Ghana Medical Journal最新文献

Objectives: To review the Computed Tomography( CT )features of pediatric oncological patients with abdominal and pelvic tumours and correlate these findings with their histopathological diagnosis.

Design: This was a retrospective cross-sectional facility-based study.

Setting: This study was conducted in the Pediatric Oncology Unit and Radiology Department of the Korle Bu Teaching Hospital.

Participants: Fifty-six pediatric oncology patients with contrast-enhanced abdominal and pelvic CT scans.

Data collection: The abdominal and pelvic CT scans findings, patient biodata, and histopathology reports of oncology patients over four years were reviewed.

Statistical analysis: Simple descriptive statistics using frequency distribution, percentages, means, and standard deviation were used to describe the various variables and presented tables.

Results: The four commonest tumours were nephroblastoma, neuroblastoma, lymphoma, and hepatoblastoma. The mean age at diagnosis was 4.8 years, with a slightly higher male predominance. The majority of the tumours were extremely large at presentation. Overall, the CT - histopathology concordance was 79.2%.

Conclusion: Abdominal and pelvic CT scans play an important role in the diagnostic workup of pediatric malignancies by ensuring early and accurate diagnosis of these tumours.

Funding: None declared.

Objectives: This study aimed to examine the association between Family Adaptability, Partnership, Growth, Affection and Resolve (Family APGAR) and HIV treatment outcomes.

Design: A cross-sectional study using the Family APGAR questionnaire.

Setting: The study was conducted in Kumasi, Ghana, at the Komfo Anokye Teaching Hospital and the Kwame Nkrumah University of Science and Technology Hospital.

Participants: Consenting HIV-positive patients who had been on treatment for at least 12 months were recruited.

Main outcome measures: The Family APGAR questionnaire was administered, and relevant data were extracted from hospital records and analysed using STATA^® software. The relationship between Family APGAR and treatment outcomes was determined using Chi-squared tests or Fisher's exact test.

Results: Approximately 70.1% of 304 participants were females with a mean age of 41.8 years (±9.9). At treatment initiation, 47.4% of the patients presented at World Health Organisation (WHO) clinical stages I and II and had a CD4 count ≥ 200 cells/mm³. Females were less likely (Odds Ratio= 0.52; 95% CI=0.31 - 0.90, p = 0.018) to report late for treatment compared with the males. After 12 months of treatment, approximately 70% recorded undetectable viral load. Patients with functional families constituted 70.4%, which had a statistically significant relationship with viral load (p = 0.041).

Conclusion: HIV care providers should incorporate family functionality evaluation into clinical practice and provide early essential support to enhance treatment outcomes.

Funding: None declared.

Objectives: This study sought to assess the level of anti-glycaemic medication-taking and its predictors among adults living with diabetes receiving treatment at Cape Coast Teaching Hospital (CCTH).

Design: This was a cross-sectional study carried out among adults living with diabetes and receiving care at CCTH. Data on socio-demographic characteristics and anti-glycaemic medication-taking were gathered using a structured questionnaire. A scale consisting of 4 domains (filling prescribed medication; taking medications appropriately according to the instructions of healthcare professionals; practising behavioural modifications, and showing up for follow-up appointments) and eight items was used to measure the level of anti-glycaemic medication-taking. Descriptive statistics, chi-square test (and Fisher's exact test where appropriate), bivariate and multivariate logistic regression models were used in analysing the data.

Setting: The study was carried out in the diabetes clinic in Cape Coast Teaching Hospital.

Participants: The total enumerative sampling technique was used to select 250 adults living with diabetes and receiving care at CCTH.

Main outcome measures: Anti-glycaemic medication-taking.

Results: Out of 250 participants studied, 42% had high anti-glycaemic medication-taking. Predictors of anti-glycaemic medication-taking included; forgetfulness (aOR=0.02, 95% CI: 0.00-0.64, p<0.001), patient's involvement in treatment plan (aOR=0.12, 95% CI: 0.02-0.64, p=0.014) and having good knowledge about one's medication (aOR=2.34, 95% CI: 1.10-4.98, p=0.028).

Conclusion: Less than half of the sample population (42%) had high anti-glycaemic medication-taking, with forgetfulness, involvement in the treatment plan and good knowledge about anti-glycaemic medications, predicting medication-taking.

Funding: None declared.

Objectives: To identify the prevalence and associated factors of anxiety in people living with HIV/AIDS in a tertiary centre in Ghana.

Design: The study employed a cross-sectional design.

