Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR)
 
Centre Head’s Report
 

The year 1997 earmarked the official establishment of the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR). It is a joint venture between the University of Science and Technology in Kumasi (UST), Ghana, the Ministry of Health of the Republic of Ghana, and the Bernhard Nocht Institute for Tropical Medicine. Its modus operandum is based on an Agreement signed by the Government of the Republic of Ghana and the Senate of the Free and Hanseatic City of Hamburg during an official visit of the Ghanaian President Fl. Lt. Dr. hc. J. J. Rawlings to Germany end of October 1997. The first contract period will be twenty years.
The objectives of the KCCR are: to conduct basic and applied research on tropical diseases


The scientific work is organized on the basis of distinct research projects or programmes headed by two principal investigators, one of them a Ghanaian.
The actual work of the Centre started in March 1997 following a memorandum of understanding between the partner institutions. Preliminary rooms were provided within the School of Medical Sciences (UST). Their refurbishment and the installation of equipment was finalised by the end of the year. The preliminary facilities include a laboratory, a computer room, office space for staff and visiting scientists, a multi-purpose room for seminars etc., store rooms and a stand-by generator. An ethernet computer network, access to e-mail and on-line Internet offer an efficient working environment for research groups.
The first research project conducted within the framework of the KCCR started in April 1997. The study was initiated by the Onchocerciasis Research Programme of the Institute and aimed to investigate the prevalence of Onchocerca ochengi in cattle in selected herds in the forest, forest-savannah and savannah zones of Ghana. Field work has been concluded, the laboratory tests at the Bernhard Nocht Institute need to be finalised.
Also the second Institute Research Programme of the Institute launched its first project at the KCCR. This hospital-based study examines the prevalence of Entamoeba histolytica among patients with diarrhoea or suspected liver abscess by using simple serological tests which have been developed at the Institute in the recent years. The study is conducted at the Komfo Anokye Teaching Hospital in Kumasi and includes the Departments of Child Health, Medicine and Clinical Microbiology. Sample collection has been finalised. Laboratory investigations will be conducted at the KCCR.
In the aftermath of the largest meningitis epidemic in Ghana for decades which forced a state of emergency in the northern regions early in 1997, the School of Medical Sciences (UST) initiated the formation of a Meningitis Study Group. The group is spearheaded by the Department of Community Health and the Department of Clinical Microbiology, and is supported by the KCCR. Its first research project was launched in October. Under collaboration with the Ministry of Health, Ghana, the study examines in a retrospective design the operational value of the international epidemic threshold definition which forms the basis for any large scale provision of meningitis vaccines and drugs through WHO and international donor organisations. This threshold definition and its application came under much criticism during the last epidemic. The study is conducted in Bawku District, Upper East Region, the epicentre of all the last meningitis epidemics in Ghana. A proposal for a second study dealing with the determination of the prevailing pathogens in a population-based design has been finalised and is expected to take off early next year.
First steps have been made on the way to develop a new programme area in malaria research. The joint expertise from researchers of the Institute and of the School of Medical Sciences who have participated in a number of national and international malaria research projects like the bed-net trials in northern Ghana offers the opportunity to contribute to the current world-wide effort to strengthen and coordinate malaria research. The first two proposals were completed in December; one study will deal with an improved method for the rapid assessment of the endemicity level in a target population by using ultrasound examination of the spleen, the second study aims to investigate host factors which influence susceptibility to malaria. Both studies will start in early 1998.
While most international research centres in Africa focus predominantly on hospital-based studies or population-based studies in rural areas, the research on infectious diseases in the modern urban environment has gained much less attention in Africa. In preparation for the establishment of an urban study site, a study was conducted to collect socio-demographic data and information about various administrative institutions and organisations in Kumasi. A final report has been published and will be of good use for future research groups.
The outgoing year was characterised by intensive work and much enthusiasm among all the staff, the Advisory Board members and the various collaborators. A number of visitors from in- and outside Ghana have provided additional input through comments and recommendations, among them the Ambassador of the Federal Republic of Germany, Mr. Christian Nakonz, who has supported this joint venture with special interest right from its beginning. The start has fulfilled most expectations - there are at least 20 rounds ahead.

