Effia Nkwanta Regional Hospital Research Articles

Thyroid dysfunction and glycaemic control among Type 2 diabetes mellitus patients in Ghana: A comparative cross-sectional study.

Thyroid disorders and diabetes mellitus coexist and are prevalent endocrinopathies among adult population. Thyroid dysfunction contributes to metabolic imbalances, increase beta-cell apoptosis and glucose intolerance. There is paucity of data and contradicting findings on how thyroid dysfunction influence glycaemic control. Therefore, we evaluated thyroid dysfunction and glycaemic control among Type 2 diabetes mellitus (T2DM) patients in Ghana. A comparative cross-sectional study was conducted among 192 T2DM patients from Effia Nkwanta Regional Hospital. Three consecutive monthly fasting plasma glucose (FBG) and glycated haemoglobin (HbA1c) were analysed and the results were classified as, moderate hyperglycaemia (MH) (FBG = 6.1-12.0 mmol/L, HbA1c < 7%), severe hyperglycaemia (SH) (FBG ≥ 12.1 mmol/L, HbA1c > 7%) and good glycaemic controls (GC) (FBG = 4.1-6.0 mmol/L, HbA1c < 7%). Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4), body mass index (BMI) and other clinical parameters were measured. Data analysis was done using R language version 4.0.2 and p < .05 was considered statistically significant. There were no significant differences in age (years) between patients in the various glycaemic groups (p = .9053). The overall prevalence of thyroid disorders was 7.8% among T2DM patients. The prevalence of thyroid disorders was higher in patients with SH (11.7%) followed by those with MH (7.5%) and then those with GC (5.4%). Serum levels of TSH and FT3/FT4 ratio were significantly lower in T2DM patients with SH compared to those with MH and the GC (p < .0001). However, FT4 was significantly higher in SH patients compared to the good glycaemic controls (p < .01). The first tertiles of TSH [aOR = 10.51, 95% CI (4.04-17.36), p < .0001] and FT3 [aOR = 2.77, 95% CI (1.11-6.92), p = .0290] were significantly and independently associated with increased odds of hyperglycaemia. The prevalence of thyroid dysfunction is high in T2DM and increases with hyperglycaemia. Reduced TSH and T3 may worsen glycaemic control. Periodic monitoring of thyroid function should be incorporated into management guidelines among T2DM patients in Ghana.

Motivation and Implications of Conflict of Interest on Public Procurement Sustainability: A Case of Effia Nkwanta Regional Hospital in Sekondi, Ghana

The focus of the study is to assess the motivation and implications of conflict of interest on public procurement sustainability in Ghana's Effia Nkwanta Regional Hospital. From a target population of 123 employees working in the supply chain department, 94 respondents were chosen via Yamane's statistical sample determination technique. The research was carried out utilizing a descriptive research design with a questionnaire serving as the primary data collection tool. The study used a multiple-stage sampling method. In all rounds, Effia Nkwanta Regional Hospital was chosen at random from among Ghana's 10 regional hospitals, as well as 94 respondents from the general population, using a straightforward random sampling methodology, specifically the lottery method. The collected data was analysed using both quantitative and qualitative methodologies. The descriptive statistics feature in SPSS was used to analyse the quantitative data to produce information that was displayed by employing graphs, tables, percentages, and frequency distribution tables. Based on observations and sample analysis, inferential statistics were also employed to draw conclusions or predictions about the population. The regression model was used to illustrate the relationship between the response variable and the independent variables. For this study, a sample size of 94 respondents was intended, and 82 of them returned with all of their responses. The study determined the impact of conflict of interest on procurement sustainability in the Effia Nkwanta Regional Hospital. It can be summed up by saying that one should always put their organization's interests first in all transactions, execute the procurement process skilfully, and adhere to any established policies. According to the study, to protect suppliers and public institutions from improper and unethical practices in procurement operations, such as fraudulent supplier activities, organizations should emphasize sustainability measurement, establish proper checks for all contracts, set supplier selection structures that avoid political interference and increase accountability management practices.&#x0D; &#x0D; Received: 5 August 2022 / Accepted: 29 October 2022 / Published: 6 March 2023

Factors Contributing to Neonatal Admissions and Outcomes at Effia Nkwanta Regional Hospital January to December 2015

