Clinic In Ghana Research Articles

Diabetes-Related Stigma and its Influence on Social Networks, Social Support, and HbA1c in Ghana.

We applied a social network approach to examine if three types of diabetes-related stigma (self-stigma, perceived stigma and enacted stigma) moderated associations between social network characteristics (network size, kin composition, household composition, and network density), social support, and blood glucose among Ghanaians with type 2 diabetes mellitus (T2DM). Data were obtained through a cross-sectional survey of 254 adults at a diabetes clinic in Ghana that assessed participants' social networks, social support, and frequency of experiencing three types of diabetes-related stigma. Self-stigma moderated associations between kin composition and social support when controlling for network size β=-.97, P=.004). Among study participants reporting low self-stigma, kin composition was positively associated with social support (β=1.29, P<.0001), but this association was not found among those reporting high self-stigma. Network size was positively associated with social support among participants reporting both low and high self-stigma. None of the types of diabetes-related stigma moderated other associations between social networks, social support, and blood glucose. Individuals with T2DM who report high self-stigma may have lower social support, which can reduce their capacity for disease management. Additionally, larger social networks may be beneficial for individuals with T2DM in countries like Ghana, and interventions that expand network resources may facilitate diabetes control.

Exploring self-management in adult sickle cell disease patients' at a Teaching Hospital in Ghana.

AimTo evaluate the relationships among self‐efficacy, uncertainty, self‐management and emergency hospital visits yearly among adult sickle cell disease patients’ and related demographics at a Teaching Hospital in Ghana.DesignA quantitative cross‐sectional design.MethodA purposive and convenience sample of 85 adult clients from a sickle cell clinic in Ghana completed research instruments. Data collection occurred in March and April 2019. Instruments used were the self‐efficacy scale, self‐care agency scale, Mishel uncertainty scale and socio‐demographic variables. Pearson correlation and regression techniques were used for analysis.FindingsThe correlation results showed a low positive and significant correlation between self‐efficacy and self‐management (r = 0.357, p < .01), a significant moderate negative relationship between self‐efficacy and uncertainty (r = −0.459, p < .01) and a significant low negative relationship between self‐management and uncertainty. For the regression, employment (p = .003) and marital status (p = .002) significantly predicted self‐management among others.ConclusionSelf‐efficacy had positive and significant relationship with self‐management. Similarly, patients with family support and employment experienced better self‐management. Furthermore, patients with higher education and living with family had reduced illness uncertainty. Thus, the findings can improve self‐care measures and mitigate illness uncertainty for better health outcomes.

Evaluating Attitudes Towards Patient Care and Operations at Korle-Bu Outpatient Clinic.

Background:Extensive research suggests that positive patient experience leads to improvement in patient health outcomes. Patient experience is particularly important in ambulatory care, where a patient builds a long-term relationship with a provider to manage his/her chronic illness over the span of years. Despite these known benefits, patient experience and its impact on health outcomes is poorly understood in low- and middle-income countries, where resources may be limited and primary care infrastructure spotty.Objectives:This paper aims to better characterize patient experience in a tertiary teaching hospital in Accra, Ghana.Methods:Forty qualitative interviews were conducted in the Outpatient Medical Clinic at Korle-Bu Teaching Hospital in Accra, Ghana. All interviews were transcribed and a qualitative analysis of central themes was evaluated by the study team.Findings:We found patients eager to share their views on clinical care in an ambulatory clinic in Ghana’s largest tertiary care center. Patients voiced desires for decreasing patient wait times, increasing wayfinding resources to navigate the clinic, creating appointment times, and implementing continuity of care with a single physician. The majority of patients also reported feeling actively engaged in their clinical care and emphasized their positive interpersonal interactions with providers.Conclusions:These findings suggest that patients described positive interpersonal experiences with providers at this ambulatory clinic, but identified numerous operational changes that could be made to vastly improve patient experience.

Ambulatory blood pressure monitoring and management of hypertension at a cardiac clinic in Kumasi Metropolis, Ghana.

Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid misdiagnosis of hypertension and allow for targeted treatment of patients with hypertension. This study sought to assess the contribution of ABPM to blood pressure (BP) control and antihypertensive therapy at a cardiac clinic in Ghana. Medical records of 97 patients, aged 18-85years (mean 55), were reviewed. Among patients with clinic BP (CBP) and ambulatory BP recorded on the same day, we assessed for the different hypertension phenotypes, CBP control 6months following ABPM, and changes to antihypertensive therapy after review of the ABPM records in patients with controlled and uncontrolled ambulatory BP. From the clinic and ambulatory BP records measured at baseline, the proportion of patients with white-coat uncontrolled hypertension (WUCH) was 19.5% (17/87) and those with masked uncontrolled hypertension (MUCH) was 16.1% (n=14). A significant reduction in average systolic CBP in the overall cohort (-6.2mm Hg, P<.01) and in the uncontrolled subgroup (-8.8mm Hg, P<.001) at follow-up was observed. After review of the ABPM records, 51.7% of the patients on treatment had changes made in their antihypertensive therapy. Antihypertensive therapy was deintensified or left unchanged in majority of the patients with WUCH and sustained controlled hypertension. In patients with MUCH and true uncontrolled hypertension (TUCH), therapy was intensified. In conclusion, ABPM improved clinical decision-making for antihypertensive therapy and BP control. ABPM should therefore be used more often in hypertension and cardiac clinics in low/middle-income countries for optimal care.

Buruli ulcer treatment: Rate of surgical intervention differs highly between treatment centers in West Africa.

BackgroundAntibiotic treatment proved itself as the mainstay of treatment for Buruli ulcer disease. This neglected tropical disease is caused by Mycobacterium ulcerans. Surgery persists as an adjunct therapy intended to reduce the mycobacterial load. In an earlier clinical trial, patients benefited from delaying the decision to operate. Nevertheless, the rate of surgical interventions differs highly per clinic.MethodsA retrospective study was conducted in six different Buruli ulcer (BU) treatment centers in Benin and Ghana. BU patients clinically diagnosed between January 2012 and December 2016 were included and surgical interventions during the follow-up period, at least one year after diagnosis, were recorded. Logistic regression analysis was carried out to estimate the effect of the treatment center on the decision to perform surgery, while controlling for interaction and confounders.ResultsA total of 1193 patients, 612 from Benin and 581 from Ghana, were included. In Benin, lesions were most frequently (42%) categorized as the most severe lesions (WHO criteria, category III), whereas in Ghana lesions were most frequently (44%) categorized as small lesions (WHO criteria, category I). In total 344 (29%) patients received surgical intervention. The percentage of patients receiving surgical intervention varied between hospitals from 1.5% to 72%. Patients treated in one of the centers in Benin were much more likely to have surgery compared to the clinic in Ghana with the lowest rate of surgical intervention (RR = 46.7 CI 95% [17.5–124.8]). Even after adjusting for confounders (severity of disease, age, sex, limitation of movement at joint at time of diagnosis, ulcer and critical sites), rates of surgical interventions varied highly.ConclusionThe decision to perform surgery to reduce the mycobacterial load in BU varies highly per clinic. Evidence based guidelines are needed to guide the role of surgery in the treatment of BU

Risk factors associated with gonorrhea and chlamydia transmission in selected health facilities in Ghana

BackgroundUnderstanding the underlying epidemiology that shapes Neisseria gonorrhoeae (GC), and Chlamydia trachomatis (CT) infections can contribute to data driven policies directed towards curbing the proliferation of these pathogens in Ghana. Information on the symptoms and risk factors for STIs will help to identify high-risk individuals which will in turn inform STI syndromic management and tailor the use of public health resources.MethodsParticipants were from 4 military clinics and 1 civilian STI clinic in Ghana and eligible if they had symptoms suggestive of STI. First void urine samples were collected and tested with Nucleic Acid Amplification Test (NAAT). A structured questionnaire was administered to all participants. Multivariate logistic regression identified factors associated with infection, separately for NG and for CT and for men and women.ResultsA total of 950 patients, 58% of whom were females were enrolled, 28% had gonorrhea and 11% had chlamydia with more males testing positive than females. Reported symptoms that were more common among patients who tested positive for gonorrhea were painful urination and urethral discharge (all P values < 0.05). Additionally, multiple sexual partners and alcohol use were statistically associated with higher rates of gonorrhea in males while only the frequency of condom use was associated with gonorrhea for females. None of the symptoms or risk factors except marital status was associated with testing positive for chlamydia.ConclusionIdentifying these symptoms and risk factors help inform health care delivery systems for STIs in Ghana. Furthermore, men and women presenting with these symptoms and risk factors are a prime target for public health education campaigns, aimed at curbing the spread of gonorrhea and chlamydia infections.

