Socio-Demographic Factors, Social Support, Quality of Life, and HIV/AIDS in Ghana

The increase in the access to biomedical interventions for people living with HIV/AIDS in the developing world has not been adequately matched with the requisite psychosocial treatments to help improve the effectiveness of biomedical interventions. Therefore, in this study the author seeks to determine whether socio-demographic characteristics and social support are associated with quality of life in individuals diagnosed with HIV/AIDS in Ghana. 

A convenience sample of 300 HIV/AIDS support group members was obtained via cross-sectional design survey. The Medical Outcome Studies (MOS) HIV Health Survey, the MOS Social Support Survey (MOS-SSS), and demographic questionnaire instruments were used to assess quality of life, social support, and demographic information respectively. Multiple regression analysis showed that there was a positive association between overall social support and overall quality of life (r = .51). 

It also showed that being younger, male, attending support group meetings for over a year, and having ≥ 13 years of schooling related to higher quality of life. Implications of the findings for practice, policy, and research in Ghana and the rest of the developing world are discussed.

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By:  Abrefa-Gyan T1, Cornelius LJ2, Okundaye J3.

• 1 Ethelyn R. Strong School of Social Work, Norfolk State University , Norfolk , Virginia , USA.
• 2 School of Social Work, University of Maryland , Baltimore , Maryland , USA.
• 3 School of Social Work, University of Maryland , Baltimore County , Maryland , USA. 
• J Evid Inf Soc Work. 2016 Mar-Apr;13(2):206-16. doi: 10.1080/23761407.2015.1018033. Epub 2015 Apr 6.

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Quality of Life among Ghanaian Adolescents Living with Perinatally Acquired HIV

In Sub-Saharan Africa, increasing numbers of children with perinatally acquired HIV (PAHIV) are living into adolescence. These adolescents face numerous unique challenges such as parent illness/death and years of medication use. Optimizing care for these youth requires an understanding of the factors that contribute to physical health, psychological well-being, social relationships, and quality of life (QOL). 

This mixed methods study collected quantitative questionnaire data from 40 Ghanaian adolescents with PAHIV (50% female, 12-19 years old) who received care through an adolescent HIV clinic in Kumasi, Ghana. The study also presents results from qualitative interviews conducted with 20 adolescents. 

Results from quantitative analyses suggested that a significant number of participants were not virally suppressed (67%) and participants reported barriers to treatment adherence, limited social support, concerns about disclosure and HIV-related stigma, limited resources, and lower than expected QOL. 

Salient themes from the qualitative analyses included limited understanding of how HIV is transmitted, the interplay between food insecurity and treatment adherence and the need for developing safe relationships through which adolescents can discuss their illness without fear of accidental disclosure of their HIV status.

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By:  Enimil A1,2, Nugent N3,4, Amoah C5,6, Norman B7,8, Antwi S1,2, Ocran J9, Kwara A10,11, Barker DH3,4.

• 1 Directorate of Child Health , Komfo Anokye Teaching Hospital , Kumasi , Ghana.
• 2 Department of Child Health , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana.
• 3 Department of Psychiatry , Rhode Island Hospital , Providence , RI , USA.
• 4 Department of Psychiatry and Human Behavior , Alpert Medical School, Brown University , Providence , RI , USA.
• 5 Psychiatry Department , Komfo Anokye Teaching Hospital , Kumasi , Ghana.
• 6 Department of Behavioural Sciences , School of Medical Sciences, Kwame Nkrumah University of Science and Technology , Kumasi , Ghana.
• 7 Directorate of Medicine , Komfo Anokye Teaching Hospital , Kumasi , Ghana.
• 8 Department of Medicine , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana.
• 9i Department of Sociology , University of Ghana , Accra , Ghana.
• 10 Department of Medicine , The Miriam Hospital , Providence , RI , USA.
• 11 Department of Medicine , Alpert Medical School, Brown University , Providence , RI , USA. 
• AIDS Care. 2016 Apr;28(4):460-4. doi: 10.1080/09540121.2015.1114997. Epub 2015 Dec 7.

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Estimating the Magnitude of Female Genital Mutilation/Cutting in Norway: An Extrapolation Model

Background

With emphasis on policy implications, the main objective of this study was to estimate the numbers of two main groups affected by FGM/C in Norway: 1) those already subjected to FGM/C and therefore potentially in need for health care and 2) those at risk of FGM/C and consequently the target of preventive and protective measures. Special attention has been paid to type III as it is associated with more severe complications.