Objectives: To investigate factors contributing to neonatal admission outcomes at Effia Nkwanta Regional Hospital (ENRH)Method: All neonatal admissions to the Neonatal &amp; Intensive Care Unit (NICU) of the hospital that were entered into the DHIMS2 database were extracted and complemented with additional information from patients’ folder review. The data from the two sourceswere merged and analysed using SPSS version 21. Univariate and multivariate regression analysis was performed to identify factors associated with admission outcomes, taking statistical significance as p &lt; 0.05. ARC-GIS version 10.1 was used to describe the geospatial distribution of health facilities referring to ENRH.Setting: Neonatal &amp; Intensive Care Unit of ENRH Participants: All neonates admitted to NICU between January and December 2015.Intervention: NoneResults: Nine Hundred and Ninety-Three out of the 1150 neonatal admissions were entered into DHIMS2. Fifty-two percent were males, 57.3% were delivered through Caesarean Section, 72% were admitted within 2 days of birth, and 56.8% had normal birth weight. Fifty- Eight percent of the neonates were delivered at the ENRH, whilst 39.9% were referred from health facilities located within Sekondi-Takoradi Metropolis. At 1 minute, only 14% of the neonates had normal Apgar score (8-10), and this improved to 50% at 5 minutes. The main causes of neonatal admission were birth asphyxia 21.0%, followed by prematurity 17.5%, neonatal jaundice 17.1% and neonatal sepsis 14.5%. The death rate was 18% with more than 80% of the deaths occurring during the early neonatal period. More than 80% of deaths were due to four admission diagnoses: birth asphyxia, prematurity, neonatal jaundice, neonatal sepsis. Factors associated with adverse admission outcome are: low birth weight, delivery by Caesarean Section and low Apgar score at 5 minutes.Conclusions: The institution of appropriate interventions to reduce or manage the four major causes of adverse neonatal admission outcomes will significantly reduce neonatal mortality in the hospital.

Experiences of Registered Nurses’ in Assessing Postoperative Pain among Children: Exploring the Challenges in Effia Nkwanta Regional Hospital, Ghana

Pain is a common occurrence in children after surgery, but it has been neglected over the years. Management of pain is a fundamental human right for everyone who undergoes any surgical procedure. Pain assessment is the initial step of pain management and involves subjective and objective (behavioural and physiological) measures. This study aimed to describe the challenges of registered nurses in assessing post-operative pain among children (0- 3 years)). Descriptive phenomenology was adopted. Purposive sampling was used to recruit nine registered nurses with experience in nursing children after surgery in Effia Nkwanta Regional Hospital (Ghana). The researchers conducted an in-depth interview which was audio-recorded, transcribed verbatim and qualitatively analysed following Colaizzi’s approach to descriptive phenomenology analysis. The study findings revealed that nurses have experienced several challenges in assessing post-operative pain, including inadequate knowledge, inadequate resources, structural challenges, time constraints, and child-imposed factors. Given these results, nurses should make opportunities to enhance their skills and utilize evidence-based approaches to formally assess paediatric post-operative pain.

A multicenter study of the prevalence and risk factors of malaria and anemia among pregnant women at first antenatal care visit in Ghana.

BackgroundMalaria in pregnancy remains a major public health problem in Africa and Ghana and has been associated with a variety of pregnancy-related adverse complications. The development of effective and timely health policies for the prevention and control of malaria and anemia in pregnancy; requires current and consistent data on the prevalence and risk factors. We report the prevalence and risk factors of malaria and anemia from three major hospitals across three regions in Ghana.MethodsThis multicenter cross-sectional study comprising a total of 628 pregnant women was conducted at the antenatal care units of the Achimota Hospital in the Greater Accra Region (n = 199), St. Michael’s Hospital in the Ashanti Region (n = 221), and Effia Nkwanta Regional Hospital in the Western Region (n = 211). Questionnaires were administered to obtain socio-demographic, obstetrics and clinical data. Venous blood, stool and urine samples were collected for hematological profile and parasite identification using microscopy. Risk factors were evaluated using logistic regression models.ResultsThe overall prevalence of P. falciparum malaria was 8.9%. Factors independently associated with malaria were self-reported mosquito exposure (moderate exposure: aOR = 3.11, 95% CI (1.12–8.61) and severe exposure: aOR = 10.46, 95% CI (3.86–28.34)) and non-use mosquito repellents (aOR = 3.29, 95% CI (1.70–6.39)). Multiparty (parity of 2: aOR = 0.19, 95% CI (0.05–0.70) and parity ≥3: aOR = 0.11, 95% CI (0.03–0.45)) and age (20–30 years old: aOR = 0.22, 95% CI (0.09–0.56)) reduced the odds of infection. The overall prevalence of anemia was 42.4%. The prevalence of mild, moderate and severe anemia were 35.7%, 6.1% and 0.6%, respectively. The use of water other than purified water (tap water: aOR = 3.05, 95% CI (2.06–4.51) and well water: aOR = 2.45, 95% CI (1.35–4.44)), increasing gestational age (second trimester: aOR = 2.05, 95% CI (1.41–2.97) and third trimester: aOR = 7.20, 95% CI (3.06–16.92)) and malaria (aOR = 2.40, 95% CI (1.27–4.53)) were independent risk factors for anemia.ConclusionsAlthough the prevalence of malaria is relatively low, that of anemia remains high. We recommend increasing efforts to make ITNs more available to strengthen malaria prevention. Public health education programs could help improve uptake and proper use of ITNs. To help reduce anemia in pregnancy, women should be empowered economically and interventions that reduce malnutrition should be encouraged. Women should be educated on early initiation of antenatal care to enhance surveillance, identification and treatment of anemia.

