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1.
Thromb Haemost ; 2024 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-39214143

RESUMO

Venom induced consumption coagulopathy (VICC) is a common complication of snakebite that is associated with hypofibrinogenaemia, bleeding, disability, and death. In remote tropical settings, where most snakebites occur, the 20-minute whole blood clotting test is used to diagnose VICC. Point-of-care (POC) coagulation devices could provide an accessible means of detecting VICC that is better standardised, quantifiable, and more accurate. In this scoping review, the mechanistic reasons that previously studied POC devices have failed in VICC are considered, and evidence-based recommendations are made to prioritise certain devices for clinical validation studies. Four small studies have evaluated a POC international normalised ratio (INR) device in patients with Australian Elapid, Daboia russelii and Echis carinatus envenoming. All of these studies used POC INR devices that rely on a thrombin substrate endpoint, which, unlike laboratory-based INR measurement, is known to underestimate INR in patients with hypofibrinogenaemia. Seventeen commercially available POC devices for measuring INR, activated clotting time (ACT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, and fibrin(ogen) degradation products (FDP) have been reviewed. POC INR devices that detect fibrin clot formation, as well as a novel POC device that quantifies fibrinogen were identified, that show promise for use in patients with VICC. These devices could support more accurate allocation of antivenom, reduce the time to antivenom administration, and provide improved clinical trial outcome measurement instruments. There is an urgent need for these promising POC coagulation devices to be validated in prospective clinical snakebite studies.

2.
J Med Virol ; 96(6): e29713, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38874194

RESUMO

Anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence is used to estimate the proportion of individuals within a population previously infected, to track viral transmission, and to monitor naturally and vaccine-induced immune protection. However, in sub-Saharan African settings, antibodies induced by higher exposure to pathogens may increase unspecific seroreactivity to SARS-CoV-2 antigens, resulting in false positive responses. To investigate the level and type of unspecific seroreactivitiy to SARS-CoV-2 in Africa, we measured immunoglobulin G (IgG), IgA, and IgM to a broad panel of antigens from different pathogens by Luminex in 602 plasma samples from African and European subjects differing in coronavirus disease 2019, malaria, and other exposures. Seroreactivity to SARS-CoV-2 antigens was higher in prepandemic African than in European samples and positively correlated with antibodies against human coronaviruses, helminths, protozoa, and especially Plasmodium falciparum. African subjects presented higher levels of autoantibodies, a surrogate of polyreactivity, which correlated with P. falciparum and SARS-CoV-2 antibodies. Finally, we found an improved sensitivity in the IgG assay in African samples when using urea as a chaotropic agent. In conclusion, our data suggest that polyreactive antibodies induced mostly by malaria are important mediators of the unspecific anti-SARS-CoV-2 responses, and that the use of dissociating agents in immunoassays could be useful for more accurate estimates of SARS-CoV-2 seroprevalence in African settings.


Assuntos
Anticorpos Antivirais , COVID-19 , Imunoglobulina G , SARS-CoV-2 , Humanos , COVID-19/imunologia , COVID-19/epidemiologia , Anticorpos Antivirais/sangue , Estudos Soroepidemiológicos , SARS-CoV-2/imunologia , Imunoglobulina G/sangue , Adulto , Masculino , Feminino , Pessoa de Meia-Idade , Malária/epidemiologia , Malária/imunologia , Malária/sangue , Imunoglobulina M/sangue , Adulto Jovem , Idoso , Adolescente , Europa (Continente)/epidemiologia , Imunoglobulina A/sangue , Doenças Endêmicas , África/epidemiologia , África Subsaariana/epidemiologia
3.
PLoS Negl Trop Dis ; 17(12): e0011838, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38091347