Setting: The study was conducted in the outpatient HIV clinic of a tertiary hospital.

Participants: Participants were adult PLWHA receiving OPD care, including those established on combined antiretroviral therapy (cART) and newer patients who were not on cART. Four hundred ninety-five participants aged ≥30 years were consecutively enrolled on the study.

Interventions: Demographic and clinical data were collected using standard questionnaires and patient files. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression analysis was done to identify associated factors.

Main outcome measure: Proportion of PLWHA who had HADS score of ≥8.

Results: Overall prevalence of anxiety was 61.0% (95%CI: 56.6 - 65.3), with no significant difference between recently diagnosed (≤ 6 months, 64.3%) and those with established diagnoses (>6 months, 59.1%). Urban residence (aOR: 1.67, 95%CI: 1.12 - 2.51), alcohol use (aOR: 1.64, 95%CI: 1.13 - 2.38) and depression (aOR: 13.62, 95%CI: 7.91 - 23.45) were independently associated with anxiety.

Conclusion: In this sample, 6 in 10 Ghanaian PLWHA had evidence of anxiety. Liaison with the national mental health service for more comprehensive and integrated care and further research into the mental health of PLWHA is recommended to reduce this high burden of anxiety.

Funding: This study was funded by a grant from the National Institutes of Health Fogarty International Center (R21 TW010479).

Objective: The study estimated the capitation policy's effect on the under-5 mortality (U5MR) rate in hospitals in Ashanti Region.

Design: We used an interrupted time series design to estimate the impact from secondary data obtained from the DHIMS-2 database. Monthly under-5 deaths and the number of live births per month were extracted and entered into Stata 15.0 for analyses. The U5MR was calculated by dividing the number of live deaths by the number of live births for each of the 60 months of the study.

Setting: Health facilities of the Ashanti Region with Data in the DHIMS 2.

Intervention: the level and trend of U5MR for 31 months during the Capitation Policy implementation (January 2015 to July 2017) were compared with the level and trend 29 months after the withdrawal of the capitation policy (August 2017 to December 2019).

Outcome measures: changes in trend or level of U5MR after the withdrawal of capitation.

Main results: During the capitation policy, monthly U5MR averaged 10.71 +/-2.71 per 1000 live births. It declined to 0.03 deaths per 1000 live births (p=0.65). After the policy withdrawal, the immediate (increase of 0.01 per 1000live births) and the trend (decline of 0.13 deaths per 1000 live births per month) were still not statistically significant.

Conclusion: We conclude that the capitation policy did not appear to have influenced under-5 mortality in the Ashanti Region. The design of future healthcare payment models should target quality improvement to reduce under-5 mortalities.

Funding: None declared.

Objectives: To investigate patient satisfaction regarding healthcare services at a district hospital. The research question was: what is the level of patient satisfaction regarding service delivery?

Design: An observational cross-sectional descriptive study conducted in September 2019.

Settings: A district hospital in Botswana serving a population of 90 000. Outpatients from the Eye clinic, Casualty and Outpatient Department, Sexual Reproductive Health clinic and Infectious Diseases Control Centre were selected for the study.

Participants: 240 stable outpatients over 17 years selected through consecutive sampling participated voluntarily after giving informed consent.

Main outcome measures: The level of satisfaction was measured using 19 questions on five-point Likert scales ranging from strongly disagree 1, disagree 2, unsure 3, agree 4 to strongly agree 5. A binary outcome was created into satisfied and unsatisfied using the mean score as the cut-off point. Age, gender, employment, education and departments were independent variables.

Results: 65% (95% CI: 58-71%) were satisfied but unsatisfied with: doctor's politeness (66.9%; 95% CI: 60-73%), explaining (67.8%; 95% CI: 61-73%), privacy (65.6%; 95% CI: 59-72%), skills (67.4%; 95% CI: 61-73%), confidence (67.4% 95% CI: 61-73%), compassion (66.5%; 95% CI: 60-72%) and waiting time (49.2%; 95% CI: 42-57%). Department visited predicted satisfaction (p=0.002); those from the Eye clinic and Sexual Reproductive Health clinic were satisfied compared to others.

Conclusion: Satisfaction was generally high but lower regarding specified services and departments visited. There is a need for targeted interventions. Studies are needed to explore reasons for lower satisfaction in Casualty, Outpatient Department and Infectious Diseases Control Centre.

Funding: None declared.

