Ghana medical journal最新文献

Objective: The study was designed to evaluate the distribution of cardiovascular risk(s), outcome modifiers and survival peculiarities among medically confined patients.

Design: Evaluated admission and discharge summaries of medically confined patients retroactively over 5 years.

Setting: Medical wards, UniOsun Teaching Hospital Osogbo, Osun State, Nigeria.

Participants: Two thousand three hundred and forty (2340) male and female patients aged between 16 and 108 years.

Main outcome measures: Admission pattern, cardiovascular risk distribution, outcome and survival peculiarities.

Results: The mean age of the respondents was 53.2 (18.3) years with male preponderance (52.0%). Non-infectious diseases predominated as the principal causes of medical confinements (82.9%). Cerebrovascular accident (13.5%), acute decompensation of chronic kidney disease (11.6%) and type 2 diabetes mellitus (6.0%) were the prominent causes of morbidity. The median duration of confinement was 6.0 days. The overall crude mortality rate was 14.3%, with the highest case fatality rate (27.2%) among those with neurological morbidities. Clinical outcome was statistically influenced by age (p= 0.004), occupation (p=0.02), duration of confinement (p=0.002) and morbidity stratification into infectious/non-infectious aetiologies (p=0.040) on regression analysis. The number of medical sub-specialties involved (p < 0.001), specialty affected (p<0.001), and yearly pattern of hospitalisation (p< 0.001) had a statistical influence on Kaplan Meier's survival plots.

Conclusion: Hospital confinements underlined by infection/non-infection-related medical causes exhibit variable outcomes. The loop-sided frequencies of its causes remain worrisome because of the unending challenges plaguing effective healthcare delivery in the tropics.

Funding: None declared.

Objective: To ascertain the experience and determinants of pain by breast biopsy patients and how the pain is managed in the first week following the procedure.

Design: This was a panel longitudinal study design.

Settings: The study was conducted at the Radiology Department of Korle Bu Teaching Hospital.

Participants: The study participants comprised adult patients who presented to the Department of Radiology of Korle Bu Teaching Hospital for breast biopsy between 1 August 2022 and 31 January 2023.

Main outcome: The severity of biopsy-related pain, its associated factors and management were evaluated and documented.

Results: The participants were between 21 and 81 years with a mean age of 48.1 years. There was no association between demographic and participant factors and the degree of pain experienced by the patient. There was a significant association between the radiologist's expertise (p<.001), blood pressure before the procedure (p=.026), quality of education given to the participant before the procedure (p<.001) and the degree of pain experienced.

Conclusion: There was significant anxiety before the procedure. Most participants experienced mild pain, which did not interfere with daily activity. There was a significant association between participant pain and pre-procedure blood pressure, the radiologist's expertise and the quality of education participants received before the biopsy.

Funding: None declared.

Objective: To compare the accuracy of foetal weight estimation using a multivariate algorithm based on maternal characteristics and pregnancy-specific factors to that of ultrasound.

Design: A cross-sectional hospital-based study.

Setting: Antenatal Clinics and Antenatal Labour wards of the Department of Obstetrics & Gynaecology, Federal Medical Centre, Asaba, Nigeria.

Participants: A total of 92 pregnant women were admitted for labour, elective caesarean section or elective induction of labour at 37 weeks to 41 weeks and 3 days.

Main outcome measures: Mean of absolute error, mean of absolute percentage error and proportion of estimated weight within 10% of actual birth weight.

Results: Between April and August 2021, 92 participants were included. An equation based on maternal characteristics was derived. Ultrasound weight estimation was done using Hadlock's 4 formula. Both methods positively correlated with actual birth weight, and their accuracy did not differ significantly. Overall accuracy within 10% of actual birth weight was higher for ultrasonography than multivariate algorithm 71.7% and 65.2%, respectively (χ²=0.286, p=0.60). The mean absolute percentage error was smaller for ultrasound (7.98±4.74%) than clinical formula (9.11±6.76%) p=0.11. The mean absolute error was 265.57±145.67g for ultrasonography and 304.32±203.29g for the multivariate model, with no statistical difference (p=0.09).

Conclusion: The multivariate algorithm based on maternal characteristics and pregnancy-specific factors was equally accurate as ultrasonography for foetal weight estimation at term.

Funding: None declared.

Objective: This study aims to determine the antibiotic susceptibility pattern and incidence of extended-spectrum beta-lactamase (ESBL) genes in isolates from vaginal discharge of symptomatic female patients.

Study design: Cross-sectional study.

Participant: Pregnant and non-pregnant women between 18 and 50 years who presented with genital tract infection and had not received antimicrobial therapy in the two weeks prior.

Interventions: The study determines the prevalence of bacteria in the vaginal discharge of female patients of reproductive age, the antibiotic susceptibility pattern of the isolates and the incidence of ESBL genes in Gram-negative isolates from the sample.