Methods

Register data from Statistics Norway (SSB) was combined with population-based survey data on FGM/C in the women/girls’ countries of origin.

Results

As of January 1^st 2013, there were 44,467 first and second-generation female immigrants residing in Norway whose country of origin is one of the 29 countries where FGM/C is well documented. About 40 pct. of these women and girls are estimated to have already been subjected to FGM/C prior to immigration to Norway. Type III is estimated in around 50 pct. of those already subjected to FGM/C. Further, a total of 15,500 girls are identified as potentially at risk, out of which an approximate number of girls ranging between 3000 and 7900 are estimated to be at risk of FGM/C.

Conclusion

Reliable estimates on FGM/C are important for evidence-based policies. The study findings indicate that about 17,300 women and girls in Norway can be in need of health care, in particular the 9100 who are estimated to have type III. Preventive and protective measures are also needed to protect girls at risk (3000 to 7900) from being subjected to FGM/C. Nevertheless, as there are no appropriate tools at the moment that can single these girls out of all who are potentially at risk, all girls in the potentially at risk group (15,500) should be targeted with preventive measures.

Below:  FGM/C Percentage of girls and women already subjected to FGM/C in Norway by country of origin

Below:  Numbers of girls and women subjected to FGM/C type III by most represented countries of origin

Full article at:   http://goo.gl/QFkFuS

By:  Mai M. Ziyada, Marthe Norberg-Schulz, and R. Elise B. Johansen

Norwegian Centre for Violence and Traumatic Stress Studies, P.b. 181 Nydalen, 0409 Oslo, Norway

Samfunnsøkonomisk analyse (Formerly DAMVAD Norge AS), Olavsvei 112, 1450 Nesoddtangen, Norway

Mai M. Ziyada, Email: on.stvkn@adayiz.m.m.

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Proportion & Factors Associated with Hepatitis B Viremia in ART Naïve & Experienced HIV Co-Infected Ghanaian Patients

Background

The global burden of Hepatitis B virus (HBV) and HIV co-infection is enormous. The risk of developing cirrhosis and hepatocellular cancer is associated with HBV DNA levels. The main objective of the study was to determine proportion of Hepatitis B viremia in ART-naïve and ART-experienced co-infected Ghanaian patients and factors associated with HBV viremia after at least 36 weeks of lamivudine with or without tenofovir containing ART.

Methods

Hepatitis B and HIV co-infected patients who were ART-naïve or had received at least 9 months of lamivudine-containing ART were enrolled in a cross-sectional study at Korle-Bu Teaching Hospital. Demographic and clinical data were collected and samples obtained for Hepatitis B serology, liver function tests and HBV DNA. Factors associated with viremia were determined using univariate and multivariate logistic regression analysis.

Results

Of 3108 HIV-infected patients screened, 257 (8.3 %) were HBsAg-positive, of which 235 enrolled. Overall, 152 (64.7 %) were ART-experienced and 83 (35.3 %) were ART-naïve. Eighty-nine-percent of ART-naïve and 42.1 % of ART-experienced patients had HBV DNA > 20 IU/mL. In multivariate analysis of all patients, being ART-naïve (OR 10.1, 95 % CI 4.6 – 21.9) and elevated ALT (OR 3.7, 95 % CI 1.8 – 7.9) were associated with Hepatitis B viremia. In treatment experienced patients, elevated ALT (OR 4.8 CI 2.0 – 12.1) and male sex (OR 2.1, 95 % CI 1.0 – 4.2) were associated with Hepatitis B viremia.

Conclusions

Majority of ART-naïve (89 %) and 42 % of ART-experienced patients had detectable hepatitis B viremia > 20 IU/mL. An abnormal serum ALT was significantly associated with hepatitis B viremia in HBV and HIV co-infected patients irrespective of treatment status. Baseline and on-treatment ALT may be a useful non-invasive predictor of Hepatitis B viremia in resource-constrained countries in sub-Saharan Africa where infection is endemic and viral load tests are not widely available.

