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    Comparative Clinical Study of Mist Amen Fevermix and Edhec Malacure: Two Polyherbal Products used for the Treatment of uncomplicated malaria in Ghana against Artemether/Lumefantrine
    (2020-11) Turkson, Bernard Kofi;
    The use of herbal medicinal products for the treatment of malaria an infectious and a life threatening disease, has increased globally. However, inadequate scientific studies, questions about the quality, safety and efficacy of such herbal products have been raised. On the other hand, the reduced sensitivity of the malaria parasites to artemisinin-based combination therapies is also of concern. There is therefore the need for new antimalarial medications including those from alternative sources such as herbal medicinal products. In this study, methods for the quality control of Mist Amen Fevermix and Edhec Malacure, two polyherbal antimalarial products used in Ghana for the management of uncomplicated malaria was undertaken. The development of the quality parameters for the test samples was based on phytochemical, physicochemical, chromatographic and spectroscopic methods. The set parameters were found to be sufficient to evaluate Mist Amen Fevermix and Edhec Malacure, and can be used as reference standards for the quality control purposes. Qualitative phytochemical screening and fingerprinting were undertaken based on standard analytical methods. The antiplasmodial activity was assessed in vitro by using field isolates of Plasmodium falciparum with SYBR® Green assays to measure parasite growth inhibition. Thermo Elemental M5 Atomic Absorption Spectrophotometer (AAS) fitted with Graphite furnace and an auto sampler was used to determine the heavy metal contents of the herbal products. The herbal samples were evaluated for microbial load by using the appropriate culture media. In vivo antiparasitic activity in mice was assessed using the Rane’s curative method using ANKA strain of Plasmodium berghei parasites. A comparative clinical study was done to assess the safety and effectiveness of the test samples at the Tafo Government Hospital, Kumasi after Committee on Human Research, Publication and Ethics approval. Male and female patients aged 15-45 years with clinically established malaria were treated with Mist Amen Fevermix and Edhec Malacure, at the specified doses of 45 mls (0.1063 g) and 30 mls (0.0521 g) three times daily after meals for three days. Basic phytochemical screening of the two products indicated the presence of the following phytochemicals: alkaloids, saponins, tannins, phytosterols and flavonoids. From the data, it was established that Mist Amen Fevermix and Edhec Malacure complied with the pharmacopoeial standards after testing for microbes. The following heavy metals were present in Mist Amen Fevermix and Edhec Malacure: Fe, Ni, K, Zn, Hg, Cu, Mn, Cr, Cd, Pb, Fe, Cu, K and Na. Ni was below detectable limit in Edhec Malacure. The phytochemical screening of the products revealed the presence of alkaloid flavonoid, tannin, steroid and saponin. The HPLC method was validated for linearity, limits of detection and quantification, precision and accuracy. The test products were found not to have been adulterated with lumefantrine, artemether and quinine. The test herbal products showed in vitro and in vivo antiplasmodial activities against Plasmodium falciparum and Plasmodium berghei parasites. Inhibitory concentration (IC50) values for Edhec Malacure was 70.89 ng/ml and that of Mist Amen Fevermix was 112.5 ng/ml. Edhec Malacure suppressed 76.17% of parasitaemia while Mist Amen Fevermix suppressed 69.03% of parasitaemia. Edhec Malacure demonstrated curative chemo suppressive potentials of 80.93% at the dose of 2.234 mgkg-1 and Mist Amen Fevermix % suppression was 69.03% at a dose of 4.56mg/kg-1. Both products demonstrated antiplasmodial activity in human red blood cells. The clinical evaluation of the test samples showed that Mist Amen Fevermix exhibited a statistically significant difference between the mean malaria parasite load recorded at the first visit and those recorded at the second visit, t(23) = 4.59, p =0 .000. Similarly, there was a significant difference between the mean parasite count recorded on the second visit and the third visit, t(6) = 1.49, p =0 .187. No difference were recorded for the third and fourth visits t(3) = 1.00, p =0 .391. Edhec Malacure also exhibited a significant difference in efficacy between the mean malaria parasite count recorded at the first visit and those recorded at the second visit, t(26) =3.77, p =0 .001. Similarly, there is a statistically significant difference between malaria parasite count at the second visits and third visits, t(16) = 1.74, p =0 .100. This shows the significant effectiveness of the products. Kidney and liver panel as well as full blood count and vital signs were within normalviii reference range at the end of the 28-day study and thus established the safety of Mist Amen Fevermix and Edhec Malacure in the treatment of uncomplicated malaria. The results support claims that Mist Amen Fevermix and Edhec Malacure may be useful antimalarial agents. This study has demonstrated the in vitro and in vivo antiplasmodial activities of Mist Amen Fevermix and Edhec Malacure, and suggests that, the products have promising antimalarial activity. The in vivo findings showed that Mist Amen Fevermix and Edhec Malacure are relatively safe for oral administration at doses tested. In addition, the study supports the use of Mist Amen Fevermix and Edhec Malacure, two polyherbal products for the treatment of uncomplicated malaria. Both products achieved a comparable clinical treatment outcome to the reference control medication artemether/lumefantrine.