RESUMO

Snakebite envenoming is a debilitating neglected tropical disease disproportionately affecting the rural poor in low and middle-income countries in the tropics and sub-tropics. Critical questions and gaps in public health and policy need to be addressed if major progress is to be made towards reducing the negative impact of snakebite, particularly in the World Health Organisation (WHO) Africa region. We engaged key stakeholders to identify barriers to evidence-based snakebite decision making and to explore how development of research and policy hubs could help to overcome these barriers. We conducted an electronic survey among 73 stakeholders from ministries of health, health facilities, academia and non-governmental organizations from 15 countries in the WHO Africa region. The primary barriers to snakebite research and subsequent policy translation were limited funds, lack of relevant data, and lack of interest from policy makers. Adequate funding commitment, strong political will, building expert networks and a demand for scientific evidence were all considered potential factors that could facilitate snakebite research. Participants rated availability of antivenoms, research skills training and disease surveillance as key research priorities. All participants indicated interest in the development of research and policy hubs and 78% indicated their organization would be willing to actively participate. In conclusion, our survey affirms that relevant stakeholders in the field of snakebite perceive research and policy hubs as a promising development, which could help overcome the barriers to pursuing the WHO goals and targets for reducing the burden of snakebite.


Assuntos
Mordeduras de Serpentes , Humanos , Mordeduras de Serpentes/epidemiologia , Mordeduras de Serpentes/prevenção & controle , Antivenenos/uso terapêutico , África/epidemiologia , Organização Mundial da Saúde , Saúde Pública
4.
PLoS Comput Biol ; 19(11): e1011666, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38011203

RESUMO

The extent to which dengue virus has been circulating globally and especially in Africa is largely unknown. Testing available blood samples from previous cross-sectional serological surveys offers a convenient strategy to investigate past dengue infections, as such serosurveys provide the ideal data to reconstruct the age-dependent immunity profile of the population and to estimate the average per-capita annual risk of infection: the force of infection (FOI), which is a fundamental measure of transmission intensity. In this study, we present a novel methodological approach to inform the size and age distribution of blood samples to test when samples are acquired from previous surveys. The method was used to inform SERODEN, a dengue seroprevalence survey which is currently being conducted in Ghana among other countries utilizing samples previously collected for a SARS-CoV-2 serosurvey. The method described in this paper can be employed to determine sample sizes and testing strategies for different diseases and transmission settings.


Assuntos
Dengue , SARS-CoV-2 , Humanos , Estudos Transversais , Estudos Soroepidemiológicos , Gana/epidemiologia , Anticorpos Antivirais
5.
Proc Natl Acad Sci U S A ; 119(42): e2202871119, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36215506

RESUMO

COVID-19 is the latest zoonotic RNA virus epidemic of concern. Learning how it began and spread will help to determine how to reduce the risk of future events. We review major RNA virus outbreaks since 1967 to identify common features and opportunities to prevent emergence, including ancestral viral origins in birds, bats, and other mammals; animal reservoirs and intermediate hosts; and pathways for zoonotic spillover and community spread, leading to local, regional, or international outbreaks. The increasing scientific evidence concerning the origins of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is most consistent with a zoonotic origin and a spillover pathway from wildlife to people via wildlife farming and the wildlife trade. We apply what we know about these outbreaks to identify relevant, feasible, and implementable interventions. We identify three primary targets for pandemic prevention and preparedness: first, smart surveillance coupled with epidemiological risk assessment across wildlife-livestock-human (One Health) spillover interfaces; second, research to enhance pandemic preparedness and expedite development of vaccines and therapeutics; and third, strategies to reduce underlying drivers of spillover risk and spread and reduce the influence of misinformation. For all three, continued efforts to improve and integrate biosafety and biosecurity with the implementation of a One Health approach are essential. We discuss new models to address the challenges of creating an inclusive and effective governance structure, with the necessary stable funding for cross-disciplinary collaborative research. Finally, we offer recommendations for feasible actions to close the knowledge gaps across the One Health continuum and improve preparedness and response in the future.