Clinical profile of diabetes at diagnosis among children and adolescents at an endocrine clinic in Ghana

Clinical profile of diabetes at diagnosis among children and adolescents at an endocrine clinic in Ghana

Homeopathy Reduces Service Users’ Self-Reported Emotional Distress in a Charity Supported Rural Community Clinic in Ghana

Homeopathy Reduces Service Users’ Self-Reported Emotional Distress in a Charity Supported Rural Community Clinic in Ghana

Pattern of Cardiovascular Diseases as Seen in an Out-Patient Cardiac Clinic in Ghana

Cardiovascular diseases (CVDs) are increasingly emerging as a major health problem in sub-Saharan Africa, but information on the epidemiology, clinical characteristics and spectrum of the diseases are scanty. Epidemiological data regarding the incidence and prevalence of CVDs in different geographical regions are essential to our understanding of global distribution and evolution of CVDs. We conducted a retrospective observational study to determine the prevalence and spectrum of cardiovascular diseases in patients seen at the out-patient cardiac clinic of the Directorate of Medicine, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Medical records of 432 patients selected from the cardiac clinic using simple random sampling. The medical history, including the socio-demographic information, was examined. The results of the patients’ laboratory tests, chest X-ray, electrocardiography, M-mode and two-dimensional echocardiography with Doppler and colour flow imaging of the patients were also examined. The patients were aged between 13 - 97 years with the mean age (±standard deviation) of 55.35 (±19) years. There were more females (53%; n = 229) than males (47%; n = 203). The main cardiovascular diseases seen included: hypertensive heart disease (35.6%; n = 154), valvular heart disease (19.7%; n = 85), cardiomyopathies (18.5%; n = 80), arrhythmias (6.3%; n = 27) and coronary artery disease (4.2%; n = 18). The most common causes of valvular heart disease, cardiomyopathies and arrhythmias were rheumatic heart disease, dilated cardiomyopathy and complete heart block respectively. In conclusion, our study has shown that hypertensive heart disease, rheumatic heart disease and cardiomyopathies were the main cardiovascular diseases,seen in 73.8% of the patients in this study.

Diabetes-related foot disorders among adult Ghanaians.

ABSTRACT Background: Diabetic foot remains a challenge in most low-middle-income countries (LMICs). A severe deficit in data exists on them in sub-Saharan Africa (SSA). Up-to-date data on the longitudinal trajectories and determinants can provide a benchmark for reducing diabetic foot complications in SSA. Objective: The primary objective of this study was to estimate trends in the incidence of diabetic foot and determine predictors in an adult Ghanaian diabetes cohort. Design: The study is a retrospective longitudinal study over a 12 year period. Methods: We applied Poisson regression analysis and Cox proportional hazard models to demographic and clinical information obtained from patients who enrolled in a diabetes specialist clinic in Ghana from 2005 to 2016 to identify longitudinal trends in incidence and predictors of diabetic foot. Results: The study comprised 7383 patients (63.8% female, mean follow-up duration: 8.6 years). The mean incidence of foot disorders was 8.39% (5.27% males and 3.12% females). An increase in the incidence of diabetic foot ranging from 3.25% in 2005 to 12.57% in 2016, p < 0.001, was determined. Diabetic foot, with adjusted hazard ratio (HR; 95% confidence interval (CI)), was predicted by disease duration, that is, for every 5-year increase in diabetes duration: 2.56 (1.41–3.06); male gender: 3.51 (1.41–3.06); increased body mass index (BMI), that is, for every 5 kg/m2: 3.20 (2.51–7.52); poor glycaemic control, that is, for every percentage increase in HbA1c: 1.11 (1.05–2.25), hypertension: 1.14 (1.12–3.21); nephropathy: 1.15 (1.12–3.21); and previous foot disorders: 3.24 (2.12–7.21). Conclusions: We have found a trend towards an increased incidence of diabetic foot in an outpatient tertiary diabetes setting in Ghana. Systemic and individual-level factors aimed at preventive foot screening as well as vascular risk factor control should be intensified in diabetic patients in Ghana and other LMICs. Abbreviations: BMI: Body Mass Index, BP: Blood Pressure, CI: Confidence Interval, HR: Hazard Ratio, HbA1c: Glycated Hemoglobin, PAD: Peripheral Arterial Disease, NCDs: Non Communicable Disease, SSA: Sub Saharan Africa.

