Ghana Medical Journal最新文献

Objective: To explore factors associated with late clinical presentation among Ghanaian women with cervical cancer.

Design: This is a cross-sectional survey using a paper questionnaire.

Setting: Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana.

Participants: Participants were women presenting for cervical cancer care at KATH. Inclusion criteria were histologically diagnosed cervical cancer and age ≥18 years. The exclusion criteria was age <18. All women presenting from August 2018-August 2019 were recruited.

Main outcome measures: The primary outcome was the proportion of participants presenting with late-stage cervical cancer, defined as stage II or higher.

Results: Of 351 total participants, 33.6% were unemployed, 35.3% had no formal education, and 96.6% had an average monthly income of less than five hundred Ghana cedis ($86 USD). Time from symptoms to seeing a doctor ranged from fewer than two weeks (16.0%) to more than twelve months (8.6%). Participants' most common barrier in seeking healthcare was financial constraints (50.0%). Most participants presented at late-stage cervical cancer (95.2%, n=334), with only 4.8% (n=17) presenting at stage I. Of participants presenting with late-stage cervical cancer, the vast majority had never had a Papanicolaou (Pap) smear (99.1%) nor a recent gynecologic exam (99.3%). After adjusting for age, parity, and distance to a healthcare facility, a late-stage presentation was associated with lower income and living in a rural area.

Conclusions: In Ghana, 95% of women with cervical cancer seek care at a late clinical stage, defined as stage II or greater, when the cancer is inoperable.

Funding: None declared.

Objective: To assess the effectiveness of seasonal malaria chemoprevention (SMC) in reducing under-five malaria morbidity and mortality.

Design: Under-five malaria data for confirmed episodes, deaths, and number of children dosed per cycle of SMC campaign were extracted from the District Health Information Management System (DHIMS-2) for 2018-2019. Data verification was done to compare extracted data with the source for completeness and consistency. Association between SMC and the main outcome variables (malaria cases and mortality) was computed from 2X2 tables and reported as rate ratios at a 95% confidence level.

Setting: All seven (7) districts in Savannah Region, Ghana.

Participants: Children under five years.

Intervention: Sulphadoxine-Pyrimethamine and Amodiaquine (SPAQ) prophylaxis given monthly, four times, durng the rainy season (July to October).

Main outcome measures: SMC coverage per cycle and under-five malaria morbidity and mortality ratios.

Results: Over 370,000 dose packs of SPAQ were administered with an average cycle coverage of 93%. There was approximately 17% (p<0.01) and 67% (p=0.047) reduction in malaria-related morbidity and mortality, respectively, in the implementation year compared with the baseline. This translated into nearly 9,300 episodes of all forms of malaria and nine malaria-attributable deaths averted by the intervention.

Conclusion: SMC (combined with existing control measures) wields prospects of accelerating the regional/national malaria elimination efforts if the implementation is optimised. Expansion of the intervention to other high-prevalence regions with seasonal variation in disease burden may be worthwhile.

Funding: None declared.

Objectives: To examine the feasibility and within-session reliability of Myoton technology to measure muscle stiffness objectively in people with Parkinson's disease in an outpatient setting.

Design: An exploratory quantitative study design was used.

Setting: The study was conducted in the outpatient physiotherapy department of a Teaching Hospital in Ghana. Participants were recruited from three sites.

Participants: Thirty adults with Parkinson's disease over 18 years with increased tone (muscle stiffness) and at Hoehn and Yahr Stages I-III were studied. Persons with severe comorbidities were excluded.

Intervention: There was no intervention before testing. The MyotonPRO device measured the mechanical properties of the biceps brachii, flexor carpi radialis and tibialis anterior muscles in a relaxed supine position. The probe applied mechanical impulses to the skin, eliciting tissue oscillations. The muscles' three parameters (stiffness, non-neural tone and elasticity) were recorded bilaterally. The reliability of two sets (of 5 impulses) of Myoton data on all three muscles was examined.

