Ghana Medical Journal最新文献

Objective: To examine the contribution of lower-level health facilities in increasing access to cervical cancer screening in the North Tongu District.

Design: A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cervical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing.

Participants: A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes.

Main outcome measure: The detection of screen positives.

Results: The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes.

Conclusion: We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of 'spokes' could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed.

Funding: None declared.

Objectives: To estimate patient treatment cost of oral diseases in Ghana.

Design: A cross-sectional study design using cost-of-illness analysis was employed.

Setting: The study was conducted at the dental unit of the University of Ghana Hospital, Legon.

Participants: About 185 patients attending the dental unit of the hospital were selected.

Interventions: None.

Main outcome measures: Direct medical and non-medical costs, indirect costs, and intangible costs of treatment of oral conditions.

Results: The estimated average cost of treatment for oral diseases was US$ 35.75. The total cost was US$ 6,614.11, with the direct and indirect costs constituting 94.5% and 5.5%, respectively of the total cost. Direct medical costs constituted 86.9%, while direct non-medical costs constituted 13.1% of the total direct cost. The richer socio-economic group had the highest cost per quintile, with a mean of US$ 46.69. The intangible cost described was highest for pain (47.1%), followed by difficulty in eating (40.8%) and sleeping (34.6%) for both men and women.

Conclusion: The costs of oral diseases are huge and cannot be overlooked. Oral diseases also pose significant productivity losses to patients.

Funding: None declared.

Objectives: Cervical precancer screening programs are difficult to establish in low resource settings partly because of a lack of human resource. Our aiming was to overcome this challenge. We hypothesized that this could be done through task shifting to trained nurses.

Design: Descriptive retrospective cross-sectional review.

Setting: Training was at the Cervical Cancer Prevention and Training Center (CCPTC) and screening was carried out at the clinic and at outreaches / peripheral facilities.

Participants: All women who reported to the clinic for screening or were recruited during outreaches.

Interventions: All 4 nurses were trained for at least 2weeks (module 1). A total of 904 women were screened by the trained nurses using the EVA system. Quality assurance was ensured.

Main outcome measures: Primary screening and follow-up were carried out by the trained nurses with quality assured through image sharing and meetings with peers and experienced gynaecologists.

Results: 828 women had primary screening and 76 had follow-up screening. 739 (89.3%) were screened at the clinic and 89 (10.7%) at outreaches/peripheral facilities. Of all screened, 130 (14.5%) had cervical lesions, and 25 (2.8%) were treated, 12 (48.0%) by Loop Electrosurgical Excision Procedure (LEEP) performed by a gynaecologist, 11 (44.0%) with thermal coagulation by trained nurses except one, and 2 (8.0%) with cryotherapy by trained nurses.

Conclusion: We demonstrate the utility of a model where nurses trained in basic colposcopy can be used to successfully implement a cervical precancer screening and treatment program in low-resource settings.

Funding: None indicated.

Objectives: To assess the determinants of COVID-19 vaccine acceptance and hesitation among Health Care Professionals (HCPs) in the Kintampo North Municipality of Ghana.

Design: An analytical cross-sectional study.

Setting: The study was carried out in the Kintampo North Municipality.

Participants: All health care professionals within the Kintampo North Municipality of Ghana.

Main outcome measure: Acceptance of COVID-19 vaccine.

Results: In all, 215 HCPs were included in this study. The overall vaccine acceptance was 78.6% among HCPs, while 21.4% were hesitant to receive the COVID-19 vaccine. Majority (57.7%) of HCPs believed that COVID-19 vaccines were safe. The following factors were found to influence vaccine acceptance significantly; those who knew someone who has taken the vaccine (adjusted Odds Ratio [aOR]; 14.9, 95% Confidence Interval [95% CI];5.0-45.0, p<0.001), those who think COVID -19 vaccine in Ghana was safe (AOR;9.2, 95%CI;3.3-25.8, P<0.001), those who said vaccines are effective in controlling COVID-19 transmission (aOR=5.0, 95%CI;2.1-12.4, p<0.001), and those who have never refused vaccines in the past (aOR=7.8, 95CI;1.6-37.8, p=0.01).

Conclusion: The study indicated high COVID-19 vaccination acceptability among HCPs. However, some HCPs are hesitant to take COVID-19 vaccinations immediately. Increased adoption of COVID-19 vaccinations among HCPs and the broader Ghanaian population requires concerted efforts, including strengthening public health education on the perceived risks and safety of COVID-19 vaccines.