Full article at:   http://goo.gl/cTjFtw

By:  Timothy N. A. Archampong, Margaret Lartey, Kwamena W. Sagoe, Adjoa Obo-Akwa, Ernest Kenu, Fizza S. Gillani,Hongmei Yang, Isaac Boamah, Timothy Flanigan, and Awewura Kwara

Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana

Korle-Bu Teaching Hospital, Accra, Ghana

Department of Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana

Warren Alpert Medical School of Brown University, Providence, RI USA

The Miriam Hospital, Providence, RI USA

Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY USA

Timothy N. A. Archampong, Phone: 00233-203039841, Email: ku.ten.srotcod@aant.

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Exploring the Linkage Between Exposure to Mass Media & HIV Testing among Married Women & Men in Ghana

Although HIV testing is critical to the treatment and prevention of HIV/AIDS, utilization rate of HIV testing services among married women and men remains low in Ghana. Mass media, as a tool to increase overall HIV testing turnouts, has been considered one of the important strategies in promoting and enhancing behavioural changes related to HIV/AIDS prevention. 

Using the 2014 Ghana Demographic and Health Survey, the current study examines the relationship between levels of exposure to print media, radio, and television and the uptake of HIV testing among married women and men in Ghana. Results show that HIV testing is more prevalent among married women than their male counterparts. 

We also find that higher levels of exposure to radio is associated with HIV testing among women, while higher levels of exposure to print media and television are associated with HIV testing among men. 

Implications of these findings are discussed for Ghana's HIV/AIDS strategic framework, which aims to expanding efforts at dealing with the HIV/AIDS epidemic. Specifically, it is important for health educators and programme planners to deliver HIV-related messages through television, radio, and print media to increase the uptake of HIV testing particularly among married women and men in Ghana.

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By:  Sano Y1, Sedziafa AP2, Amoyaw JA1, Boateng GO1, Kuuire VZ3, Boamah S4, Kwon E1.

• 1 Department of Sociology , University of Western Ontario (http://sociology.uwo.ca/), Room 5306, Social Science Centre, London , ON , Canada.
• 2 Department of Gender Studies , Memorial University of Newfoundland , Science Building 4082, St. John's , NL , Canada.
• 3 Department of Geography , University of Western Ontario , Room 1424, Social Science Centre, London , ON , Canada.
• 4 Arthur Labatt Family School of Nursing, Health Sciences Addition , University of Western Ontario , London , ON , Canada. 

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Syphilis Screening Practices in Blood Transfusion Facilities in Ghana

OBJECTIVE:

The primary objective of the study was to compare laboratory practices for screening blood donors for syphilis at blood transfusion facilities in Ghana with WHO and The National Blood Service, Ghana (NBSG) recommendations. In addition we estimated the prevalence of syphilis antibodies in blood donors in Ghana.

METHODS:

Over an 11-month period from February 2014 to January 2015, we administered a semi-structured questionnaire to 122 laboratory technical heads out of a total of 149 transfusion facilities in Ghana and the response rate was 81.9%.

RESULTS:

A total of 58 (48%) transfusion facilities tested donors for syphilis with an estimated 3.7% seroprevalence (95% CI; 3.6% - 3.8%). A total of 62,782 out of 91,386 (68.7%) donations were tested with assays that are not recommended. Voluntary donations had an estimated syphilis seroprevalence of 2.9% compared with family donations of 4.0% (p=0.001). Only 6.9% of the health facilities were using Standard Operating Procedures (SOPs).

CONCLUSION:

Despite international and national recommendations more than half of the studied health facilities that provide blood transfusions in Ghana are not screening blood donations for syphilis. Our data show a considerable mismatch between recommendations and practice with serious consequences for blood safety and public health.

Full [PDF] article at:   http://goo.gl/ILRLKR

By:  Sarkodie F1, Hassall O2, Owusu-Dabo E3, Owusu-Ofori S4, Bates I2, Bygbjerg IC5, Ansah JK6, Ullum H7.

• 1Komfo Anokye Teaching Hospital, Kumasi, Ghana; Liverpool School of Tropical Medicine, UK. Electronic address: fsarkodie29@gmail.com.
• 2Liverpool School of Tropical Medicine, UK.
• 3School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Kumasi Centre for Collaborative Research, KNUST, Ghana.
• 4Komfo Anokye Teaching Hospital, Kumasi, Ghana.
• 5Department of Public Health, University of Copenhagen, Denmark.
• 6National Blood Service, Ghana.
• 7Department of Clinical Immunology, Copenhagen, University Hospital Denmark. 