Results: All 30 participants (66.3±8.9 years) were recruited and tested within eight weeks. Intraclass correlation coefficients (ICC 3,2) were above 0.92 for biceps brachii and tibialis anterior and above 0.86 for flexor carpi radialis.

Conclusion: The MyotonPRO was reliable for measuring two sets of data within the same session, indicating that only one set of measurements is needed. The technique is feasible and easy to use in a clinical setting in Ghana, with the potential to assess the effect of medical and physiotherapy interventions on muscles in people with Parkinson's disease.

Funding: M.S discloses a grant from the Science and Technology Facilities Council Impact Acceleration Account at the University of Southampton to support this collaborative research (no personal finance received). All other authors, M.W.A, P.E.M, C.O.Y, B.E.A.S, S.A.-B, and A.A have no financial disclosure.

Objective: To quantify and describe the burden of COVID-19 infection amongst doctors in Ghana.

Design: A quantitative and qualitative analysis of cross-sectional data was performed.

Setting: All 16 regions in Ghana.

Participants: Participants were medical doctors diagnosed with COVID-19 between March 2020 and March 2021.

Main outcome measures: Data sources were Ghana Medical Association and Ministry of Health records. Demographics and workplace data included age, gender, the rank of the doctor, and location and type of current facility. Characteristics of the COVID-19 infection included the likely source, clinical and recovery status, and place of management. Doctors reported their desire for a general checkup and psychological support and described the challenges encountered.

Results: The prevalence of COVID-19 infection was 88.9 cases per 1000 doctor-population. Of 544 infected doctors, 59.2% were stable but symptomatic, and 1.7% were in critical condition, with a case fatality rate of 1.7%. Overall, 31.6% had recovered from their COVID-19 infection, and the majority (82.4%) were managed at home in self-isolation. Compared to medical officers, house officers (OR 1.36, p=0.03), senior house officers (OR 7.60, p<0.001), and consultants (OR 2.94, p=0.001) were more likely to have a COVID-19 infection. Desire for support was varied, with 13.0% desiring someone to check on them and 9.7% desiring psychological support. The majority (75.3%) reported facing a challenge, including difficulty obtaining needed vitamins and medications, and accessing daily necessities like groceries.

Conclusions: In Ghana, COVID-19 infections greatly burden medical doctors.

Funding: None declared.

Objectives: To ascertain the prevalence and pattern of reported facility-based disrespect and abuse of women during labour in Abia State, South-East, Nigeria.

Design: A cross-sectional questionnaire-based study.

Setting: One urban and one rural healthcare facility in Abia State- Federal Medical Centre, Umuahia and Nigerian Christian Hospital (NCH) Nlagu, respectively.

Participants: A total of 312 women who were recently delivered of their babies in the two facilities in Abia State and attending postnatal clinics were sampled for the survey.

Main outcome measure: Disrespect and abuse D&A) during labour among women who give birth in healthcare facilities in Abia State.

Result: In all, over half (54.5%) of the women experienced disrespect and abuse in Abia State (50% urban and 63.5% in rural areas). The commonest form of disrespect and abuse was non-confidential care (22.9%). The commonest disrespectful and abusive care received was lack of privacy in the labour ward (18.3%).

Conclusion: The study recorded a high prevalence of reported facility-based disrespect and abuse of women during delivery in Abia State. Training and re-training healthcare providers to promote respectful care, advocacy to policy makers and healthcare stakeholders on the development of respectful maternal care policies and further research in the area are needed.

Funding: No funding was obtained for this study.