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    Risk Factors and Human coronaviruses Associated with Upper Respiratory Tract Infections in Three Rural Areas of Ghana.
    (2014.) Owusu, Michael
    Acute respiratory tract infections (ARI) are the leading cause of morbidity and mortality in developing countries, especially in Africa. In spite of its importance, information on the viral aetiology and risk factors associated with ARI are limited in Ghana. Even though human coronaviruses (HCoVs) are known to be associated with respiratory disease outbreaks and severe infections in some developed countries, their epidemiological role is understudied in many African countries including Ghana. It is therefore not known whether HCoVs are pathogenic viruses associated with ARI or only exist as normal commensals of the upper respiratory tract. The aim of this study was to find the association between HCoVs and ARIs, describe the sero-molecular epidemiology of HCoVs and identify the risk factors associated with upper respiratory tract infection. An unmatched case control study was conducted in Buoyem, Forikrom and Kwamang communities of Ghana. Subjects were interviewed on various socio-demographic factors and hygienic practices using structured questionnaires. Nasal/Nasopharyngeal swabs were taken from older children and adults, and tested for Middle East respiratory syndrome coronavirus (MERS-CoV), HCoV-229E, HCoV-OC43, HCoV-NL63 and HCoV-HKU1 using Reverse Transcriptase Real-Time Polymerase Chain Reaction. A total of 1272 subjects were recruited comprising of 662 (52%) controls and 610 (48%) cases. Risk factors associated with upper respiratory tract infections were school attendance to the level of Senior High and tertiary education, and being a health worker. Out of 322 subset of cases interviewed, 212 (66%) covered their nose with handkerchiefs when they sneezed, 52 (16%) covered with their hands upon xix sneezing and 79 (25%) sneezed in the open. Self-administered drugs such as herbs (2%), analgesics (25%) and antibiotics (16%) were used to manage upper respiratory tract infections. Out of the 1,272 subjects recruited, nasal swabs were taken from 1,213. Of the 1,213, 150 (12.4%) subjects were positive for one or more viruses. Of these, single virus detections occurred in 146 subjects (12.0%) and multiple detections occurred in 4 (0.3%). Compared with control subjects, infections with HCoV-229E (OR = 5.15, 95% CI = 2.24 – 11.78), HCoV-OC43 (OR = 6.16, 95% CI = 1.77 – 21.65) and combine HCoVs (OR = 2.36, 95% CI = 1.5 = 3.72) were associated with upper respiratory tract infections. Significant median virus concentration difference was observed for only HCoV- NL63 (cases: 2.41 x 106 copies per PCR reaction; IQR = 1.96 x 104 - 2.3 x 106 vrs controls: 1876.5 copies per PCR reaction; IQR =387.2 – 8.6 x 104, P=0.003) and the clinically relevant cut-off viral concentration was determined to be 7,510 copies per PCR reaction. HCoVs were found to be seasonally dependent with high proportions identified in the harmattan season (54/215, 25.1%) compared to the wet (80/516, 15.5%) seasons. The most frequent viruses detected in the harmattan and wet seasons were HCoV-229E and HCoV-NL63 respectively. HCoV-OC43 and HCoV-HKU1 were almost distributed equally throughout the year. Sequencing of the partial spike region was successful for 53 out of 146 samples (36.3%). Of the 53, 12 (22.6%) were HCoV-OC43, 14 (26.4%) were HCoV-NL63, 24 (45.3%) were HCoV-229E and 3 (5.7%) were HCoV-HKU1. A comparison of the obtained sequences resulted in no differences to sequences already published in GenBank. xx This study has identified risk factors of URTI and also demonstrated that HCoVs could play significant role in causing upper respiratory tract infections among adults and older children in rural arrears of Ghana. This information could be useful to policy makers, public health practitioners and other stakeholders in Ghana.
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    Bioactive constituents from the Ghanaian medicinal plant Chlorophora regia and its root endophytic fungus JK10.