Congenital arhinia is a life-threatening, rare craniofacial disorder, which, when not identified and managed early can cause severe respiratory distress at birth due to upper airway obstruction. Since neonates are obligate nasal breathers, simultaneous sucking and breathing requirement in neonates with arhinia leads to respiratory distress. Inspiration and expiration through the oral passage alone may result in thoracic retraction, thereby further exacerbating respiratory distress. We report a rare case of congenital complete arhinia with alobar holoprosencephaly in a 9-month-old. With no family history of congenital malformations, maternal risk factors and uneventful pregnancy, a term female neonate was delivered vaginally without immediate post-delivery respiratory distress. Examination revealed microcephaly, absent fontanelles, fused cranial sutures and bilateral microphthalmia. Breathing was spontaneous, with no immediate signs of respiratory distress. An additional diagnosis of alobar holoprosencephaly was made after a head computed tomography (CT) scan was done. Management included the initial stabilisation phase of supplemental oxygen and an orogastric tube for feeding. The baby did not require both tracheostomy and gastrostomy tubes, as she was not in severe respiratory distress requiring a tracheostomy tube nor having difficulties feeding with the orogastric tube.

Objectives: This study identified the predictors of weight reduction among adult obese patients in a Family Practice Setting and developed a statistical model to predict weight reduction.

Design: A prospective cohort design.

Setting: The Family Practice Clinic, University College Hospital, Ibadan, Nigeria.

Participants and study tools: Obese adults were recruited into a three-month weight reduction program. Patient Information Leaflets were used for counselling, while questionnaires were administered to obtain socio-demographic and lifestyle factors. Potential predictors were assessed using the Multidimensional Scale of Perceived Social Support, Zung Depression Scale, Rosenberg Self-Esteem scale, Garner's Eating Attitude Test-26 (EAT-26), 24-hour dietary recall and International Physical Activity Questionnaire-short form. Anthropometric indices, blood pressure and Fasting Lipid Profile were assessed. Descriptive and inferential statistics were used for analysis with a significance set at α0.05.

Results: Most 99(76.2%) of the 130 participants achieved weight reduction and had a median weight change of -2.3kg (IQR-4, -0.5), with 66 (66.7%) out of 99 attaining the weight reduction target of 10%. The regression model showed predictors of weight reduction to be Total Cholesterol [TC] (p=0.01) and Low-Density Lipoprotein Cholesterol [LDL-C] (p=0.03). The statistical model derived for Weight reduction = 0.0028 (LDL-C) -0.029 (TC)-0.053 (EAT-26) +0.041(High-Density Lipoprotein Cholesterol). The proportion of variance of the model tested was R² = 0.3928 (adjusted R² = 0.2106).

Conclusion: Predictors of weight reduction among patients were eating attitude score, Total Cholesterol, Low-Density Lipid and High-Density Lipoprotein Cholesterol levels. A statistical model was developed for managing obesity among patients.

Funding: Self-funded, with a discount from the Public-Private Partnership Laboratory obtained for the patients recruited.

Objectives: Early diagnosis and treatment of sepsis are associated with a better outcome. With the change in the definition of sepsis, SOFA score and qSOFA score (heart rate, systolic blood pressure and Glasgow coma scale) were introduced and SIRS criteria were removed. This study compared the qSOFA score, SIRS criteria and SOFA score as predictors of mortality in patients with sepsis.

Design: Prospective observational study.

Setting: Department of General Medicine of a tertiary hospital.

Participants: The study included 116 patients.

Interventions: SOFA scores (range, 0 [best] to 24 [worst] points), SIRS status (range, 0 [best] to 4 [worst] criteria), and qSOFA scores (range, 0 [best] to 3 [worst] points) were calculated using physiological and laboratory parameters recorded within the first 24 hours of ICU admission.

Main outcome measures: SOFA, qSOFA, and SIRS scores were calculated and measured using physiological and laboratory parameters. Patients were followed till mortality (non-survivors) or discharge from the hospital (survivors). Data were analysed using software SPSS version 20.

Results: 54 (46.6%) of included patients died. Higher SOFA, qSOFA, and SIRS scores; tachycardia; hypotension; hypoxemia; basophilia; hypoproteinemia; hypoalbuminemia; and need for inotropic support and mechanical ventilation significantly associated with increased mortality. The area under the receiver operating curve for qSOFA ≥2 (0.678; p=0.001) and SOFA (0.74; p=0.000) were comparable and significant, whereas SIRS ≥2 (0.580, p=0.139) was not statistically significant.

Conclusions: A qSOFA score of greater than 2 is comparable to SOFA and is better than SIRS score greater than 2 for predicting mortality.

Funding: None indicated.