Results: Bacteria were found in 74 (80.4%) and 88 (81.5%) samples from pregnant and non-pregnant women, respectively. Escherichia coli (n=48; 27.6%) occurred mostly in the samples, followed by Staphylococcus aureus (n=38; 21.8%). Among the Gram-positive, all Streptococcus. pneumoniae and Staphylococcus. epidermidis were sensitive to imipenem and meropenem (100%). S. aureus was the most resistant to cephalexin (71.4%), cefoxitin (60.5%) carbenicillin (60.5%) and ceftazidime (57.9%). Escherichia coli was highly resistant to carbenicillin (85.4%), cephalexin (64.6%) and cefotaxime (56.3%). Klebsiella pneumoniae showed the highest level of imipenem resistance (31.6%), followed by E. coli (29.2%). The prevalence of ESBL genes in Gram-negative isolates from pregnant women was 25.6% (11/43), compared to 30.3% (23/76) in non-pregnant women. Both bla _TEM and bla _SHV had the highest occurrence of 14.3% (17/119) of the isolates.

Conclusion: This study found Gram-negative pathogens isolated from the vaginal tract of both pregnant and non-pregnant women to be resistant to multiple antibiotics and have ESBL genes.

Funding: None declared.

Objectives: This study assessed the risk perception of COVID-19 and the uptake of the COVID-19 vaccine among patients with chronic illnesses in a tertiary health facility.

Design: A hospital-based cross-sectional study.

Setting: The outpatient clinics in a tertiary health facility in Ilorin, North-Central Nigeria.

Participants: Patients with chronic diseases attending outpatient clinics in UITH, Ilorin from November- December 2022, excluding patients under 18 years of age, using simple random sampling by balloting for outpatient clinics, proportional allocation for participants from each clinic, and systematic sampling method for eligible respondents.

Main outcome measure: Risk perception of COVID-19 and vaccine uptake among patients with chronic illnesses in Nigeria.

Results: Respondents believed that older people were most at risk of COVID-19. Over two-thirds, 278 (69.5%) of the respondents had received the COVID-19 vaccine. Fear of the unknown (36.0%) and fear of side effects 30 (24.6%) were the most common reasons for not taking the vaccine. Those married were more likely to have received at least one dose of the vaccine (p=0.007).

Conclusion: COVID-19 risk perception and COVID-19 vaccine uptake were relatively above average. Fear of the unknown and side effects were significant reasons for not taking the vaccines.

Funding: None declared.

Hypertension is the top cause of preventable deaths in the African region. The burden of hypertension is increasing in Ghana, along with other countries in the African continent. Many people with hypertension in Ghana are unfortunately unaware of their diagnosis, and those who are aware often have poorly controlled blood pressure. The current situation is a signal of critical gaps in hypertension care in Ghana that need to be urgently addressed to curb this epidemic. The World Heart Federation (WHF), sponsored by Resolve to Save Lives, responded to this need by organising advocacy roundtables on hypertension in selected countries in sub-Saharan Africa to scale up hypertension management efforts in these countries. The roundtable on hypertension in Ghana was organised in collaboration with the Ghanaian Society of Cardiology (GSC) and the Stroke Association Support Network (SASNET) Ghana. A country mapping detailing the current situation and evolution of hypertension in Ghana over the years formed the basis of the roundtable discussions. The roundtable convened diverse stakeholders in hypertension care in Ghana to discuss the roadblocks to hypertension management in Ghana, proffer solutions to address them and chart a course with timelines for action. Major roadblocks to the management of hypertension in Ghana identified included inadequate financing for cardiovascular disease (CVD) care, inadequate capacity for CVD care across all levels of the healthcare system and insufficient education to empower people with hypertension for optimal self-care.

Funding: The roundtable was funded through a grant by Resolve to Save Lives through the World Heart Federation.

Objective: This study assessed the prevalence of infection, management strategies and associated disease outcomes of COVID-19 among Autoimmune Rheumatic Disease (AIRD) patients in a teaching hospital in Ghana.

Design: This was a retrospective cross-sectional study.

Setting: Rheumatology Unit, Korle Bu Teaching Hospital.

Participants: Autoimmune Rheumatic Disease patients.

Results: Thirty-one (31) out of approximately 1700 AIRD patients in the unit tested positive for COVID-19, registering a COVID-19 prevalence of 1.82%. The majority, 25(80.6%), were females with a mean ± SD age of 41.7 ± 12.8 years. Systemic lupus erythematosus was the most affected autoimmune rheumatic condition, reporting fever as the commonest COVID-19-related symptom. Most participants, 22(71%), were managed by the "self-isolation"/home management" strategy. In comparison, 7(22.5%) were monitored at the hospital, with both strategies having resulted in complete recovery. The remaining 2(6.5%) patients who managed under "intensive care unit" strategy resulted in mortality.

