Ghana medical journal最新文献

Objective: To determine the seroprevalence of the rubella virus among pregnant women and the perinatal outcome of neonates of mothers with active rubella virus.

Design: A cross-sectional and longitudinal study.

Setting: The study was conducted in the Obstetrics and Gynaecology Department of a teaching hospital in Nigeria.

Participants: Pregnant women at the gestational age of 18-20 weeks.

Intervention: Screening pregnant mothers for immunoglobulin (IgG, IgM) for the rubella virus. Neonates of pregnant mothers with active rubella infection (IgM positive) were screened at birth for rubella IgM to assess for congenital rubella infections and congenital rubella syndrome.

Main outcome measure: Prevalence of rubella immunoglobulin G and active rubella infection IgM, congenital rubella infection, and congenital rubella syndrome.

Results: Of the 327 participants, 68.8% were rubella IgG seropositive, while 7.6% were Rubella IgM seropositive. Fifty-six (56) per cent of neonates of women with active rubella infection were Rubella IgM seropositive at birth, and 14.3% of the neonates of Rubella IgM seropositive pregnant women with active rubella infection had occipitofrontal circumference of less than 10^th percentile for gestational age.

Conclusion: Rubella virus is present in our environment with the risk of pregnant mother and neonate of being infected.

Funding: None declared.

Objectives: This study determined the prevalence of motorcycle accidents and associated risk factors in Accra, Ghana.

Design: Cross-sectional.

Setting: Legon, Pentecost, Madina, and Kekele hospitals, Motor Transport and Traffic Unit offices in Accra, and Kaneshie District Court. Data were collected using structured questionnaires.

Participants: Road traffic accident victims (387), aged 15 years and above, were randomly selected from health facilities' registers and interviewed.

Main outcome measure: Number of road traffic accidents involving motorcycles.

Results: The prevalence of motorcycle accidents among road traffic accidents was 37% [95% CI: 32.0-42.0]. Motorcycle accidents predominantly occurred among people aged 15-25 and 26-35 years. The prevalence among men was 38% while women reported 24% [95% CI: 85.0-91.0]. Motorcycle accident occurrence was higher (63% vs 10%) among those earning < GH₵349 ($22.37) a month compared to those earning above GH₵3000 ($192.31). After adjusting for all the factors that showed association at the univariate level and potential confounders like sex, followed by post-estimation analysis and a Hosmer-Lemeshow goodness of fit test, factors that were significantly associated with motorcycle accidents included ownership [AOR:2.32, p=0.018 95%CI: 1.16-4.65], education level [AOR=1.48, p=0.020 95%CI: 1.06-2.05], motor license [AOR=132.74, p<0.001 95%CI: 17.56-1003.62], and income level [AOR=0.65, p=0.002 95%CI: 0.50-0.85].

Conclusion: Motorcycle accidents remain prevalent and significantly related to income level, ownership level, education level, and having a motor license. To reduce motorcycle accidents, governments must implement policies that address these factors and support safer road practices.

Funding: None declared.

Cardiovascular diseases in pregnancy increase the risk of adverse maternal and foetal outcomes. Diagnosis and management of cardiovascular diseases, such as arrhythmias and heart failure in pregnancy, in resource-limited settings, is, however, challenging. We present a 31-year-old multiparous woman whose index presentation was for worsening symptoms of acute heart failure at 33 weeks of gestation. She had, however, had a prior history of breathlessness in a previous pregnancy for which she was diagnosed with peripartum cardiomyopathy. During this index clinical presentation, she was found to have dilated cardiac chambers with severe left ventricular systolic dysfunction and monomorphic ventricular tachycardia. Multidisciplinary team management resulted in successful cardioversion and satisfactory maternal and foetal outcomes.

Funding: None declared.

Objective: The aim was to determine the aetiological factors and clinical and paraclinical aspects of stroke in children in Cameroon.

Design: retrospective study of the records.

Setting: At two university hospitals in the city of Yaoundé (Yaoundé Gynaeco-Obstetric and Paediatric Hospital and the Chantal Biya Foundation Mother and Child Centre).

Participants: 47 children with stroke for seven and half years.

Interventions: Data were collected from medical records. The variables studied included clinical and paraclinical data.

Main outcome measures: Key variables were summarised in the form of mean ± standard deviation, frequencies and percentages.