Funding: None declared.

Objective: To examine the association between animal contact (primarily dogs and cats) and non-malarial fever, as well as with secondary symptoms of headache, nausea, vomiting, and cough, in 687 children in Greater Accra Region, Ghana.

Design: Cross-sectional study of acute febrile illness among children aged 1-15 years old between October 2016 and August 2017.

Setting: Ledzokuku-Krowor Municipal Assembly (LEKMA) Hospital, Teshie, Greater Accra Region.

Participants: The study included children with acute fever, defined as a measured temperature of greater than 37.5°C, occurring less than seven days before the hospital visit, and afebrile children as controls.

Main outcome measures: Measured fever, self-reported fever, and secondary symptoms, each adjusting for patient household characteristics.

Results: Animal contact was neither associated with measured fever (OR = 1.04, 95% CI 0.73-1.49) nor with self-reported fever (OR = 0.97, 95% CI 0.68-1.39). Animal contact was associated with headache (OR = 3.26, 95% CI 2.23-4.77, P < .01) and nausea (OR = 3.05, 95% CI 1.99-4.68, P < .01), but not with vomiting or cough. Additional models that used alternate inclusion criteria to define non-malarial fever yielded similar results. Several bacterial zoonoses that could plausibly have been transmitted by dogs and cats were diagnosed in the study population.

Conclusion: These findings suggest the need for future studies to evaluate animal contact as a risk factor for bacterial zoonoses that may serve as an etiological driver of acute febrile illness.

Funding: no external funding.

Objectives: The study assessed the prevalence, determinants and coercive strategies relating to Marital Rape (MR) among women in Oyo State, Nigeria.

Design: A cross-sectional survey.

Setting: The study was conducted in 120 communities, 30 wards, 6 Local Government Areas in Oyo State.

Participants: A total of 1200 ever-married women aged 18-60 years were recruited using a multi-stage sampling.

Methods: The participants were interviewed using a semi-structured questionnaire which captured MR-related experiences and coercive strategies. Data were analysed using descriptive statistics, Chi-square, and logistic regression. Odds ratios (OR) and their corresponding 95% Confidence Interval (CI) were reported.

Results: Respondents' mean age was 36.6±9.6 years, while husbands' mean age was 42.1±10.3 years. Most (n=1094, 91.2%) respondents had ever married once and 82.8% (n=993) were currently married. The prevalence of MR was 15.3%. Physical force (n=153, 25.9%), followed by threat (n=139, 23.5%) topped the list of coercive strategies involved in MR. Currently, married women were at a higher risk of MR (OR: 2.73, CI: 1.39-5.37, P = 0.04) relative to divorced women. Respondents whose husbands were aged <30 years were at lower risk of MR (OR:0.03, CI: 0.002-0.47, P=0.01). Women who take decisions on sex alone were more likely to suffer MR (OR:3.95, CI: 1.38 - 11.31, P=0.01).

Conclusions: Marital rape existed among women with increased risk among those who were currently married, married to older partners or sole decision-makers on sex. Physical force was the commonest coercive strategy used to facilitate MR. Community-based MR -related interventions are recommended.

Funding: None declared.

Objective: To determine the efficacy of intravenous tranexamic acid versus rectal misoprostol in decreasing intraoperative blood loss during caesarean section (C/S).

Design and setting: Randomised controlled study involving pregnant women undergoing C/S at Alex Ekwueme Federal University Teaching Hospital, Abakaliki in Nigeria.

Participants and interventions: Five hundred and fourteen women undergoing elective C/S were assigned randomly (257 patients per group) to receive either pre-operative 1000 µg rectal misoprostol or 1000mg intravenous tranexamic acid after spinal anaesthesia. Data from 248 patients were analysed in the misoprostol group, while data from 250 patients were analysed in the tranexamic acid group. Sixteen patients were excluded from analysis; nine had incompletely filled proforma, while seven were lost to follow-up.

Main outcome: Intraoperative blood loss.

Results: The mean intraoperative blood loss was not significantly different between the misoprostol group and the tranexamic acid group (547 ± 183.75ml vs. 551.66 ± 21.74ml, P = 0.157). The mean difference in pack cell volume (PCV) changes was not significant between the groups (2.41±0.95% vs. 2.36±0.56%, P = 0.474). The side effects profile was similar for both groups except for shivering, which was statistically higher among the misoprostol group (RR = 0.70; 95%CI 0.40 - 0.91, P = 0.028).