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What Are the Characteristics of 'Sexually Ready' Adolescents? Exploring the Sexual Readiness of Youth in Urban Poor Accra, Ghana

BACKGROUND:

Adolescent sexual activity, especially among the urban poor, remains a challenge. Despite numerous interventions and programs to address the negative consequences arising from early and frequent sexual activity among youth in sub-Saharan Africa, including Ghana, only slight progress has been made. A plausible explanation is that our understanding of what adolescents think about sex and about their own sexuality is poor. In that sense, examining how adolescents in urban poor communities think about their sexual readiness, and identifying characteristics associated with that sexual self-concept dimension, should deepen our understanding of this topical issue.

METHODS:

A total of 196 male and female adolescents, ages 12 to 19, were surveyed in the 2011 RIPS Urban Health and Poverty Project in Accra, Ghana. The youth responded to three statements which determined their levels of sexual readiness. Other background characteristics were also obtained enabling the assessment of the correlates of their preparedness to engage in sex. The data were analyzed using ordered logistic regression models.

RESULTS:

Overall, the majority of respondents did not consider themselves ready for sex. Multivariate analyses indicated that sexual experience, exposure to pornographic movies, gender, ethnicity and household wealth were significantly linked to their readiness for sex.

CONCLUSION:

Sexual readiness is related to sexual activity as well as other characteristics of the adolescents, suggesting the need to consider these factors in the design of programs and interventions to curb early sex. The subject of sexual readiness has to be investigated further to ensure adolescents do not identify with any negative effects of this sexual self-view.

Full article at:   http://goo.gl/qA9IoE

By:  Biney AA1, Dodoo FN2,3.

• 1Regional Institute for Population Studies, University of Ghana, P. O. Box LG96, Legon, Accra, Ghana. abiney@rips-ug.edu.gh.
• 2Regional Institute for Population Studies, University of Ghana, P. O. Box LG96, Legon, Accra, Ghana. duf2@psu.edu.
• 3211 Oswald Tower, The Pennsylvania State University, University Park, PA, 16802, USA. duf2@psu.edu.
• BMC Public Health. 2016 Jan 5;16(1):9. doi: 10.1186/s12889-015-2620-6. 

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Women’s Approval of Domestic Physical Violence Against Wives: Analysis of the Ghana Demographic & Health Survey

Background

Intimate partner violence (IPV) has serious consequences for the physical, psychological, and reproductive and sexual health of women. However, the factors that make women to justify domestic violence against wives in many sub-Saharan African countries have not been explored. This study investigates factors that influence women approval of domestic physical violence among Ghanaian women aged 15–49.

Method

A nationally representative sampled data (N = 10,607) collected in the 2003 and 2008 Ghana Demographic and Health Survey were used. Multivariate logistic regression was used to study the associations between women’s economic and socio-demographic characteristics and their approval of domestic physical violence against wives.

Results

Women aged 25–34 and 15–24 were 1.5 and 1.3 times, respectively, more likely to approve domestic physical violence against wives compared to those aged 35 years and above. Furthermore, women with no education , primary education and junior secondary education had higher probability of approving domestic physical violence compared to a woman who had secondary education or higher. Compared to women with Christian belief, Moslems and Traditional believer  were more likely to approve domestic physical violence of wives. Women who were in the richest, rich and middle wealth index categories were less likely to approve domestic physical violence of wives compared to the poorest.

Conclusion

These findings fill a gap in understanding economic and socio-demographic factors associated with approval of domestic physical violence of wives. Interventions and policies should be geared at contextualizing intimate partner violence in terms of the justification of this behaviour, as this can play an important role in perpetration and victimization.

Full article at:   http://goo.gl/cXTKyC

By:   David Teye Doku and Kwaku Oppong Asante

Department of Population and Health, University of Cape Coast, Private Mail Bag, University Post Office, Cape Coast, Ghana

University of KwaZulu-Natal, Durban, South Africa

David Teye Doku, Email: moc.liamg@divadukod.