Tumour thrombus is the presence of tumour cells in great vessels. The reported incidence of tumour thrombus in thyroid carcinoma is about 0.2-3.8%. Being asymptomatic, detection of tumour thrombosis clinically is difficult. We present the report of internal jugular vein (IJV) tumour thrombosis in a known follicular thyroid carcinoma patient, detected with multimodality imaging. Grayscale ultrasound scan of the neck showed a well-defined, bi-lobed (2.4 x 1.5) cm, intraluminal solid lesion with homogeneous echotexture within the distal left IJV close to its confluence with the ipsilateral subclavian vein. The lesion showed significant internal vascularity on colour Doppler assessment. The sonographic findings confirmed further imaging with computed tomography (CT) and radioisotope scans. We conclude that patients with thyroid cancer should be evaluated for tumour thrombosis both clinically and with imaging, particularly with ultrasound and CT/MRI or nuclear medicine, as it has prognostic implications.

Funding: None declared.

Amputation of the penis is a rare and devastating injury. The etiologies vary from accidental, self-inflicted to attacks due to sexual jealousy and revenge. In the present era of microvascular surgery, replantation is the standard care. However, replantation of the penis comes with its own set of difficulties and complications. Knowledge of the anatomy and prior knowledge of the possible complications makes the surgeon aware of the course of events after a replantation. It helps in devising strategies to overcome these challenges methodically. We present a case of penile replant with the complications that we encountered, and the measures are taken to counter them on our way to a successful outcome.

Funding: No external funding.

Polycythaemia vera (PV) is a rare myeloproliferative neoplasm characterized primarily by erythrocytosis and an increased risk of thrombosis. We report a case of PV in a 60-year-old female with diabetes mellitus (DM) and a past history of recurrent abdominal pain and documented oesophageal varices who was followed up for 2 years as a case of non-cirrhotic portal hypertension of unknown cause. PV was only diagnosed after persistent complaints of vaso-motor symptoms and better scrutiny of full blood count results.

Objective: This study assessed the coping strategies of Nigerian medical students during the COVID-19 pandemic.

Design: We conducted an online descriptive cross-sectional study among medical and dental students attending three of the largest Colleges of Medicine in the Southwestern zone of Nigeria.

Settings: Our study involved students across the pre-clinical and clinical levels of the three Colleges of Medicine.

Participants: We selected the respondents through a purposive sampling technique and disseminated questionnaires applied using an online survey platform (Google forms https://forms.gle/19yfEzehJKwsme759). A total of 1010 participants out of 2404 eligible students completed the questionnaires accurately, giving a response rate of 42%.

Methods: The Brief-COPE questionnaire assessed the participants' coping strategies (approach and avoidant) during the COVID-19 pandemic. We conducted a bivariate analysis using the chi-square test and multiple regression analysis (p< 0.05) to determine the predictors of avoidant coping strategies.

Results: Respondents mean age was 21.8±2.9 years, results were presented as Odds Ratios(OR) at 95% confidence intervals(CI). About 95% of respondents employed an approach coping strategy, while the minority(5%) adopted an avoidant coping strategy. Females were three times more likely to employ an avoidant coping strategy (OR=3.32 (95% CI 1.67-6.21) compared to male students.

Conclusion: This study reveals that the majority of the respondents employed an approach coping strategy towards the COVID-19 pandemic. Females were more likely to employ an avoidant coping strategy. We recommend gender-specific programs to help medical students cope with the COVID-19 pandemic.

Funding: No External Funding.

A tailgut cyst is a rare congenital lesion that develops from a residual posterior remnant of the intestine and presents as a mass in the presacral space. They are generally asymptomatic or have atypical symptoms, are usually benign but may rarely become malignant. We report a case of a 37-year-old female who initially presented to the Surgical Department of Korle Bu Teaching Hospital, Accra, Ghana with a malignant tailgut cyst after having repeated surgical procedures for recurrent perianal infective pathologies but still had persistence of symptoms. The lesion was initially excised and found to be a dermoid cyst histologically. The mass recurred after a year and had a re-excision; the lesion was diagnosed histologically as mucinous adenocarcinoma. This report emphasizes the different forms of presentation of a patient with a tailgut cyst and the possibility of malignant transformation, as well as the presentation of this tailgut cyst which can be diagnosed using radiological investigations and histological findings.

Funding: None.