yamagata lineage. The U.S. CDC recently reported a deletion sub-group in influenza B virus, but this was not identified among the Ghanaian specimens. Close monitoring of the patterns of influenza B evolution is necessary for the efficient selection of representative viruses for the design and formulation of effective influenza vaccines.

Challenges with the pursuit of ISO 15189 accreditation in a public health laboratory in Ghana.

Background: Accreditation is important for all medical laboratories, particularly public health laboratories in developing countries. Several laboratories in Ghana implemented the requirements of the International Organization for Standardization (ISO) 15189 but were unable to proceed to accreditation. This article describes the challenges faced by the Pathology Division Laboratory of the 37 Military Hospital, Accra, Ghana, during the acquisition of ISO 15189 accreditation and suggests solutions for a better approach. Intervention: Following ISO 15189 accreditation in 2017, an online survey was conducted between 01 and 30 March 2020 among the laboratory staff. Respondents were required to grade, on a scale of 0 (least) to 5 (most), the extent to which 16 key challenges influenced the process of obtaining accreditation. Key informant interviews were also held with laboratory personnel who were directly involved in the establishment of the quality management system in the laboratory and the accreditation acquisition process. Lessons learnt: Documentation, laboratory safety measures, laboratory management support, and reagent unavailability were estimated as the challenges that most affected the acquisition of laboratory accreditation. Challenges such as poor communication, staff apathy and workload had the least effect on the accreditation process. There was no difference in challenges identified between persons who worked in the laboratory before or after accreditation (p = 0.11). Recommendations: To surmount the anticipated challenges, there is the need for national strategic direction for laboratory accreditation, hospital and laboratory management support for the accreditation acquisition and maintenance processes, and sufficient technical assistance in the form of training and mentorship.

Prevalence and sociodemographic determinants of developmental delay: a cross-sectional study of under-five Nigerian children

Background: developmental problems or delays are preventable and others may be ameliorated by interventions. Developmental delay and factors associated with it therefore need to be identified in order for early and appropriate interventions to be instituted. This study therefore aimed to determine the prevalence of developmental delay among under-fives and identify the sociodemographic factors associated with the delay.Methods: Four hundred and fifteen Nigerian children, aged 6- 59 months were assessed for development using the Schedule of Growing Skills II tool. Developmental quotient below threshold point of 85% in a developmental domain was used to define developmental delay. Results: Of the 415 children assessed, 147 (35.4%) had delay in the various developmental domains. The highest prevalence was in the manipulative domain (25.8%) followed by visual (17.1%), cognitive skill (13.5%), hearing and language (6.3%), interactive social (5.8%), self-care social (4.4%) and speech and language (4.1%). Low maternal education was significantly associated with delay in locomotive domain (4.3%; OR=5.00; 95% CI=1.04-23.84), manipulative domain (32.4%; OR=1.89; Most 95% CI=1.21-2.95), visual domain (22.9%; OR=2.11; 95% CI=1.25-3.55), speech and language (6.4%; OR=3.03; 95% CI=1.05-8.75), interactive social (8%; OR=3.05; 95% CI=1.32-7.04), self-care social (6.9%; OR=3.30; 95% CI=1.15-9.43), cognitive (17.6%; OR=1.89; 95% CI= 1.07-3.35). Birth order and household size also had significant association with delay in various domains. There was no significant association between socioeconomic class and developmental delay in any of the domains.Conclusion: The study showed that developmental delay was relatively common among under-five children in North-West Nigeria; and has a strong association with some socio demographic factors. There is need to screen children for developmental delay for early intervention

Recent illness, feeding practices and father's education as determinants of nutritional status among preschool children in a rural Nigerian community.

Good nutrition is necessary for the growth and development of preschool children. In sub-Saharan Africa, however, data on the determinants of their nutritional status are lacking. A cross-sectional survey of 366 preschool children was conducted in a rural community in northern Nigeria. Anthropometric measurements of the children were taken and information about feeding practices, immunization and parental education was obtained from their mothers. Fifty-two percent were stunted, 30% were underweight and 25% were wasted. Recent history of diarrhea was associated with wasting (OR = 2.66, p < 0.001). Children whose fathers had postsecondary education were less likely to be stunted (OR = 0.45, p = 0.01) or underweight (OR = 0.37, p = 0.005). Promoting exclusive breastfeeding, preventing recurrent diarrhea and including fathers in community interventions will improve the health of children in this community.

Diagnosing renal failure due to diethylene glycol in children in a resource-constrained setting.

BACKGROUND: In 2008, several Nigerian children developed acute kidney injury (AKI) after ingesting teething syrup contaminated with diethylene glycol (DEG). Because there are limited diagnostic facilities in resource-constrained countries, this study investigated whether AKI associated with DEG could be identified by other means. METHODS: This was a multicenter study. Information was obtained from hospital records. Clinicopathological features of all children with AKI over a 6-month period were reviewed. RESULTS: Sixty (50.4%) of 119 children ingested "My pikin" teething syrup. Compared to children who had not ingested it, they were significantly (p < 0.05) younger (11.95 vs. 31 months), more were anuric (98.3 vs. 74.6%), hypertensive (84 vs. 52%), had severe metabolic acidosis (46.7 vs. 20.5%), and died (96.6 vs. 71.2%). They developed increasing metabolic acidosis and multiorgan dysfunction despite peritoneal dialysis. Late presentation, financial difficulties, inadequate facilities for toxicology, and hemodialysis complicated management. CONCLUSIONS: Identifying AKI associated with DEG is difficult. Detailed drug history, increasing metabolic acidosis, and multiorgan deterioration despite peritoneal dialysis should arouse suspicion. Simple diagnostic tests need to be developed and facilities for hemodialysis of infants and financial support provided. Recurrences can be prevented by creating awareness, improving manufacturing practices, field-testing of drugs, and international monitoring of pharmaceuticals imported for manufacture.