Assuntos
COVID-19 , Quirópteros , Saúde Única , Animais , Animais Selvagens , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Pandemias/prevenção & controle , SARS-CoV-2 , Zoonoses/epidemiologia , Zoonoses/prevenção & controle
6.
BMC Public Health ; 22(1): 1676, 2022 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064368

RESUMO

BACKGROUND: The current COVID-19 pandemic affects the entire world population and has serious health, economic and social consequences. Assessing the prevalence of COVID-19 through population-based serological surveys is essential to monitor the progression of the epidemic, especially in African countries where the extent of SARS-CoV-2 spread remains unclear. METHODS: A two-stage cluster population-based SARS-CoV-2 seroprevalence survey was conducted in Bobo-Dioulasso and in Ouagadougou, Burkina Faso, Fianarantsoa, Madagascar and Kumasi, Ghana between February and June 2021. IgG seropositivity was determined in 2,163 households with a specificity improved SARS-CoV-2 Enzyme-linked Immunosorbent Assay. Population seroprevalence was evaluated using a Bayesian logistic regression model that accounted for test performance and age, sex and neighbourhood of the participants. RESULTS: Seroprevalence adjusted for test performance and population characteristics were 55.7% [95% Credible Interval (CrI) 49·0; 62·8] in Bobo-Dioulasso, 37·4% [95% CrI 31·3; 43·5] in Ouagadougou, 41·5% [95% CrI 36·5; 47·2] in Fianarantsoa, and 41·2% [95% CrI 34·5; 49·0] in Kumasi. Within the study population, less than 6% of participants performed a test for acute SARS-CoV-2 infection since the onset of the pandemic. CONCLUSIONS: High exposure to SARS-CoV-2 was found in the surveyed regions albeit below the herd immunity threshold and with a low rate of previous testing for acute infections. Despite the high seroprevalence in our study population, the duration of protection from naturally acquired immunity remains unclear and new virus variants continue to emerge. This highlights the importance of vaccine deployment and continued preventive measures to protect the population at risk.


Assuntos
COVID-19 , SARS-CoV-2 , Anticorpos Antivirais , Teorema de Bayes , Burkina Faso/epidemiologia , COVID-19/epidemiologia , Gana/epidemiologia , Humanos , Madagáscar/epidemiologia , Pandemias , Estudos Soroepidemiológicos
7.
PLoS One ; 16(10): e0258164, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34714857

RESUMO

This paper uses publicly available data and various statistical models to estimate the basic reproduction number (R0) and other disease parameters for Ghana's early COVID-19 pandemic outbreak. We also test the effectiveness of government imposition of public health measures to reduce the risk of transmission and impact of the pandemic, especially in the early phase. R0 is estimated from the statistical model as 3.21 using a 0.147 estimated growth rate [95% C.I.: 0.137-0.157] and a 15-day time to recovery after COVID-19 infection. This estimate of the initial R0 is consistent with others reported in the literature from other parts of Africa, China and Europe. Our results also indicate that COVID-19 transmission reduced consistently in Ghana after the imposition of public health interventions-such as border restrictions, intra-city movement, quarantine and isolation-during the first phase of the pandemic from March to May 2020. However, the time-dependent reproduction number (Rt) beyond mid-May 2020 does not represent the true situation, given that there was not a consistent testing regime in place. This is also confirmed by our Jack-knife bootstrap estimates which show that the positivity rate over-estimates the true incidence rate from mid-May 2020. Given concerns about virus mutations, delays in vaccination and a possible new wave of the pandemic, there is a need for systematic testing of a representative sample of the population to monitor the reproduction number. There is also an urgent need to increase the availability of testing for the general population to enable early detection, isolation and treatment of infected individuals to reduce progression to severe disease and mortality.