Profiling of cardio-metabolic risk factors and medication utilisation among Type II diabetes patients in Ghana: a prospective cohort study

BackgroundType II diabetes mellitus (T2DM) is complicated by multiple cardio-metabolic risk factors. Controlling these factors requires lifestyle modifications alongside utilisation of anti-diabetic medications. Different glucose lowering [(biguanides (BIGs), sulfonylureas (SUAs), thiazolidinediones (TNZ)], lipid lowering (statins), and anti-hypertensive medicines [angiotensin converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), angiotensin II receptor blockers (ARBs) and central acting drugs (CADs)] have been approved for controlling hyperglycaemia, dyslipidaemia and hypertension respectively. Here, we examined factors that characterise T2DM and explored the response to medication therapy among T2DM patients.MethodsThis prospective cohort study recruited 241 T2DM patients reporting at a clinic in Ghana, from January through to August, 2016. Each patient’s demographic, medications and anthropometric data was obtained while information on medication adherence was captured using Morisky adherence scale-8 (MMAS-8). Fasting blood samples were collected for biochemical analysis.ResultsThe mean age of participants was 57.82 years for baseline and six-month follow-up. Physical activity differed at baseline and follow up (p < 0.05) but not body mass index (BMI). BIG alone, or in combination with SUA and TNZ did not improve glycaemic status at follow up (p > 0.05). Many participants using either ACEI or ARB were able to control their blood pressures. Among dyslipidaemia patients under statin treatment, there was an improved lipid profile at follow-up.ConclusionsStatin medications are effective for reducing dyslipidaemia in T2DM patients. However, control of modifiable risk factors, particularly blood glucose and to a lesser degree blood pressure is suboptimal. Addressing these will require concomitant interventions including education on medication adherence and correct dietary plans, lifestyle modifications and physical activity.

Postpartum contraceptive choices among women attending a well-baby clinic in Ghana.

To assess postpartum contraceptive choices among women attending a well-baby clinic in Ghana. From April 1 to May 31, 2011, a descriptive cross-sectional survey was conducted among women who attended the well-baby clinic of Komfo Anokye Teaching Hospital, Kumasi, at 6-24months after delivery. Participants were consecutively recruited and interviewed using semi-structured questionnaires. Data were collected on demographics, exposure to family planning counseling, message content, and postpartum contraceptive choices. Differences between the profiles of women who did or did not take up postpartum family planning were assessed. Of the 200 women enrolled, 44 (22.0%) wanted no more children and the last pregnancy was unintended among 88 (44.0%). In all, 110 (55.0%) women took up postpartum contraception, with the calendar method (n=57; 51.8%) and injectable contraceptives (n=22; 20.0%) cited as popular choices. Family planning counseling was received at the prenatal clinic by 47 (23.5%) women, with 12 (6.0%) given written referrals on the postnatal ward. More previous contraceptive users than previous non-users chose long-acting or permanent postpartum methods (P<0.001). Inadequate postpartum family planning counseling and referrals during maternity care were recorded, suggesting that a comprehensive educational intervention is required to improve uptake.