    ( AUGUST, 2016 ) Kyekyeku, James Oppong
    The extracts of the Ghanaian medicinal plant Chlorophora regia A. Chev (Moraceae) has been used for the treatment of various ailments in traditional medicine including burns, wounds, snake bite, wasp bite. A search through the literature, however, revealed there were no available data on the phytochemical composition of the plant. Therefore, the main objective of this study was to isolate, characterize and evaluate some biological activities of secondary metabolites from the stem bark of the plant and further investigate the endophytic community harbored in the inner tissues of the plant. Extensive phytochemical investigation of the stem bark resulted in the isolation and characterization of four new metabolites, regiafuran A–C and 6–prenylated–3,5,7,4ʹ–tetrahydroxy–2ʹ–methoxyflavonol in addition to fifteen known compounds. The isolated compounds were tested for their free radical scavenging activities. Regiafuran A–B, mulberrofuran Y, kuwanol E and 5,7,4ʹ–trihydroxy–2ʹ–methoxyflavanone demonstrated significant free radical scavenging activities with IC50 values of 1.9 μg/ml, 2.4 μg/ml, 2.2 μg/ml, 2.1 μg/ml and 1.8 μg/ml respectively. An unidentified endophytic fungus, JK10, was isolated from the root of C. regia. Twelve compounds including seven new 7–desmethyl derivatives of fusarin C and five known compounds were isolated from the endophytic fungus, JK10. The planar and relative configurations of the new compounds were elucidated by combined spectroscopic analyses of their UV, IR, HRESI–MSn, ECD and NMR data. The absolute configuration of solaniol was established for the first time by X–ray diffraction analysis of a single crystal. The antibacterial activities of the isolated compounds were evaluated. 7–desmethyl fusarin C–22/23 and 7–desmethyl fusarin C–25 exhibited remarkable activity at concentrations of 10.0 μg/mL against the soil bacterium Acinetobacter sp. BD4 comparable to the reference standard streptomycin. All the tested compounds demonstrated activity against the environmental strain of E. coli. Based on the results it could be proposed that the endophytic fungus, whose origin is from the roots, contributes a chemical–mediated defensive mechanism to the host plant against iii invading specific soil and environmental bacterial pathogens. This may confirm the existence of a unique cost–benefit endophyte–plant association. The spatial distribution of three kaurane diterpenes, xylopic acid, ent–kaur–16–en–19–oic acid and 15–oxo–ent–kaur–16–en–19–oic acid, in the fruits of Xylopia aethiopica (Dunal) A. Rich (Annonaceae) were visualized by MALDI–HRMS imaging techniques. The distribution of the compounds was predominantly in the pericarp region of the fruit with non-detectable levels in the seed.
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    Pathophysiological indicators of pregnancy-induced hypertension in Ghanaian women
    (OCTOBER, 2016) Pobee, Richard Orleans Samuel
    Pregnancy-Induced Hypertension (PIH) is the abnormal increase in blood pressure (BP) of pregnant women who do not have pre-gestational chronic hypertension or renal diseases or proteinuria before the final half of gestation, but present with high BP and proteinuria in the final half of pregnancy which normalizes postnatally. PIH ranges from high BP without proteinuria, through high BP with proteinuria and multiorgan dysfunction to high BP with proteinuria, multiorgan dysfunction with seizures. PIH is usually diagnosed when BP rises above 140/90 mmHg.Ten percent (10%) of complications of pregnancy are as a result of hypertension and this accounts for the increased risk of adverse foetal, neonatal and maternal outcomes. This necessitates early diagnosis to avert these fatal outcomes. This study sought to find the biomarkers that would assist in the early diagnosis of pregnancy-induced hypertension in Ghanaian women. To achieve this, the following specific objectives were set: The determination of the concentrations of biomarkers of systemic inflammation, endothelial injury and systemic oxidative stress in PIH and controls;the evaluation of the relationship of hepcidin levels with iron regulation and systemic inflammation in PIH and controls; the determination of the concentrations of Soluble urokinase plasminogen activator receptor, Interlukin-6 and C-reactive protein in PIH and healthy pregnancy were studied in order to evaluate the best marker for the characterization of the inflammatory status during pregnancy and the determination of serum lipids levels and its correlation with C-reactive protein, Interlukin-6, 8-iso-prostagladin F2α and fibronectin in PIH.This research took place at the antenatal clinics of Ridge Regional Hospital, Accra, La General Hospital, Accra and Lister Hospital and Fertility Centre, Accra, Ghana from June, 2014 to July, 2015. This study involved forty-eight (48) women with gestational hypertension, fifty-seven (57) with preeclampsia, eighteen (18) with eclampsia and forty-five (45) normotensive