Assuntos
COVID-19 , Pandemias/prevenção & controle , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Gana/epidemiologia , Humanos , Modelos Estatísticos , Saúde Pública , Quarentena
8.
Vaccines (Basel) ; 9(8)2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34451939

RESUMO

The impact of COVID-19 vaccination programmes on disease transmission, morbidity and mortality relies heavily on the population's willingness to accept the vaccine. We explore Ghanaian adult citizens' vaccine hesitancy attitudes and identify the likelihood of participation or non-participation in the government's effort to get citizens vaccinated. A fully anonymised cross-sectional online survey of 2345 adult Ghanaians was conducted from 23 to 28 February 2021. Differences in intentions regarding COVID-19 vaccination were explored using Pearson Chi-square tests. Additionally, multinomial logistic regression was used to analyse the factors associated with willingness to receive vaccines. Responses were weighted using the iterative proportional fitting technique to generate a representative sample. About half (51%) of mostly urban adult Ghanaians over 15 years are likely to take the COVID-19 vaccine if made generally available. Almost a fifth (21%) of the respondents were unlikely to take the vaccine, while another 28% were undecided. Additionally, we find differences in vaccine hesitancy among some socio-demographic characteristics such as age, gender, and primary sources of information. Attaining the proverbial 63% to 70% herd immunity threshold in Ghana is only possible if the preventive vaccination programmes are combined with an enhanced and coordinated public education campaign. Such a campaign should focus on promoting the individual and population-level benefits of vaccination and pre-emptive efforts towards addressing misinformation about vaccines.

9.
Womens Health Rep (New Rochelle) ; 2(1): 234-244, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34318293

RESUMO

Background: Breast cancer is the leading cause of cancer death among Ghanaian women and most women are identified once they develop symptoms. Women then must navigate a complex health care system to get diagnosed and receive orthodox medicine. We describe Ghanaian women's pathways of care from breast cancer-related symptom detection to treatment receipt. Methods: We conducted a qualitative study using an empirical phenomenological approach. We used a purposive sampling technique to recruit 31 women with breast cancer who were receiving treatment at Komfo Anokye Teaching Hospital in Kumasi, Ghana. They participated in semistructured in-depth interviews between November 2019 and March 2020. All interviews were transcribed verbatim and analyzed using a deductive coding approach. Results: Women navigate approximately nine steps from symptom detection to receiving orthodox breast cancer treatment. The breast cancer care pathway is not linear and women frequently move among different management approaches, including alternative therapy (faith healing and traditional herbal healing). All the women detected the symptoms themselves. Some of the women sought orthodox medicine due to information from the media. Conclusions: Alternative therapy providers play a critical role in the breast cancer diagnosis and care pathways in Ghana underscoring the need to formally integrate them into the health care system. Breast cancer awareness programs through the media and educational programs aimed at alternative therapy providers may reduce the time from symptom detection to receipt of orthodox medicine.

10.
PLoS Negl Trop Dis ; 15(4): e0009298, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33861735

RESUMO

BACKGROUND: Snakebite envenoming is a medical emergency which is common in many tropical lower- and middle-income countries. Traditional healers are frequently consulted as primary care-givers for snakebite victims in distress. Traditional healers therefore present a valuable source of information about how snakebite is perceived and handled at the community level, an understanding of which is critical to improve and extend snakebite-related healthcare. METHOD: The study was approached from the interpretive paradigm with phenomenology as a methodology. Semi-structured interviews were conducted with 19 traditional healers who treat snakebite patients in two rural settings in Ghana. From the Ashanti and Upper West regions respectively, 11 and 8 healers were purposively sampled. Interview data was coded, collated and analysed thematically using ATLAS.ti 8 software. Demographic statistics were analysed using IBM SPSS Statistics version 26. FINDINGS: Snakebite was reportedly a frequent occurrence, perceived as dangerous and often deadly by healers. Healers felt optimistic in establishing a diagnosis of snakebite using a multitude of methods, ranging from herbal applications to spiritual consultations. They were equally confident about their therapies; encompassing the administration of plant and animal-based concoctions and manipulations of bite wounds. Traditional healers were consulted for both physical and spiritual manifestations of snakebite or after insufficient pain control and lack of antivenom at hospitals; referrals by healers to hospitals were primarily done to receive antivenom and care for wound complications. Most healers welcomed opportunities to engage more productively with hospitals and clinical staff. CONCLUSIONS: The fact that traditional healers did sometimes refer victims to hospitals indicates that improvement of antivenom stocks, pain management and wound care can potentially improve health seeking at hospitals. Our results emphasize the need to explore future avenues for communication and collaboration with traditional healers to improve health seeking behaviour and the delivery of much-needed healthcare to snakebite victims.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Medicinas Tradicionais Africanas , Aceitação pelo Paciente de Cuidados de Saúde , Mordeduras de Serpentes/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gana , Acessibilidade aos Serviços de Saúde/economia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Grupos Populacionais , População Rural
12.
Sci Total Environ ; 764: 142919, 2021 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-33097250