Results: The mean age was 6.5±2.8 years. The Male Female sex ratio was 1.8:1. The average consultation time was 31.8 hours. Hemiplegia/hemiparesis (95.7%) was the main clinical manifestation, associated with signs such as convulsions (27.7%), fever (46.8%) and pallor (27.7%). Ischaemic and haemorrhagic stroke accounted for 41 cases (87.2%) and 6 cases (12.8%), respectively. The aetiological factors for ischaemic stroke were sickle cell disease (72.3%), sepsis (4.2%), protein S deficiency (2.1%) and dilated cardiomyopathy with mitral insufficiency (2.1%). The aetiology was not found in 3 patients (6.4%) with ischaemic stroke. Apart from sickle cell disease (66.6%), the aetiological factors for haemorrhagic stroke were idiopathic thrombocytopenic purpura (16.7%) and haemophilia B (16.7%). Ischaemia mainly involved the middle cerebral artery (86.1%). Haemorrhagic attacks were mainly supratentorial.

Conclusion: In urban Cameroon, strokes frequently occur around the age of 6, with a predominance of ischaemic strokes resulting in motor deficits. Sickle cell disease is the most common cause.

Funding: None declared.

Spontaneous bowel evisceration with umbilical hernia is very rare and has been reported in a patient with chronic liver disease with tense ascites. There has been one reported case of spontaneous evisceration in a patient with inguinal hernia and chronic obstructive pulmonary disease. Here, we present a case of a right inguinoscrotal hernia with spontaneous scrotal bowel evisceration in a patient with no apparent underlying chronic conditions. Management of such a case involves stabilising the patient and avoiding further injury to the bowel, with the definitive treatment being surgical repair. Using a nylon darn repair technique seems better than a prosthetic mesh due to the risk of infection of the latter. The principle of surgical treatment is that the bowel is carefully inspected, a thorough saline wash of the abdomen is done and appropriately repairing the hernia defect.

Funding: None declared.

Isolated internal iliac artery aneurysm (IIIAA) is a rare condition, with limited information available about its symptoms and surgical treatment outcomes, particularly in Ghana. This case report presents the 4-year surgical treatment outcomes of three patients (aged 42, 58, and 22 years) with IIIAA, each exhibiting different clinical presentations. All patients experienced pelvic pain and difficulty walking but had uneventful post-operative recoveries. They made significant progress with physiotherapy and were able to mobilise with a Zimmer frame before discharge. Currently, all three patients are mobilising unaided, and post-operative Computed Tomography (CT) scans show no complications. This report highlights the importance of early diagnosis to minimise complications and improve the prognosis for IIIAA, which often presents asymptomatically and can manifest with a wide range of clinical findings. The study underscores the effectiveness of open surgical repair in achieving positive outcomes for IIIAA patients in Ghana.

Funding:

Objective: This study aims to evaluate the ancillary benefit of intermittent preventive therapy with sulfadoxine-pyrimethamine (IPTp-SP) in preventing maternal anaemia (MA) among parturient women differentially exposed to the regimen.

Design: A health facility-based retrospective analytical cross-sectional study.

Settings: The study was conducted at the Kade Government Hospital's maternity/labor suit.

Participants: Data from 2,545 parturient women were abstracted from birth registers.

Statistical analysis: Baseline characteristics were described, and stratified analyses assessed their impacts. Differences in mean mHgbc based on IPTp-SP exposure were determined using one-way ANOVA. An unpaired two-sample t-test evaluated the significance of inter-dose group differences. The bivariable analysis examined crude and adjusted risks of anaemia with differential IPTp-SP exposure.

Main outcome measure: The main outcome measure was the level of mHgbc with varying IPTp-SP exposure.

Results: The overall mean exposure to IPTp-SP was 2.35 (±2.35) doses. Of the women, 5.9% had 'nil' exposure, with a mean mHgbc of 9.71 g/dL (±1.6). Among the 75.9% who received 1-3 doses, the mean mHgbc was 10.39 g/dL (±1.3). For the 18.2% who received ≥4 doses, the mean mHgbc was 10.77 g/dL (±1.4). The mHgbc notably rose as the mean doses of IPTp-SP increased. The crude odds ratios (COR) were 1.96 (95% CI: 0.99-3.89, p = 0.06) for 'nil' exposure, 1.28 (95% CI: 0.92-1.78, p = 0.16) for 1-3 doses, and 0.59 (95% CI: 0.41-0.84, p = 0.002) for ≥4 doses.

Conclusion: The consistent linear increase in mean mHgbc with higher IPTp-SP doses remains clinically crucial.

Funding: None declared.

Objective: To determine the prevalence of anaemia, clinical features, hospitalisation outcomes, and associated factors among paediatric patients with severe malaria-related anaemia admitted to a tertiary hospital in northwestern Nigeria.

Design: This was a retrospective study of children with confirmed severe malaria-related anaemia admitted between 2019 and 2022.

Participants: Paediatric patients aged three months to 14 years with confirmed severe malaria-related anaemia.

Main outcomes measures: Hospitalization outcomes and associated factors among paediatric study patients.