Individual factors that influence experiences and perceptions of stigma and discrimination towards people with mental illness in Ghana.

People with a mental illness often encounter stigma and discrimination from a variety of sources, reinforcing negative self-perceptions and influencing their health and well-being. Even though support systems and attitudes of the general public act as powerful sources of stigma, views and perceptions held by people with mental illness also influence their sensitivity to the experiences they encounter. The aim of the present qualitative study was to examine perceptions of stigma and discrimination and self-stigma in individuals diagnosed with a mental illness. This study adopted a narrative, descriptive method, using a semistructured interview guide to elicit participant perceptions regarding sources of stigma, discrimination, and personal factors that might influence their experiences. Twelve outpatients attending a clinic in Ghana were interviewed. Thematic content analysis was completed and augmented by field notes. Participants' perceptions about personal impacts of stigma were found to be influenced by self-stigma, anticipated stigma and discrimination, perceived discrimination, and their knowledge about their illness. For many participants, their views served to augment societal views, and thus reinforce negative self-perceptions and their future. However, for other participants, their views served as a buffer in the face of environmental situations that reflect stigma and discrimination. Stigma is a complex, socially-sanctioned phenomenon that can seriously affect the health of people with mental illness. As such, it requires coordinated strategies among public policy makers, governmental bodies, and health-care providers to address stigma on a societal level, and to address its potential impacts on broad health outcomes for individuals with mental illness.

Prevalence and Predictors of Sleep Apnea Risk among Ghanaian Stroke Survivors

Sleep apnea (SA) has emerged as a potent risk factor for stroke recurrence and mortality. The burden of SA among stroke survivors in sub-Saharan Africa where stroke incidence and mortality are escalating is unknown. We sought to assess the prevalence of SA risk and its clinical correlates and predictors among Ghanaian stroke survivors. This cross-sectional study involved 200 consecutive stroke survivors attending a neurology clinic in a tertiary medical center in Kumasi, Ghana. The validated Berlin, STOP-BANG, and Epworth Sleepiness Scale questionnaires were administered to all eligible subjects to assess SA risk and daytime somnolence, and their demographic and clinical information, health-related quality of life, and symptoms of depression were collected using the questionnaires. The median (interquartile range) age of stroke survivors was 62 (52-72) years and 52.5% were male. Ninety-nine (49.5%) subjects were identified as high risk for SA using the Berlin questionnaire, whereas 26 (13%), 137 (68.5%), and 37 (18.5%) subjects were classified as low, intermediate, and high risk for SA, respectively, using the STOP-BANG questionnaire. Patients at high risk of SA were significantly older, used excess alcohol, and were less able to perform activities of daily living, although their mean National Institutes of Health Stroke Scale scores were significantly lower than those with low risk for SA. None of the stroke survivors had ever been screened for SA. One out of every 2 stroke survivors attending a neurology clinic in Ghana is at high risk for undiagnosed SA. Greater regional awareness about SA presence and outcomes among patients and providers is warranted.

HIV Case Management Support Service Is Associated with Improved CD4 Counts of Patients Receiving Care at the Antiretroviral Clinic of Pantang Hospital, Ghana.

Background Factors associated with individual patient-level management of HIV have received minimal attention in sub-Saharan Africa. This study determined the association between support services and cluster of differentiation 4 (CD4) counts among HIV patients attending ART clinic in Ghana. Methodology This was a cross-sectional study involving adults with HIV recruited between 1 August 2014 and 31 January 2015. Data on support services were obtained through a closed-ended personal interview while the CD4 counts data were collected from their medical records. Data were entered into EpiData and analyzed using Stata software. Results Of the 201 patients who participated in the study, 67% (129/191) received case management support service. Counseling about how to prevent the spread of HIV (crude odds ratio (cOR) (95% confidence interval (CI)) (2.79 (1.17–6.68)), mental health services (0.2 (0.04–1.00)), and case management support service (2.80 (1.34–5.82))) was associated with improved CD4 counts of 350 cells/mm3 or more. After adjusting for counseling about how to prevent the spread of HIV and mental health services, case management support service was significantly associated with CD4 counts of 350 cells/mm3 or more (aOR = 2.36 (CI = 1.01–5.49)). Conclusion Case management support service for HIV patients receiving ART improves their CD4 counts above 350 cells/mm3. Incorporating HIV case management services in ART regimen should be a priority in sub-Saharan Africa.