RESUMO

For over 15-years, proponents of the One Health approach have worked to consistently interweave components that should never have been separated and now more than ever need to be re-connected: the health of humans, non-human animals, and ecosystems. We have failed to heed the warning signs. A One Health approach is paramount in directing our future health in this acutely and irrevocably changed world. COVID-19 has shown us the exorbitant cost of inaction. The time to act is now.


Assuntos
COVID-19 , Saúde Única , Animais , Berlim , Ecossistema , Saúde Global , Humanos , SARS-CoV-2
13.
Trans R Soc Trop Med Hyg ; 115(2): 196-199, 2021 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-33179054

RESUMO

To maximise the likelihood of success, global health programmes need repeated, honest appraisal of their own weaknesses, with research undertaken to address any identified gaps. There is still much to be learned to optimise work against neglected tropical diseases. To facilitate that learning, a comprehensive research and development plan is required. Here, we discuss how such a plan might be developed.


Assuntos
Medicina Tropical , Erradicação de Doenças , Saúde Global , Humanos , Doenças Negligenciadas/prevenção & controle , Pesquisa
15.
J Transl Med ; 18(1): 358, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32957995

RESUMO

COVID-19 caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan (Hubei province, China) during late 2019. It has spread across the globe affecting nearly 21 million people with a toll of 0.75 million deaths and restricting the movement of most of the world population during the past 6 months. COVID-19 became the leading health, economic, and humanitarian challenge of the twenty-first century. In addition to the considerable COVID-19 cases, hospitalizations, and deaths in humans, several cases of SARS-CoV-2 infections in animal hosts (dog, cat, tiger, lion, and mink) have been reported. Thus, the concern of pet owners is increasing. Moreover, the dynamics of the disease requires further explanation, mainly concerning the transmission of the virus from humans to animals and vice versa. Therefore, this study aimed to gather information about the reported cases of COVID-19 transmission in animals through a literary review of works published in scientific journals and perform genomic and phylogenetic analyses of SARS-CoV-2 isolated from animal hosts. Although many instances of transmission of the SARS-CoV-2 have been reported, caution and further studies are necessary to avoid the occurrence of maltreatment in animals, and to achieve a better understanding of the dynamics of the disease in the environment, humans, and animals. Future research in the animal-human interface can help formulate and implement preventive measures to combat the further transmission of COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/veterinária , Pandemias/veterinária , Pneumonia Viral/veterinária , Zoonoses/transmissão , Criação de Animais Domésticos , Animais , Betacoronavirus/classificação , Betacoronavirus/genética , Betacoronavirus/patogenicidade , COVID-19 , Gatos , Coronavirus/classificação , Coronavirus/genética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Reservatórios de Doenças/veterinária , Reservatórios de Doenças/virologia , Cães , Genoma Viral , Humanos , Vison/virologia , Países Baixos/epidemiologia , Exposição Ocupacional , Animais de Estimação/virologia , Filogenia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , SARS-CoV-2 , Glicoproteína da Espícula de Coronavírus/genética , Pesquisa Translacional Biomédica , Zoonoses/epidemiologia
19.
BMC Public Health ; 18(1): 840, 2018 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-29976173