Results: There were 278 malaria-related anaemia cases with a prevalence of 29.3% (278/948) among malaria cases and 3.4% (278/8,295) among all paediatric admissions. Of 278 patients with malaria-related anaemia, 110 (39.6%) had severe anaemia. The prevalence of severe anaemia was 11.6% (110/948) and 1.3% (110/8,295) from malaria cases and paediatric admissions, respectively. Clinical features were comparable across the levels of anaemia except for the loss of consciousness (p = 0.038). Severe anaemia was more common among under-fives (76/159, 47.8%), p=003, and males (p = 0.013). The crude mortality rate was 6.5% (18/278) and comparable [6.4%, (7/110)] with severe anaemia (p = 0.924). Factors that were associated with hospitalisation deaths included unconsciousness [adjusted odds ratio (AOR) 5.8, 95% confidence interval (CI) 1.800-18.441], hypoxemia AOR [7.3, 95% CI, 1.749- 30.473] and first 24 hours of admission, AOR [18.4, 95% CI 3.430-98.705].

Conclusion: In childhood, severe malaria anaemia remains a greater burden among under five and is associated with high mortality. Unconsciousness and hypoxemia at presentation and the first 24 hours of admission were associated with increased odds of death.

Funding: None declared.

Objectives: E6 and E7 DNA sequence profile of HPV-18 and HPV-45 lineage/sublineage variants in Ghana.

Design: A cross-sectional study.

Setting: Obstetrics/Gynaecology Directorate, Komfo Anokye Teaching Hospital, Kumasi and Department of Radiotherapy/Nuclear Medicine and the Family Planning Unit, Korle-Bu Teaching Hospital, Accra.

Participants: 207 individuals referred with clinical suspicion of cervical cancer (CxCa) or confirmed CxCa/precancer cases.

Methods: Cervical swabs were collected (from October 2018 to November 2020) from individuals, with L1 DNA positivity for HPV-18(40 samples) and/or HPV-45(28 samples), out of 207 samples tested for 24-HPV-genotypes. DNA was extracted from a convenience sample and HPV-E6/E7-PCR (33/40-HPV-18-+ve- or 20/28-HPV-45-+ve samples), sequencing, and BLAST analysis was carried out.

Results: After PCR amplification, the E6/E7 gene regions of 26 out of 33(HPV-18+ve) samples and ten (10) out of 20 (HPV-45+ve) samples were eligible for sequencing. For HPV-18 variants, 24 out of 26 samples (92.31%) were of lineage-B/C, including samples of lineage-C and 22 samples of lineage-B (out of which ten (10) samples were with E7-SNP-C665T). Nine out of ten HPV-45 variants were sublineage-A1, of which two (2) samples harboured both E6-SNPs-C134T and C4I7T including one sample with E6-SNPs-C134T, G415C, C4I7T detected together.

Conclusions: Our study confirms a dominance of HPV-45-sublineage-A1 and HPV-18-lineage-B (with rare occurrence of Africa-specific HPV-18-lineage-C) variants in Ghana. Our study provides preliminary data on E6/E7 SNPs of HPV-18 and HPV-45 lineages and sublineages among CxCa cases in Ghana. We hope our data will inform future studies on pattern and distribution of HPV type-specific nucleotide changes that can be useful for therapeutic intervention.

Funding: UK Government, (GK) Commonwealth Split-Site Scholarship with research support grant, number GHCN201823. GK also received Ghana public universities senior members book & research allowance, for research activities carried out in Ghana.

Objective: This study compared the preoperative ocular biometric parameters of children who had cataract with age-matched healthy children to provide an understanding of a range of typical measurements in indigenous African eyes and aid management of childhood cataract.

Design: Observational, cross-sectional, comparative study of two groups- cases and controls.

Setting: Child eye health tertiary health facility.

Participants: Group A consisted of children aged 2 to 6 years with cataracts, and Group B of age-matched controls. Ocular biometry measurements including keratometry, axial length (AXL), pachymetry (central corneal thickness [CCT]) and tonometry were measured.

Results: Thirty eyes of 24 children were studied in each group. Seventeen (70.8%) children had bilateral cataracts. The mean age of the cataract group (A) was 5.97±2.93 years, while that of the control group (B) was 6.33±2.89 years. The mean preoperative values for the ocular biometric parameters were: Group A AXL= 23.4(±1.4) mm versus Group B AXL= 22.7(±0.9) mm, p= 0.028; Group A CCT= 563.6(±59.7) µm versus Group B CCT= 551.0(±36.4) µm, p= 0.33; and Group A K = 43.4(±2.3) D versus Group B K = 42.5(±1.5) D, p= 0.08. Group A IOP was 13.7(±2.8) mmHg, while Group B IOP was 13.8 (±3.1) mmHg, p =0.93.

Conclusion: There was no statistically significant difference in ocular biometric parameters between children's eyes with and without cataracts except for the axial length.

Funding: None declared.