Experience of Registered Nurses of Postoperative Pain Assessment Using Objective Measures among Children at Effia Nkwanta Regional Hospital in Ghana

Introduction: People undergoing surgical operations experience some level of pain. Assessing pain intensity is one of the duties of the nurse and it involves subjective measures (self-report), and objective measures (behavioural and physiological). It has been observed by the researcher that nurses in clinical practice do not assess pain before management more so among children. Also, there is limited research in the area of pain assessment in children who cannot communicate. This study aimed to describe the experiences of registered nurses in assessing postoperative pain among children (0-3 years) using objective measures. Methods: Descriptive phenomenology was the chosen design. Maximum variation sampling was used to recruit nine registered nurses with experience in nursing children after surgery at Effia Nkwanta Regional Hospital (ENRH) in Ghana. The researchers conducted audio-recorded in-depth interviews, transcribed verbatim and qualitatively analyzed following Colaizzi’s approach to descriptive phenomenology analysis. Results: The study revealed that the nurses have more experience with using behavioural measures with limited experience with the use of physiological measures. The behavioural measures mostly reported from their experience were changes in facial expression and unusual crying of the child. In general, the nurses do not formally use consistent approaches to assess pain among children. Conclusion: Given these results, opportunities should be made available for nurses to enhance their skills and utilize evidence-based approaches to formally assess pain among post-operative children.

Vitamin B12 deficiency in type 2 diabetic patients on metformin: a cross-sectional study from South-Western part of Ghana

ABSTRACTIntroduction: Metformin is the most widely administered anti-diabetic medication among type 2 diabetes mellitus (T2DM) patients. However, metformin induces vitamin B12 malabsorption which may increase the risk of vitamin B12 deficiency among T2DM patients. We determined the prevalence of vitamin B12 deficiency and related risk factors among Ghanaian T2DM patients on metformin therapy.Methods: This cross-sectional study recruited 196 T2DM patients attending the outpatient diabetic clinic at the Effia Nkwanta Regional Hospital, Ghana. Fasting venous blood was collected for biochemical analysis. Vitamin B12 deficiency was defined as serum B12 <100 pg/ml and methylmalonic acid (MMA) ≥ 0.4µmol/L.Results: The prevalence of vitamin B12 deficiency based on serum vitamin B12, MMA, and the combination of both methods were 32.1%, 14.8%, and 14.3%, respectively. Longer duration of metformin use [5-9 years; aOR= 2.83, 95% CI (1.03-7.81), p=0.045 and ≥10 years; aOR= 4.17, 95% CI (1.41-12.33), p=0.010], higher daily dose of metformin [1000-2000 mg/day; aOR= 1.34, 95% CI (0.25-2.74), p=0.038 and >2000 mg/day; aOR= 1.13, 95% CI (0.39-2.97), p=0.047], and very high body fat [aOR= 2.98, 95% CI (1.47-6.05), p=0.020] were significantly associated with increased odds of vitamin B12 deficiency. For daily dose of metformin, a cutoff value of 1500 mg/day presented with a sensitivity, specificity, and AUC of 71.4%, 40.1%, and 0.54 (95% CI, 0.53-0.54), respectively, in predicting vitamin B12 deficiency. A ≥ six (6) years duration of metformin therapy presented with a sensitivity, specificity, and AUC of 70.4%, 62.9%, and 0.66 (95% CI, 0.57-0.75), respectively, in predicting vitamin B12 deficiency.Conclusion: Vitamin B12 deficiency is high among T2DM patients on metformin therapy in Ghana. There is the need for regular monitoring of vitamin B12 levels especially in T2DM patients on metformin daily dose of ≥ 1500 mg for duration of therapy ≥ 6 years.