RESUMO

BACKGROUND: The major drawback of the community-based mass drug administration (MDA) approach against schistosomiasis is that treatment is offered blindly without testing for the targeted infection. This partly contributes to the low treatment coverage. One approach to overcome this limitation is to introduce a diagnostic component in the treatment approach. This will improve drug uptake and compliance to treatment. This study is conducted to assess the feasibility and acceptability of integrating point-of-care Circulating Cathodic Antigen (POC-CCA) test to community-based directed MDA in improving treatment coverage and compliance with treatment among adults. METHODS: This is a randomized control community trial in which 30 clusters were randomly assigned to either an intervention or control arm to evaluate two interventions on treatment coverage and compliance with treatment. In each cluster, 150 adult participants were enrolled. Community Health Workers (CHW) in both arms were trained on all aspects of praziquantel (PZQ) distribution and management of mild side effects. In the intervention arm, CHWs had additional training on how to use POC-CCA to diagnose intestinal schistosomiasis. In the intervention arm, participants were tested using POC-CCA test for presence of intestinal schistosomiasis and treated based on test results, while in the control arm, participants were treated with PZQ without testing. The primary outcome measure was the proportion of participants provided with PZQ between the two arms and geographical clusters. Secondary outcomes were prevalence of S. mansoni infection based on the POC-CCA test conducted by CHWs, ability of CHWs to use the POC-CCA test accurately and safely and community acceptability of the POC-CCA test results from CHWs. Both quantitative and qualitative techniques have been used to collect data at study endpoint. DISCUSSION: The study will generate evidence on the importance of integrating a diagnostic component into the community directed MDA conducted by CHWs. Findings will generate discussion on the current MDA policy and practice in Tanzania. TRIAL REGISTRATION: PACTR201804003343404 (25/4/2018).


Assuntos
Agentes Comunitários de Saúde , Técnicas e Procedimentos Diagnósticos , Administração Massiva de Medicamentos , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Praziquantel/uso terapêutico , Schistosoma mansoni/isolamento & purificação , Esquistossomose mansoni/diagnóstico , Adulto , Animais , Antígenos de Helmintos/análise , Feminino , Humanos , Masculino , Schistosoma mansoni/imunologia , Esquistossomose mansoni/tratamento farmacológico , Tanzânia
20.
Ghana Med J ; 50(3): 142-148, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27752188

RESUMO

BACKGROUND: Most sexually transmitted infection (STI) management efforts focus on the syndromic approach to diagnose and treat patients. However, most women with STIs have been shown to be entirely asymptomatic, or if symptoms exist, are often missed when either clinical or conventional bacteriologic diagnostic tools are employed. METHODS: We assessed the performance of a multiplex real time PCR assay to describe other potential pathogens that could be missed by conventional bacteriological techniques in 200 women attending a routine STI clinic in Kumasi, Ghana. RESULTS: Although a total 78.00% of the women were asymptomatic, 77.1% of them tested positive for at least one bacterial STI pathogen. Mycoplasma genitalium was the most commonly detectable pathogen present in 67.5% of all women. Of those testing positive, 25.0% had single infections, while 38.0% and 19.5% had double and triple infections respectively. Altogether, 86.54% and 90.91% of the symptomatic and asymptomatic women respectively tested positive for at least one pathogen (p<0.05). There were no significant associations (p<0.05) between the clinical manifestations of the symptomatic women and the pathogens detected in their samples. CONCLUSIONS: Our study confirmed the importance of complementing the syndromic approach to STI management with pathogen detection and most importantly recognise that STIs in women are asymptomatic and regular empirical testing even for both symptomatic and asymptomatic patients is critical for complete clinical treatment. FUNDING: EOD (Ellis Owusu-Dabo Research working group, KCCR).


Assuntos
Reação em Cadeia da Polimerase Multiplex , Infecções por Mycoplasma/microbiologia , Mycoplasma genitalium , Doenças Bacterianas Sexualmente Transmissíveis/microbiologia , Adolescente , Adulto , Idoso , Infecções Assintomáticas , Criança , Feminino , Gana , Humanos , Pessoa de Meia-Idade , Infecções por Mycoplasma/diagnóstico , Doenças Bacterianas Sexualmente Transmissíveis/diagnóstico , Adulto Jovem
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