Fever in focus: Symptoms, diagnoses and treatment of febrile children in Ghana-A longitudinal hospital study.

BACKGROUND: Healthcare resources are often limited in areas of sub-Saharan Africa. This makes accurate and timely diagnoses challenging and delays treatment of childhood febrile illness. We explored longitudinal characteristics related to symptoms, diagnosis and treatment of hospitalised febrile children in a rural area of Ghana highly endemic for malaria. METHODS: Febrile children under 15 years, admitted to the study hospital paediatric ward, were recruited to the study and clinical data were collected throughout hospitalisation. Descriptive statistics were reported for all cases; for longitudinal analyses, a subset of visits with limited missing data was used. RESULTS: There were 801 hospitalised children included in longitudinal analyses. Malaria (n = 581, 73%) and sepsis (n = 373, 47%) were the most prevalent suspected diagnoses on admission. One-third of malaria suspected diagnoses (n = 192, 33%) were changed on the discharge diagnosis, compared to 84% (n = 315) of sepsis suspected diagnoses. Among malaria-only discharge diagnoses, 98% (n/N = 202/207) received an antimalarial and 33% (n/N = 69/207) an antibiotic; among discharge diagnoses without malaria, 28% (n/N = 108/389) received an antimalarial and 83% (n/N = 324/389) an antibiotic. CONCLUSIONS: Suspected diagnoses were largely based on clinical presentation and were frequently changed; changed diagnoses were associated with lingering symptoms, underscoring the need for faster and more accurate diagnostics. Medications were over-prescribed regardless of diagnosis stability, possibly because of a lack of confidence in suspected diagnoses. Thus, better diagnostic tools are needed for childhood febrile illnesses to enhance the accuracy of and confidence in diagnoses, and to cut down unjustified medication use, reducing the risk of antimicrobial and malaria resistance.

Aerodynamic effects and performance improvements of running in drafting formations.

Drafting as a process to reduce drag and to benefit from the presence of other competitors is applied in various sports with several recent examples of competitive running in formations. In this study, the aerodynamics of a realistic model of a female runner is calculated by computational fluid dynamics (CFD) simulations at four running speeds of 15 km h-1, 18 km h-1, 21 km h-1, and 36 km h-1. Aerodynamic power fractions of the total energy expenditure are found to be in the range of 2.6%-8.5%. Additionally, four exemplary formations are analysed with respect to their drafting potential and resulting drag values are compared for the main runner and her pacers. The best of the formations achieves a total drag reduction on the main runner of 75.6%. Moreover, there are large variations in the drag reduction between the considered formations of up to 42% with respect to the baseline single-runner case. We conclude that major drag reduction of more than 70% can already be achieved with fairly simple formations, while certain factors, such as runners on the sides, can have a detrimental effect on drag reduction due to local acceleration of the passing flow. Using an empirical model for mechanical power output during running, gains of metabolic power and performance predictions are evaluated for all considered formations. Improvements in running economy are up to 3.5% for the best formation, leading to velocity gains of 2.3%. This translates to 154 s (≈2.6 min) saved over a marathon distance. Consequently, direct conclusions are drawn from the obtained data for ideal drafting of long-distance running in highly packed formations.

Three monthly doses of 60 mg/kg praziquantel for Schistosoma haematobium infection is a safe and effective treatment regimen.

BACKGROUND: Praziquantel (PZQ) is the standard treatment for Schistosomiasis in sub-Saharan Africa. However, there is evidence suggesting praziquantel treatment failure in Schistosome infections with associated potential renal impairment. The objective of this study was to determine the effect of three monthly doses of 60 mg/kg/day PZQ on schistosome egg count, liver and renal function during the treatment of urinary schistosomiasis in Ghana. METHODS: A nested case-control study was designed from a cohort screened for schistosomiasis; 28 schistosomiasis positive cases by microscopy matched with 53 healthy controls by age and gender. The study population was urban dwellers from the Asokwa sub-metropolitan area, Kumasi in Ghana. Participants were within the age range of 6 to 30 years. We assessed Schistosoma haematobium egg counts in urine and its associated impact on liver and renal function at baseline, treatment and post-treatment phases using serum. RESULTS: Of the 28 cases and 53 controls, 78.6% and 81.1% were males respectively. Globulin levels before treatment was higher in cases [36.7 (32.8, 40.1) vrs 30.5 (22.4, 33.8), p = 0.005] at pre-treatment but not at post-treatment [35.8 (31.2, 39.1) vrs 37.4 (29.7, 43.0), p = 0.767]. Estimated cure rate was 42.9, 46.4 and 96.4% after first, second and third dose respectively. Schistosome egg counts dropped significantly (p = 0.001) from before second dose to post-treatment. Similarly, levels of alanine aminotransferase (p = 0.001), aspartate aminotransferase (p = 0.028) and gamma glutamyl transferase (p = 0.001) significantly declined towards post-treatment. Estimated glomerular filtration rate significantly improved from before second dose to post-treatment using both the Chronic Kidney Disease Epidemiology Program (p = 0.001) and 4-variable Modification of Diet in Renal Disease (p = 0.002) equations. CONCLUSION: Treatment of urinary Schistosoma hematobium infections with a repeated high monthly dose of 60 mg/kg of praziquantel for 3 months is safe and effective.

Zoonotic Gastrointestinal Parasites of Baboons (Papio anubis) in the Shai Hill Reserve in Ghana.

Several intestinal parasites of baboons are of zoonotic importance, especially where there is considerable interaction between the baboons and humans. The identification of gastrointestinal parasite infections of baboons (Papio anubis) was undertaken at the Shai Hills Reserve Resort, Ghana. A total of 51 faecal samples were collected randomly from individual baboons (51) and examined for cysts, eggs, and larvae of parasites of medical importance, using the direct saline smear and formol-ether concentration technique. The baboons were in 7 troops and were grouped into juveniles, subadults, and adults. The survey showed that 92% of the baboon samples examined were infected with at least one or more parasite(s) of medical importance. Hookworm had the highest prevalence of 38.39% followed by Ascaris lumbricoides (22.32%), whilst Diphyllobotrium latum recorded the lowest prevalence of 0.89%. Adults had the highest prevalence of A. lumbricoides (35.42%). Hookworm (47.92%) occurred most in the juveniles. This is the first report of intestinal parasitic infection in baboons within the Shai Hills Reserve. The results showed a high level of multiparasitism in the nonhuman primates, thus the need for possible interventions to maintain ecosystem health and control the infections as they may be a potential source of transmission to humans.