Conclusion: These findings highlight the relatively low frequency of COVID-19 infection among AIRD patients, the encouraging recovery, and the low severe disease rates observed within this cohort. Additionally, the outcome of self-isolation and home management strategies underscore the importance of personalised approaches to COVID-19 management in this population.

Funding: None.

Objectives: Previous studies suggest that patients' thyroid status might directly impact the course of Coronavirus disease 2019 (COVID-19). The objective of the study was to determine the clinical profile of COVID-19 patients with hypothyroidism and compare it with that of COVID-19 patients without hypothyroidism.

Design: Retrospective observational study.

Setting: The study was conducted in a tertiary healthcare centre in Tamil Nadu between May and June 2021.

Participants: The study included 117 patients admitted with hypothyroidism and COVID-19 as well as 117 age and Gender matched COVID-19 patients without hypothyroidism.

Main outcome measures: Data regarding the demography, comorbidities, presenting symptoms, method of diagnosis of COVID-19, computed tomography (CT) severity score, Interleukin 6 (IL-6), D-dimer, oxygen requirement, number of days in hospital and outcome were collected for both groups. Data analysis was conducted, and p<0.05 was considered statistically significant.

Results: The study comprised 234 patients over two months, from May to June 2021. Distribution of presenting symptoms showed that the hypothyroidism group presented with a higher incidence of fever (66.67%), loose stool (18.80%) and myalgia (7.69%). Results show that RTPCR+, O₂ Requirement, death, D-dimer, IL-6, number of days admitted as well as CT-severity did not show any statistically significant differences (p>0.05) between both groups. The outcomes also showed that both groups reported four mortalities.

Conclusions: The results of the study help conclude that the hypothyroidism status of a COVID-19 patient is not associated with higher severity of clinical symptoms, deranged laboratory values as well as mortality.

Funding: None declared.

Objective: To assess the clinical presentation and evaluation of acute life-threatening chest pain in Accra, Ghana.

Design: This was a cross-sectional study at the emergency departments of two leading tertiary hospitals in Accra.

Settings: The study was conducted at the Korle-Bu Teaching Hospital and the 37 Military Hospital in Accra.

Participants: The study participants comprised adult patients aged 18 years and above who presented with acute chest pain at the emergency departments between April and June 2018.

Main outcome: Acute coronary syndrome is the leading life-threatening cause of chest pain with poor pre- and in-hospital care.

Results: 232 patients with chest pain were enrolled as respondents aged 18 to 94 years. The prevalence of life-threatening conditions causing chest pain was 31.9% of those who presented with acute chest pain. These included acute coronary syndrome (82.4%), pulmonary embolism (14.9%), and acute chest syndrome (2.7%). A few (6.6%) with life-threatening conditions such as acute coronary syndrome were transported by ambulances, and 44.3% reported to the facility within 2 to 9 days after the onset of chest pain. None of the patients with pulmonary embolism and acute chest syndrome had computer tomography pulmonary angiogram (CTPA) and echocardiogram done, respectively.

Conclusion: Our study found that life-threatening conditions amongst patients presenting with acute chest pains are common; however, there is a need to improve pre-hospital care and in-hospital assessment of these cases.

Funding: The study was partly funded by the Medtronic Foundation.

Objective: The study aimed to assess the equity of access to free maternal and child health services among reproductive-age women in Delta State, Nigeria.

Design: the study adopted a descriptive cross-sectional survey design.

Participants: The population for the study were 368 women of reproductive age (15-49 years) who had given birth between April 2015 and December 2015 in two randomly selected senatorial districts of Delta State. Data were collected using a pre-tested interviewer-administered questionnaire.

Results: 368 women were recruited for the study, consisting of 73.3% (N =270) from the urban setting and 26.7% (N=98) from the rural setting. 54.1% (N=199) had completed secondary school, while 28.8% (N=106) had completed tertiary education. Most respondents were aged 21 to 30 years 217(59.0%). 20% of respondents belonged to the poorest, poor and least poor socioeconomic status (SES) groups and 19.8% to average poor and rich SES groups. The results showed equity between different SES (0.014) and educational (0.027) backgrounds, as indicated in concentration curves. However, the concentration index between the geographical areas (-0.0200) indicates inequity in access in favour of urban dwellers.

Conclusion: Free maternal and child health services (FMCHS) were equitable across the different SES groups and educational levels. However, there was inequity in access due to distance to the hospitals among the women of childbearing age in the communities. This study is relevant to all healthcare professionals, especially those in public health, because it will encourage them to exercise their energy towards home care to reduce maternal and child mortality.

Funding: None declared.