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Socio-Cultural & Economic Factors Influencing Adolescents’ Resilience Against the Threat of Teenage Pregnancy: Accra, Ghana

Background

Adolescent pregnancy exposes female adolescents to medical, social and economic risks. In Ghana, adolescent mothers are more likely to experience complications during pregnancy and delivery as compared to older mothers. This study examined the competencies of adolescent girls to either proactively prevent teenage pregnancy or reactively cope effectively with it.

Methods

A cross-sectional survey approach was used to interview 820 adolescent girls aged 15–19 years in Accra, Ghana. The main focus of the study was to examine how social capital (various kinds of valued relations with significant others), economic capital (command over economic resources, mainly cash and assets), cultural capital (personal dispositions and habits; knowledge and tradition stored in material forms and institutionalized) and symbolic capital (honour, recognition and prestige) contribute to the development of competencies of adolescents to deal with the threat of teenage pregnancy and childbirth.

Results

Out of 820 adolescents interviewed, 128 (16 %) were pregnant or mothers. Adolescents in both groups (62 % never pregnant girls and 68 % pregnant/young mothers) have access to social support, especially from their parents. Parents are taking the place of aunts and grandmothers in providing sexual education to their adolescent girls due to changing social structures where extended families no longer reside together in most cases. More (79 %) pregnant girls and young mothers compared to never pregnant girls (38 %) have access to economic support (P = <0.001). Access to social, economic and cultural capitals was associated with high competence to either prevent or deal with pregnancy among adolescent girls.

Conclusion

Findings showed that adolescent girls, especially those that get pregnant should not be viewed as weak and vulnerable because many of them have developed competencies to cope with pregnancy and childbirth effectively. Thus, focusing on developing the competencies of girls to access social, economic and cultural capitals may be an effective way of tackling the threat of teenage pregnancy than focusing only on their vulnerability and associated risks.

Below:  Reproductive Resilience framework (modified Multi-layered Social Resilience framework by Obrist et al., 2010). The frame work illustrates how a threat of teenage pregnancy could be influenced by the capacity- personal disposition and life skills; Capitals- social, economic, cultural and symbolic and Socio-demographic context which could enhance proactive actions or becomes constraining factors. As indicated by the arrows, these factors interact with each other to produce competence levels of adolescents to develop resilience against teenage pregnancy of cope well with it when it occurs

Below:  Reproductive Resilience framework

Full article at:   http://goo.gl/lDTVUs

By:   Collins K Ahorlu^1*, Constanze Pfeiffer²³ and Brigit Obrist²³⁴

¹Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana

²Swiss Tropical and Public Health Institute, Basel, Switzerland

³University of Basel, Basel, Switzerland

⁴Institute of Social Anthropology, University of Basel, Basel, Switzerland

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The Role of Relationship Types on Condom Use among Urban Men with Concurrent Partners in Ghana & Tanzania

Multiple concurrent partnerships are hypothesized to be important drivers of HIV transmission. Despite the demonstrated importance of relationship type (i.e., wife, girlfriend, casual partner, sex worker) on condom use, research on concurrency has not examined how different combinations of relationship types might affect condom use. 

We address this gap, using survey data from a sample of men from Ghana (GH: n = 807) and Tanzania (TZ: n = 800) who have at least three sexual partners in the past three months. We found that approximately two-thirds of men's reported relationships were classified as a girlfriend. 

Men were more likely to use a condom with a girlfriend if their other partner was a wife compared to if their other partner was a sex worker (GH: OR 3.10, 95% CI, 1.40, 6.86; TZ: OR 2.34, 95% CI 1.35, 4.06). 

These findings underscore the importance of considering relationship type when designing HIV prevention strategies in these settings.

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By:   Fleming PJ1, Mulawa M, Burke H, Shattuck D, Mndeme E, Attafuah J, Mbwambo J, Guest G.

• 1 FHI 360 , Durham , NC , USA. 

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"Correcting an Erring Wife Is Normal": Moral Discourses of Spousal Violence in Ghana

This study draws insights from discursive psychology to explore moral discourses of spousal violence in Ghana. In particular, it investigates how sociocultural norms and practices are invoked in talk of perpetrators and victims as moral warrants for husband-to-wife abuse in Ghana. 

Semi-structured focus group and personal interviews were conducted with a total of 40 participants: 16 victims, 16 perpetrators, and eight key informants from rural and urban Ghana. 