Overdiagnosis and overtreatment of malaria in children in a secondary healthcare centre in Sekondi-Takoradi, Ghana.

Overdiagnosis and overtreatment of malaria is a major problem in children in malaria-endemic countries. This retrospective study identified children who were admitted with fever and were treated with or without anti-malarial medications and discharged at the Paediatric Unit of the Effia-Nkwanta Regional Hospital. The medical records of all children were searched, retrieved and assessed. A total of 1160 records from children (age range, 0-12 years) were reviewed and evaluated. Of the total number, 21.3% had laboratory confirmed malaria, 38.4% were malaria negative, while 40.3% had no malaria tests performed. In addition, the results showed that 4.5% of the laboratory confirmed malaria positive cases were not given anti-malarial medication while 84.1% of the malaria negative cases were given these incorrectly. Furthermore, 78.2% of the children with no malaria tests were prescribed anti-malarial medication. The presumptive diagnosis of malaria should be abandoned and the installation of a functional laboratory services promoted.

Evaluation of Blood Transfusions in Anemic Children in Effia Nkwanta Regional Hospital, Sekondi-Takoradi, Ghana.

Blood transfusion is a common practice in sub-Saharan Africa as a way of correcting anemia in children with mild and severe sicknesses. This study evaluated this practice in a secondary health-care institution in Ghana. A retrospective study was done over a 3-year period from January 2010 to December 2012. Medical records of children admitted, successfully treated, and discharged from the hospital were collected and analyzed. Data were analyzed using Epi Info version 7. Transfusions were more among male children (89, 63.1%) than female children (52, 36.9%). The highest number of blood transfusions were carried out on children in the age range 0-1 year (66, 46.8%). The majority of the blood transfusions were done on children with hemoglobin concentration level of 5 g/dL and below. Children with malaria parasitemia (83, 58.9%) had more transfusions than children without malaria parasitemia (58, 41.1%). Fever alone (43, 30.5%) and fever with gastrointestinal symptoms (33, 23.4%) were the predominant symptoms among children who had blood transfusions. In conclusion, younger children received more transfusions than older children. Also, male children received more blood transfusions than female children. Malaria was observed as a major contributory factor to the requirement for blood transfusions among the children.

Prevalence of Malaria Positive Rapid Diagnostic Test and Antimalarial Treatment in Patients with Fevers in the Accident and Emergency Unit of Effia Nkwanta Regional Hospital, Western Region, Ghana

Background: Rapid diagnostic test (RDT) is a simpler, easy to read malaria diagnostic test. It was introduced by the World Health Organization (WHO) to supplement the use of microscopy and can be used alone in areas where microscopy is unavailable. Its introduction was necessary to maintain the WHO test-based treatment protocol for malaria, as dependence of microscopy which is the gold standard is not possible in many areas in Sub-Saharan Africa which lack the wherewithal to run efficient laboratory services. WHO strongly recommends that only patients with parasitological confirmation of malaria should be treated with antimalarial drugs. In this study, the prevalence of malaria positive RDT and antimalarial treatment was evaluated in patients presenting with fevers at the outpatient section of the accident and emergency unit of the Effia Nkwanta Regional Hospital, Ghana. Methodology: This was a retrospective study carried out in the outpatient section of the accident emergency unit of Effia Nkwanta Regional Hospital. The outpatient register was reviewed from October 2014 to March 2015, for patients who came with fever. Data on demographics, malaria RDT status and antimalarial treatment were collected and analyzed. Result: A total of 607 patients with fever had their RDT performed. Of these, 131 (21.58%) were positive for malaria while 467 (78.42%) were negative. Out of the 131 tested positive, 55 represented patients above 12 years and 76 represent children aged 0 to12 years, p = 0.002. Fifty children under the age of 5 years tested positive for malaria whereas 26 were above the age 5 years, p = 0.03. All the 131 positive patients were treated for malaria while 276 out of 476 negative patients were also treated for malaria, p

Malaria and associated co-morbidity in children admitted with fever manifestation in Western Ghana: A retrospective study.

