Improved detection of microbiological pathogens: role of partner and non-governmental organizations.
Michael Owusu1,2*, Bernard Nkrumah 3, Godfred Acheampong 1, Ebenezer Kofi Mensah4,Abass Abdul-Karim Komei 5, Festus Kofi Sroda 6, Sambian David 1, Shannon Emery 7, Lucy Maryogo Robinson 7, Kwame Asante 7,and David Opare 8
1 Centre for Health Systems Strengthening, Kumasi, Ghana
2 Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana A full list of author information is available at the end of the article
Background: Proper detection of disease-causing organisms is very critical in controlling the course of outbreaks and avoiding large-scale epidemics. Nonetheless, availability of resources to address these gaps have been difficult due to limited funding. This report sought to highlight the importance of in-country partners and nongovernmental organizations in improving detection of microbiological organisms in Ghanaian Public HealthLaboratories (PHLs). Methods/context: This study was conducted between June, 2018 to August, 2019. U. S CDC engaged the Centrefor Health Systems Strengthening (CfHSS) through the Association of Public Health Laboratories to design and implement strategies for strengthening three PHLs in Ghana. An assessment of the three PHLs was done using the WHO/CDS/CSR/ISR/2001.2 assessment tool. Based on findings from the assessments, partner organizations (CfHSS/APHL/CDC) serviced and procured microbiological equipment, laboratory reagents and logistics. CfHSS provided inhouse mentoring and consultants to assist with capacity building in detection of epidemic-prone infectious pathogens by performing microbiological cultures and antimicrobial susceptibility tests. Results: A total of 3902 samples were tested: blood (1107), urine (1742), stool (249) and cerebrospinal fluid (CSF) (804). All-inclusive, 593 pathogenic bacteria were isolated from blood cultures (70; 11.8%); urine cultures (356; 60%); stool cultures (19; 3.2%) and from CSF samples (148; 25%). The most predominant pathogens isolated from blood, urine and stool were Staphylococcus aureus (22/70; 31%), Escherichia coli (153/356; 43%) and Vibrio parahaemolyticus (5/19; 26.3%), respectively. In CSF samples, Streptococcus pneumoniae was the most frequent pathogen detected (80/148; 54.1%). New bacterial species such as Pastuerella pneumotropica, Klebsiella oxytoca, Vibrio parahaemolyticus, and Halfnia alvei were also identified with the aid of Analytical Profile Index (API) kits that were introduced as part of this implementation. Streptococcus pneumoniae and Neisseria meningitidis detections in CSF were highest during the hot dry season. Antimicrobial susceptibility test revealed high rate of S. aureus, K. pneumoniae and E. coli resistance to gentamicin (35–55%). In urine, E. coli was highly resistant to ciprofloxacin (39.2%) and ampicillin (34%).
Laboratory capacity in COVID-19 diagnosis and the need to enhance molecular testing in Ghana.
Godfred Acheampong, Michael Owusu, Bernard Nkrumah, Priscilla ObengBoadi, David A. Opare, David J. Sambian, Pawan Angra & Chastity Walker
COVID-19 pandemic has posed an unprecedented threat to both public health and the global economy. In an effort to manage and contain this pandemic, the World Health Organization (WHO) has prioritised laboratory testing (https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—16-march-2020). We examine the testing capacity of the laboratory system in Ghana during the COVID-19 pandemic. According to WHO, gold standard for COVID-19 diagnosis is real-time reverse-transcriptase–polymerase chain reaction (RT-PCR). However, this molecular technique is not widely used in Ghana for disease diagnosis because of lack of infrastructure, lack of trained laboratory staff, high maintenance cost, and scarcity of reagents. Ghana has a three-tier health delivery system, with limited molecular diagnostic capacity. Three of the four public health laboratories (PHLs) have the capacity to perform molecular diagnosis of certain diseases. There are two main biomedical research institutions that are well-equipped to perform various molecular diagnostic tests. Nonetheless, their testing capacity is significantly limited in critical situations such as the current COVID-19 pandemic, which has led to testing backlogs and delays in returning test results at early stages of the pandemic. In an effort to address this situation, capacities of PHLs and nonclinical laboratories have been increased. Plans to use GeneXpert platform in certain areas of the country have been instituted in sixteen facilities, following system upgrades, risk assessments, and quality-checks. Enhanced molecular diagnostic testing in Ghana will help ensure a swift, accurate, and timely response to COVID-19 and future outbreaks. The data gained from these testing improvements may also help stimulate a robust bioeconomy because they can be used to improve the health of Ghanaians, as well as increase productivity through the implementation of data-driven and evidence-based policies. As outlined in WHO’s Joint External Evaluation report for Ghana, the country faces several challenges, including the need to build strong laboratory systems and capacities that connect disease-specific areas.