Participants' discursive accounts suggest that husbands have implicit moral right and obligation to punish their wives for disobedience and other infractions against male authority in marriage. Both perpetrators and victims build their talk around familiar normative discourses and practices that provide tacit support for spousal violence in Ghana. 

While perpetrators mobilize culturally resonant and normative repertoires to justify abuse, blame their victims, and manage their moral accountability; victims position husband-to-wife abuse as normal, legitimate, disciplinary, and corrective. These moral discourses of spousal violence apparently serve to relieve perpetrators of moral agency; prime battered women to accept abuse; and devastate their agency to leave abusive marital relationships. 

The findings contribute to our understanding of how cultural and social norms of spousal violence are morally constituted, reproduced, and sustained in talk of perpetrators, victims, and other key members of society.

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By:   Adjei SB1.

• 1Aarhus University, Denmark bstephen@psy.au.dk. 

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Next-Generation Sequencing Reveals Frequent Opportunities for Exposure to Hepatitis C Virus in Ghana

Globally, hepatitis C Virus (HCV) infection is responsible for a large proportion of persons with liver disease, including cancer. The infection is highly prevalent in sub-Saharan Africa. West Africa was identified as a geographic origin of two HCV genotypes. However, little is known about the genetic composition of HCV populations in many countries of the region. 

Using conventional and next-generation sequencing (NGS), we identified and genetically characterized 65 HCV strains circulating among HCV-positive blood donors in Kumasi, Ghana. Phylogenetic analysis using consensus sequences derived from 3 genomic regions of the HCV genome, 5'-untranslated region, hypervariable region 1 (HVR1) and NS5B gene, consistently classified the HCV variants (n = 65) into genotypes 1 (HCV-1, 15%) and genotype 2 (HCV-2, 85%). 

The Ghanaian and West African HCV-2 NS5B sequences were found completely intermixed in the phylogenetic tree, indicating a substantial genetic heterogeneity of HCV-2 in Ghana. Analysis of HVR1 sequences from intra-host HCV variants obtained by NGS showed that three donors were infected with >1 HCV strain, including infections with 2 genotypes. Two other donors share an HCV strain, indicating HCV transmission between them. The HCV-2 strain sampled from one donor was replaced with another HCV-2 strain after only 2 months of observation, indicating rapid strain switching. 

Bayesian analysis estimated that the HCV-2 strains in Ghana were expanding since the 16^th century. The blood donors in Kumasi, Ghana, are infected with a very heterogeneous HCV population of HCV-1 and HCV-2, with HCV-2 being prevalent. The detection of three cases of co- or super-infections and transmission linkage between 2 cases suggests frequent opportunities for HCV exposure among the blood donors and is consistent with the reported high HCV prevalence. 

The conditions for effective HCV-2 transmission existed for ~ 3–4 centuries, indicating a long epidemic history of HCV-2 in Ghana.

Below:  PFnet of all sequences present in two patients at different time points. Each time point is shown with a different color. Sequences found on the first time point are shown in red and the second time point in blue. Each node represents a single sequence variant. The size of the node reflects frequency of the corresponding variant in the population. This network includes all of the links in any minimum spanning tree. The time interval between each time point is ~2 months.

Below:  Bayesian skyline plot, showing the epidemic history of HCV genotype 2. The thick black line in the middle represents the estimated mean effective number of infections through time in years. The two grey lines represent the 95% highest posterior density of this estimate.

Full article at:   http://goo.gl/rfcb1c

By:   

Joseph C. Forbi, Guo-liang Xia, David S. Campo, Michael A. Purdy, Zoya E. Dimitrova, Lili T. Punkova, Pavel Skums, Gilberto Vaughan, Hajung Roh, Yury E. Khudyakov

Molecular Epidemiology and Bioinformatics Laboratory, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America

Jennifer E. Layden, Nallely Mora, Richard S. Cooper

Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, United States of America

Jennifer E. Layden

Department of Medicine, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, United States of America

Richard O. Phillips, Dorcas O. Owusu, Shirley Owusu-Ofori, Fred Stephen Sarfo, Ohene K. Opare-Sem

Komfo Anokye Teaching Hospital, Kumasi, Ghana, West Africa

Richard O. Phillips, Fred Stephen Sarfo

Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, West Africa

 

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