Conclusion: Intravenous tranexamic acid was comparable to rectal misoprostol in the reduction of blood loss during C/S. Tranexamic acid could act as a good alternative to misoprostol for prophylaxis for blood loss during elective C/S.

Funding: None declared.

Objectives: We estimated the length-of-stay (LOS) in the health facility after childbirth and identified associated factors in three sub-Saharan African countries.

Design: Secondary analysis using data from the most recent Multiple Indicator Cluster Surveys.

Setting: Multiple Indicator Cluster Surveys from Ghana, Malawi and Eswatini were selected.

Participants: Women aged 15-49 years who had a facility delivery in the two years preceding the survey were included.

Main outcome measures: Length-of-stay recorded in days and weeks were converted to hours and analysed as a continuous variable.

Results: Length-of-stay was estimated for 9147 women, wherein 6610 women (median LOS and IQR: 36 36,60 hours), 1698 women (median LOS and IQR 36 10,60 hours) and 839 women (median-length-stay 36 36,60 hours) were from Malawi, Ghana and Eswatini respectively. Being from Ghana [RC, -20.6 (95%CI:-25.2 - -16.0)] and then Eswatini [RC: -13.0 (95%CI: -19.9 - -9.8)] and delivery in a government hospital [RC: -4.9 (95%CI -9.9- -0.3)] were independently associated with having a shorter LOS. Having a caesarean section, assistance by Nurses/Midwives or Auxiliaries/CHOs, single birth, heavier birth weight, and death of newborn before discharge increased the duration of stay.

Conclusions: Necessitating and facility factors are important determinants of length of stay. Socio-demographic characteristics, however, have a restricted role in influencing the duration of postpartum stay in sub-Saharan Africa. Further prospective research is required to identify more determinants and provide evidence for policy formulation and clinical guidelines regarding the safest time for discharge after delivery.

Funding: None declared.

Objective: Stress and life changes such as ageing, spouse's death, divorce, marriage, job loss, retirement, illness, interpersonal relationships and a history of suicide ideation or attempt may be considered risk factors for suicide attempts. This study aimed to investigate the relationship between stress and suicide.

Design: Case-controlled and retrospective study.

Participants: Patients referred to the Emergency Poisoning Unit of Yazd, were used as a case group and other admitted patients with various plans and etiologies were a control group, matched on age, gender, marital status and place of residence.

Settings: Patients were asked to fill out a questionnaire including age, gender, economic status, marital status, place of residence, a background of suicide, and history of family members' suicide as well as the Holmes-Rahe scale. SPSS 16, chi-square and t-test were used for analyzing data.

Results: Comparing the Holmes-Rahe stress scale's scores of the case group (312.9±84.60) and control group (224.62±85.57) showed a significant statistical difference (P<0.0001). Regarding stress intensity, the score in the case group showed 6% mild stress, 40% moderate stress, 54% severe stress, and in the control group, 13%, 61% and 26%, respectively. Holmes-Rahe stress scale score of stress intensity showed a significant statistical difference between groups (P<0.0001).

Conclusion: The results of this study suggest that stress was associated with increased suicide attempts.

Funding: None declared.

Objectives: To evaluate a newly developed, self-expandable anti-reflux Trumpet (ART) stent customized for cardio oesophageal junctional (COJ) cancer on the feasibility of deployment, stent migration, quality of life, and symptom relief.

Design: Prospective case series, Proof of concept pilot study.

Setting: Tertiary Health Care Center, Hospital Tuanku Jaafar, Seremban, Malaysia. Department of Surgery.

Participants: A total of 17 patients diagnosed with advanced COJ tumour and who had never undergone any surgical, endoscopic, or chemoradiotherapy and indicated for stenting were recruited.

Interventions: The study period was over nine months, and follow-up was one-month post-stenting.

Main outcome measures: Endpoint measures were feasibility of deployment of the new design, symptoms relief, early stent migration, early complication, GERD Q score, and (QOL)assessment.

Results: The ART stent was inserted successfully in all cases (17/17, 100%). There were two stent migrations due to the flexibility of the stent at the neck. There were no early or post-stenting one-month complications associated with the procedure. A good flow of contrast was seen in all the stents deployed. GERD Q score was low in all patients pre and post-stenting. Post-stenting there was a relief of dysphagia, weight gain, and a 60% improvement in QOL score.

Conclusions: ART stent is feasible and technically successful in COJ tumours. It provides good symptom relief, improves the QOL, and has minimal early complications.

Funding: None declared.