Clinical profile of diabetes at diagnosis among children and adolescents at an endocrine clinic in Ghana.

AIMTo determine the clinical features of diabetes in children and adolescents in Ghana.METHODSRetrospective review of clinical features of all children and adolescents with new-onset diabetes seen at the paediatric endocrinology clinic of Komfo Anokye Teaching Hospital in Kumasi, from February 2012 to Auguest 2016.RESULTSOne hundred and six subjects presented with diabetes. Ninety (84.9%) were diagnosed by clinical features and family history as type 1, and 16 (15.1%) type 2. For type 1 subjects, age range at diagnosis was 0.9-19.9 year (y), peak age of onset 12-13 year, and 3.3% were < 5 year, 21.1% 5- < 10 year, 45.6% 10- < 15 year and 30.0% 15- < 20 year. Seventy-one point one percent were female. Common clinical features were polyuria (100%), polydipsia (98.9%), and weight loss (82.2%). Mean BMI SD was -0.54, range -3.84 to 2.47. 60.0% presented in diabetic ketoacidosis (DKA). Nine had infections at onset (skin, abscess, leg ulcer). Mean ± SD HbA1c at diagnosis was 12.7% ± 1.9% (115 ± 21 mmol/mol). Four have since died: Hypoglycaemia (2), recurrent DKA (1), osteosarcoma (1). Two other type 1 cases died of DKA at presentation in emergency before being seen by the paediatric endocrinologist. Crude mortality rate including these 2 cases was 32.2/1000 patient years. Type 2 cases were 81% female, age of onset 9-19 year. Mean BMI SD was 1.49, range -0.87 to 2.61. Forty-three point eight percent presented in DKA. All type 2 cases had acanthosis nigricans. Overall, 9.8% did not have home refrigeration, most using clay pot evaporative cooling for insulin storage.CONCLUSIONType 1 occurs with a female preponderance and high DKA rates. Type 2 also occurs. Typology based on clinical features is difficult. Community and professional awareness is warranted.

Pattern of Ocular Conditions among Patients Attending an Eye Clinic in Ghana

Purpose: The aim of the study was to determine the pattern of ocular conditions among patients who attended the Salvation Army Eye Clinic at Wiamoase in the Ashanti Region of Ghana in 2016. Method: A retrospective study of all patients attending the Salvation Army eye clinic at Wiamoase in 2016 was done. Results: A total of 1000 folders were used in the study. There were 382 males (38.20%) and 618 females (61.80%) with a male to female ratio of 1:1.6. The mean age was 45.99 years (SD= ± 27.69). The commonest eye disorder encountered was conjunctivitis (39.70%). This was followed by cataract (24.40%), glaucoma (9.70%) and refractive errors (8.90%). 96.72% of cases of cataract and 85.57% of cases of glaucoma occurred in those above 40 years. Of those with refractive error, there were 40.45% with myopia, 34.83% with astigmatism and 24.72% with hyperopia. Conjunctivitis and cataract were significantly higher in females with p values of 0.008 and 0.000 respectively using the chi square test. However, there was no significant difference in the prevalence of glaucoma and refractive errors between males and females with p values of 0.189 and 0.255 respectively. Presbyopia was significantly higher in males with p values of 0.017. Conclusion: Conjunctivitis, cataract, glaucoma and refractive errors were the major ocular conditions seen in this study. Efforts aimed at reducing ocular morbidity should target these conditions.