Children under five years of age are highly vulnerable to malaria infection and often face dire consequences such as severe malaria if they are not promptly and adequately treated with effective anti-malarial medications. We set out to evaluate malaria and associated co-morbidity among children admitted with febrile illness in Sekondi-Takoradi, Ghana. This retrospective study focused on children admitted with fever over a three-year period at the pediatric unit of Effia-Nkwanta Regional Hospital. The children were identified, and the medical records of those who were successfully treated and discharged were searched, retrieved, and reviewed. A total of 1,193 children were identified and selected for analysis. The mean duration of admission increased from 2.17 days in 2010 to 3.36 in 2012. Conversely, the mean age decreased from 3.85 years in 2010 to 2.74 in 2012. Overall, laboratory-confirmed malaria prevalence decreased; however, this decrease was only observed among children five years of age or younger, while malaria prevalence increased among children one year of age or younger. The proportion of children with severe malarial anemia significantly increased, while the proportion of those with mild malaria decreased significantly. Despite the general decrease in malaria morbidity seen in this study, children younger than one year of age remain at increased risk of malaria morbidity. With an increase in malaria prevalence among children younger than one year of age over the three years of study, integrated and targeted control measures are highly needed for this age group.

Evaluation of Blood Transfusion in Anemic Children in Effia Nkwanta Regional Hospital, Sekondi-Takoradi, Ghana

Evaluation of Blood Transfusion in Anemic Children in Effia Nkwanta Regional Hospital, Sekondi-Takoradi, Ghana

Cases of Brought in Dead Patients in the Accident and Emergency Unit of a Referral Hospital in the Western Region of Ghana

The objective of this study was to evaluate cases of brought in dead (BID) patients in the accident and emergency unit of Effia-Nkwanta Regional Hospital through a retrospective study of a period of 3 years. A retrospective descriptive study of BID cases from the death register and patients’ records of the accident and emergency unit of the hospital was carried out from January 2011 to December 2013. 31% (180/574) of BID cases were recorded over the study period with the age range from below 1 year to over 70 years. They were 58.5% male and 41.5% female with a ratio of 1.4:1. The majority of the BID cases (20.7%) were patients above 70 years and most cases (40.8%) have no known clinical condition associated with the death. The majority of the unexplained deaths were highest among young adults between the ages 30 and 40 years (22.6%). The highest cases of BID (20%) were seen in the month of December and majority of the cases (72.5%) lived within the metropolis. This study showed a concerning trend of BID cases in the hospital with a high prevalence among the elderly and unexplained death among the young adults. Hence there is an urgent need to upgrade hospitals in the area with the hope of relieving the burden off Effia-Nkwanta Regional Hospital and also a need to increase health promotion strategies among the people of the area so as to instill health seeking behavior in order to prevent avoidable deaths.

Mortality among tuberculosis patients at the Effia-Nkwanta regional hospital: 1999-2001

Mortality among tuberculosis patients at the Effia-Nkwanta regional hospital: 1999-2001

Factors associated with tuberculosis treatment default and completion at the Effia-Nkwanta Regional Hospital in Ghana

The level of defaulting from treatment among tuberculosis (TB) patients at the Effia-Nkwanta Regional Hospital between January 2000 and December 2001 was 13.9%. This study was therefore designed to assess factors associated with TB treatment default and completion at the hospital. The initial part of the study consisted of three separate focus group discussions for health workers, defaulters and non-defaulters. The information collected was used to design a questionnaire that was administered to defaulters and non-defaulters selected from the Institutional TB Register. Univariate logistic regression analysis was performed to identify significant factors associated with treatment default. Statistical significance was taken as P < 0.05. Default from treatment was significantly associated with income per month (P = 0.03), ability to afford supplementary drugs (P = 0.008), availability of social support (P = 0.005) and problems relating with others while on treatment (P = 0.01). A cordial relationship between patients and health staff was the main motivating factor for completion of treatment, whilst financial difficulty was the main reason for defaulting from treatment. Determination of the characteristics found to be associated with defaulting in this study among TB patients at the start of treatment may be helpful in improving compliance among patients registered for treatment at the hospital.