pregnant women (controls) in at least their second trimester of gestation. All participants were within 18yrs to 40 yrs of age and with singleton pregnancy based on ultra-sound results. After ethical approval and informed consent had been obtained, blood (ie. EDTA whole blood, heparinized-plasma and serum) and urine samples of participants were obtained for biochemical, haematological and urine analysis. There were significantly higher levels of markers of systemic inflammation : IL-6 (19.60±10.32pg/ml vs 13.85±2.80pg/ml, p=0.04), CRP (3.31±2.81ng/L vs 0.98±0.05ng/L, p<0.0001), suPAR (2.04±0.66pg/ml vs 1.57±0.56pg/ml, p=0.03), endothelial injury: FN (21.87±11.95ng/ml vs 13.85±2.80ng/ml, p=0.01) and systemic oxidative stress: 8-iso-PGF2α (43.03±27.29pg/ml vs 5.55±5.33pg/ml, p=0.03) in PIH women compared to controls respectively.The results of the level of hepcidin in relation to iron homeostasis and systemic inflammation among the participants indicates significant increase in the levels of hepcidin (7.72±1.07 vs 6.46±0.82, p<0.0001), ferritin (183.0±156.2 vs 37.1±30.5, p<0.0001), IL-6 (19.60±10.32 vs 13.85±2.80, p=0.04) and CRP (3.31±2.81 vs 0.98±0.05, p<0.0001) in the PIH women compared to the normotensive ones respectively. Whereas there was significantly lower iron (85±39.09 vs 138±30.33, p<0.0001) and TIBC (308.9±95.29 vs 360±68.0, p=0.0013) levels in the PIH compared to normotensive women respectively.
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    Effects of a computerised clinical decision support system and performance-based incentives on maternal healthcare providers in Northern Ghana.
    (NOVEMBER, 2016) Aninanya, Gifty Apiung
    Computerized clinical decision support system (CDSS) and performance-based incentive (PBI) have a potential to contribute to improving motivation and performance of healthcare providers in developing countries. However, there is currently a dearth of rigorous evidence on the effectiveness of these strategies in improving maternal health care in developing countries including Ghana. This study sought to evaluate the impact of CDSS and PBI on motivation and performance of healthcare providers in northern Ghana. The study employed a quasi-experimental design with an explanatory mixed-methods model to assess the effects of the social and technological interventions on motivation and performance of providers. The quantitative research component consisted of a controlled pre- and post-test design, which allowed the quantitative measure of motivation and performance of healthcare providers. To obtain explanatory descriptions of the effects of the interventions on motivation and performance of providers, 66 in-depth interviews (IDIs) with midwives, nurses and their supervisors were conducted in twelve health facilities in the Kassena-Nankana and Builsa districts at intervention endline. A difference-in-difference logistic regression analysis controlling for potential covariates compared variables across intervention and comparison facilities at baseline and endline. Nvivo version 10 was used to analyse qualitative data. CDSS and PBIs were associated with improvements in maternal healthcare providers’ motivation and performance in the intervention facilities compared with the comparison arm. At endline, constructs of motivation that improved were: job satisfaction, intrinsic motivation, organizational commitment, timeliness and attendance. Furthermore, CDSS vi and PBIs strategies improved providers’ management of antenatal and delivery clients. There was statistically significant increase in the proportion of anti-tetanus vaccinations, Human Imuno Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) testing compliance and hemoglobin examined during antenatal care consultations in the intervention sites. Additionally, perceptions of antenatal clients on providers’ technical performance, client-provider interaction and provider availability in the intervention arm at endline improved significantly. Furthermore, delivery clients’ perception of providers’ performance in terms of technical performance, healthcare provider availability and general satisfaction with delivery services significantly improved. Endline qualitative findings revealed that CDSS and PBIs interventions have enhanced providers’ knowledge and adherence to World Health Organisation (WHO) reproductive health treatment guidelines. CDSS prompted them on actions such as diagnosis, prescriptions, checking blood pressures of clients and use of partograph to monitor progress of labour. While the introduction of CDSS and PBIs interventions show positive improvement in healthcare delivery within these selected institutions, there is the need to provide evidence on sustainance mechanisms for large-scale implementation of this intervention. Therefore, future studies on the long-term effects of these interventions are required employing larger samples of different healthcare worker populations, including those of midwives, nurses as well as Medical Doctors.