Bacterial etiology of sexually transmitted infections at a STI clinic in Ghana; use of multiplex real time PCR

Background: Most sexually transmitted infection (STI) management efforts focus on the syndromic approach to diagnose and treat patients. However, most women with STIs have been shown to be entirely asymptomatic, or if symptoms exist, are often missed when either clinical or conventional bacteriologic diagnostic tools are employed.Methods: We assessed the performance of a multiplex real time PCR assay to describe other potential pathogens that could be missed by conventional bacteriological techniques in 200 women attending a routine STI clinic in Kumasi, Ghana.Results: Although a total 78.00% of the women were asymptomatic, 77.1% of them tested positive for at least one bacterial STI pathogen. Mycoplasma genitalium was the most commonly detectable pathogen present in 67.5% of all women. Of those testing positive, 25.0% had single infections, while 38.0% and 19.5% had double and triple infections respectively. Altogether, 86.54% and 90.91% of the symptomatic and asymptomatic women respectively tested positive for at least one pathogen (p&lt;0.05). There were no significant associations (p&lt;0.05) between the clinical manifestations of the symptomatic women and the pathogens detected in their samples.Conclusions: Our study confirmed the importance of complementing the syndromic approach to STI management with pathogen detection and most importantly recognise that STIs in women are asymptomatic and regular empirical testing even for both symptomatic and asymptomatic patients is critical for complete clinical treatment.Funding: EOD (Ellis Owusu-Dabo Research working group, KCCR)Keywords: Etiology, Syndromic, Sexually Transmitted Infections, Multiplex real time PCR

Post-stroke bacteriuria among stroke patients attending a physiotherapy clinic in Ghana: a cross-sectional study.

BackgroundInfections are known to be a major complication of stroke patients. In this study, we evaluated the risk of community-acquired bacteriuria among stroke patients, the associated factors, and the causative organisms.MethodsThis was a cross-sectional study involving 70 stroke patients and 83 age- and sex-matched, apparently healthy controls. Urine specimens were collected from all the study subjects and were analyzed by standard microbiological methods. Demographic and clinical information was also collected from the study subjects. For stroke patients, the information collected also included stroke parameters, such as stroke duration, frequency, and subtype.ResultsBacteriuria was significantly higher among stroke patients (24.3%, n=17) than among the control group (7.2%, n=6), with a relative risk of 3.36 (confidence interval [CI], 1.40–8.01, P=0.006). Among the control group, all six bacteriuria cases were asymptomatic, whereas the 17 stroke bacteriuria cases comprised 15 cases of asymptomatic bacteriuria and two cases of symptomatic bacteriuria. Female sex (OR, 3.40; CI, 1.12–10.30; P=0.03) and presence of stroke (OR, 0.24; CI, 0.08–0.70; P=0.009) were significantly associated with bacteriuria. The etiology of bacteriuria was similar in both study groups, and coagulase-negative Staphylococcus spp. were the most predominant organisms isolated from both stroke patients (12.9%) and the control group (2.4%).ConclusionStroke patients in the study region have a significantly higher risk of community-acquired bacteriuria, which in most cases is asymptomatic. Community-acquired bacteriuria in stroke patients appears to have little or no relationship with clinical parameters of stroke such as stroke subtype, duration and frequency.

Observation Report from Clinical Practice in Ghana: Children and Adolescent Depression

The priority of Ghanaian parents is seeking higher academic attainment for their children. This is associated with the first President of Ghana, President Nkrumah, who stated that Ghanaians should seek first the status of education and everything shall be added unto it. As a result parents compete with each other to achieve the higher status of education for their children. Parents desperately seek help to intervene learning difficulties among school children and adolescents. The aim of this study is to investigate learning disability cases that are seen in a psychological clinic in Ghana using a survey method. The analysis included cases of young people from 3 to 18 years (mean age = 12.7 years, SD = 5.21) that were seen from the year 2011 to 2013. Eighty eight (58%) of the cases were learning disabilities associated with environmental factors whereas 64 (42%) were organic learning disability associated with biological factors. Children experiencing non-organic learning disability conditions were from low socio-economic status families (X2 = 5.95, df = 1, p < 0.05). Findings revealed that high demands of academic performance on these school children manifest as mental health symptoms of depression and anxiety including substance abuse. Practitioners in Ghana are encouraged to assess cognitive functioning of children diagnosed with emotional difficulties in order to get a correct diagnosis and plan appropriate treatment for these children.