Christoph Hamelmann



Investigator’s Reports


Seroprevalence of Entamoeba histolytica among Patients with Diarrhoea or Liver Abscess at Komfo Anokye Hospital, Kumasi

C. Hamelmann, O. Adjei*), J. W. Acheampong*), B. Baffoe Bonnie*), E. Tannich

A variety of new tests for the diagnosis of E. histolytica has been developed during the recent years which can replace the tedious process of microscopic analysis of stool samples and cultures for the further differential diagnosis between Entamoeba species. These new tests are easy to perform and therefore enable the rapid screening of populations for the prevalence of Entamoeba histolytica.
We recently developed two new assays for the detection of anti-amoebic serum antibodies which have been shown to be reliable even when introduced in areas endemic for amoebiasis. These assays comprise an ELISA based on a recombinant E. histolytica membrane antigen as well as a latex agglutination test using polystyrene beads coupled with an E. histolytica membrane fraction. In this hospital-based study, the two tests were employed to examine the anecdotal evidence of a high number of patients with invasive amoebiasis at the Komfo Anokye Teaching Hospital, the reference hospital of the Ashanti region which serves a total population of about three million people.
In- and out-patients aged 5 years or older were enrolled on consecutive basis until the required sample size of 300 (diarrhoea) and 50 (suspected liver abscess) was fulfilled. Diarrhoea was defined as 3 or more loose stools for 3 or more days, or bloody diarrhoea. Suspected liver abscesses were further examined by ultrasound. A blood sample was taken from each patient. In addition, blood was collected from 100 age-matched controls without liver abscess or diarrhoea during the last year to investigate the specificity of the two tests in this study population.
The required sample size was reached within about 5 months. The serum is currently being tested at the laboratory of the KCCR.
*) School of Medical Sciences, Kumasi
 
 

The Operational Value of the Meningitis Epidemic Threshold Definition - a Retrospective Analysis of the 1996/97 Meningitis Epidemic in Bawku East District, Ghana

C. Hamelmann, O. Adjei*), A. Nangbeifubah**), E. Agongo**), E. Browne*)

During the dry season of 1996/97, northern Ghana experienced the largest meningitis epidemic for decades with a total of 18,799 reported cases and 1,352 deaths. The epicentre of the epidemic was Bawku East District with over 7,000 cases and the highest cumulative attack rate (1970 per 100,000 population). The area belongs to the sub-Saharan "meningitis belt" in which besides a seasonal pattern of sporadic cases major epidemics have been described since the beginning of this century in an interval of about every 8 to 10 years. Despite the availability of a vaccine the recent epidemic was a drastic proof that public health measures were insufficient to prevent this major outbreak. A key parameter for these control measures is the international meningitis epidemic threshold definition. It holds that provision of large quantities of drugs and vaccines for mass vaccination through WHO and other donor organisations can only be granted if more than 15 cases per 100,000 population per week have been reported on sub-district level, or 5 cases per 100,000 population per week if a neighbouring district has already declared an epidemic by passing the threshold. In the light of the recent epidemic, both the practical application and the scientific robustness of this threshold definition has been questioned.
Our study aims at retrospectively examining the operational value of the threshold definition. All cases of Bawku East District are currently computerized by sub-district based on the original patient records. The earliest date when the epidemic could have been declared according to a proper application of the definition will be calculated and compared to the actual date of declaration during the epidemic. Using a mathematical model the potential of cases prevented through proper application of the definition will be estimated and put into correlation with improvement of logistics in the delivery of vaccines or alternative control methods. The study is ongoing.
*) School of Medical Sciences, Kumasi
**) Ministry of Health, Upper East Region



Advisory Board

Chairman:
Professor Dr. Frank O. Kwami, Kumasi

Members:
Professor Dr. Eugene H. Amonoo-Neizer
(Vice-Chancellor, University of Science and Technology, Kumasi)
Professor Dr. Dr. George W. Brobby
(Dean, School of Medical Sciences, Kumasi)
Professor Dr. Bernhard Fleischer
(Director, Bernhard Nocht Institute for Tropical Medicine, Hamburg)
Professor Dr. Rolf Horstmann
(Chairman, Committee on Research in the Tropics)

Staff

Dr. Christoph Hamelmann, Head

Dr. Enoch K. H. Frimpong, Deputy Head

Collaborating Scientists

Professor Dr. J. W. Acheampong (Department of Medicine, School of Medical Sciences, Kumasi, Ghana)
Dr. Ohene Adjei (Department of Clinical Microbiology, School of Medical Sciences, Kumasi)
Olivia Agbenyega (Socio-Economist, Kumasi)
Dr. Ben Baffoe Bonnie (Department of Child Health, School of Medical Sciences, Kumasi)
Prof. Dr. Dr. George W. Brobby (Department of Ear, Nose and Throat, School of Medical Sciences, Kumasi)
Dr. Edmund Browne (Department of Community Health, School of Medical Sciences, Kumasi)
Dr. Samuel Tay (Department Clinical Microbiology, School of Medical Sciences, Kumasi)

Support Staff (Ghana)

Baindu Dorley
Philip Frimpong
Lincoln Gankpala
Martin Kweku Kumah
Mariama Massaquoi
Kwame Nyarko
Hubert Obiri-Yeboah
Jaqueline Ofori-Akuamoah