Greater Accra Regional Hospital Research Articles

Human papillomavirus (HPV) vaccination in a privately funded program in Ghana: A qualitative case study

ABSTRACT HPV vaccination is one of the safest and most effective interventions against HPV-related cancers. From 2013 to 2018, HPV vaccination was piloted in Ghana in preparation for a national program. Yet, at the time of this study, there was no publicly funded HPV vaccination program in Ghana. We explored an existing privately funded HPV vaccination program in Ghana to identify challenges and gaps and to gather insights to inform vaccination practice and national policy. This study used a qualitative case study research design. We conducted semi-structured interviews on experiences, barriers, and challenges in HPV vaccination at the Greater-Accra Regional Hospital between October 1 and November 26, 2023. Participants (N = 16) included HPV vaccinators (n = 8) and program/policy leaders (n = 8). Our thematic analysis focused on HPV vaccination processes, practice challenges, and policy interests. Four main themes emerged from our analyses. Our findings revealed many challenges faced by the HPV vaccination program. These include a lack of guiding policy/framework for the HPV vaccination program, an emphasis on sexual history, cervical screening, and HPV DNA test in determining vaccination eligibility by vaccinators, and a lack of formal provider and recipient HPV education programs. Although many vaccinators advocated for a universal HPV program, some policy/program leaders were reluctant to prioritize HPV vaccination advocacy due to their focus on acute health concerns. A vaccination program without a policy can be limited in quality and efficiency, as there will be no accountability and sustainability measures. We recommend the need to develop standardized guidelines to support evidence-based HPV vaccination practice.

Investigation of Factors Influencing Infant Mortality at Greater Accra Regional Hospital, Ghana.

Annually, 5.4 million children under five face mortality, with 2.5 million deaths in the first month, 1.6 million between one and eleven months, and 1.3 million aged one to four. Despite global strides, sub-Saharan Africa, including Ghana, grapples with persistent high child mortality. This study employs statistical methods to pinpoint factors driving under-five mortality in the Greater Accra Regional Hospital. The data was acquired from Greater Accra Regional Hospital, Ghana, spanning January to December 2020. The data comprised all under-five deaths recorded in the hospital in 2020. The statistical tools employed were the chi-square test of association and the multinomial logistic regression model. In 2020, there were 238 cases of under-five mortality recorded in the hospital, with males constituting the majority (55%). About 85% of these cases occurred within the first month of birth, primarily attributed to respiratory distress, prematurity, and sepsis. Notably, meconium aspiration was the least common among grouped diagnoses. The test of association and multinomial logistic model emphasised the child's age, birth type, and weight at birth as significant factors influencing child mortality. Conversely, attributes like sex, marital status, and mother's age displayed no notable association with the diagnosis of death. The study on child mortality at the Greater Accra Regional Hospital unveils key factors shaping child health outcomes, emphasising the role of age, birth type, and weight. While specific demographics show no significant association, identified predictors are vital for targeted interventions. Proposed strategies encompass education programs, improved care, birthing practices, and data-driven policies.

Implementation matters: assessing the effectiveness and sustainment of an obstetric triage program at a high-volume facility in Ghana

BackgroundMaternal mortality remains stubbornly high in Ghana. Current national efforts are focused on improving the quality of care offered in health facilities. Obstetric triage is one intervention that has been proposed to improve the timeliness and appropriateness of care, two key elements of quality. In this study, we describe and evaluate a theory-based implementation approach to introduce obstetric triage into Tema General Hospital, a high-volume maternity hospital in Greater Accra, that blends concepts from implementation science and quality improvement. This implementation project was a first attempt to scale this intervention into a new facility, following initial development in the Greater Accra Regional Hospital (formerly Ridge Hospital) in Accra.MethodsThis was a retrospective mixed-methods evaluation of two stages of implementation: active implementation and sustainment. We triangulated monitoring data captured during active implementation with clinical outcome data (timeliness of first assessment, accuracy of diagnosis, and appropriateness of care plan) from direct observation or patient obstetric triage assessment forms at baseline, at the completion of the active implementation stage, and following a 12-month “washout” period with no contact between hospital staff and the purveyor organization. Finally, we assessed embeddedness of the new triage procedures using the NoMad, a quantitative assessment of constructs from normalization process theory (NPT).ResultsPatient waiting time decreased substantially during the study. At baseline, the median arrival-to-assessment waiting time was 70.5 min (IQR: 30.0–443.0 min). Waiting time decreased to 6.0 min (IQR: 3.0–15.0 min) following active implementation and to 5.0 min (IQR: 2.0–10.0 min) during the sustainment period. Accuracy of diagnosis was high at the end of active implementation (75.7% correct) and improved during the sustainment period (to 77.9%). The appropriateness of care plans also improved during the sustainment period (from 66.0 to 78.9%). Per NoMad data, hospital staff generally perceive obstetric triage to be well integrated into the facility.ConclusionsThis theory-based implementation approach proved to be successful in introducing a novel obstetric triage concept to a busy high-volume hospital, despite resource constraints and a short implementation window. Results proved long-lasting, suggesting this approach has high potential for engendering sustainability in other facilities as well. Our approach will be useful to other initiatives that aim to utilize program data to create and test implementation theories.

Acceptability of breast milk donor banking: A qualitative study among health workers in Greater Accra Regional Hospital, Ghana.

Despite the compelling evidence demonstrating the immediate and long-term health advantages of prompt breastfeeding from birth, not all newborns are breastfed exclusively for a variety of reasons. As a result, the World Health Organization has made new recommendations for the adoption of breastmilk donor banks to make sure that children receive breastmilk when mothers are unable to produce it. In order to better understand how health professionals at the Greater Accra Regional Hospital, who would be leading the charge in putting this policy into practice, perceive and accept the practice of storing breastmilk, this study was conducted. At the Greater Accra Regional Hospital, 18 healthcare professionals were chosen using maximum variation purposive sampling procedures. They were made up of eleven midwives, a medical officer, six nurses, and two nutritionists and all participants were interviewed face to face using a semi structured interview guide. Data was transcribed verbatim and was analyzed using thematic analysis. Participants in the study admitted that they would be open to using or contributing to a bank of breastmilk. Participants also said that if safety precautions are taken, they would urge their customers to give breastmilk and recommend breastmilk from a breastmilk bank to them when the situation calls for it. Health professionals recommended that education be provided prior to the installation of breast milk donor banking to lessen or eliminate any misconceptions people may have about it. The concept of breastmilk donor banking was fairly accepted among health workers. Misconceptions about the safety of breast milk was the main concern. The results emphasize the necessity of greater stakeholder engagement and education prior to the implementation of this policy in order to boost acceptance and uptake.

Acute Complications of Leiomyoma During Pregnancy: Report of Three (3) Cases that Required Antepartum Myomectomy

Introduction: Some women with uterine leiomyoma can experience life threatening complications during pregnancy. These leiomyomas are usually large and their associated symptoms were either neglected before the onset of the pregnancy or surgical treatment may have been rejected earlier by the patient. Case Presentation: Three cases of antepartum myomectomy are reported in this paper. They had severe abdominal pains not responding to medical treatment with gross abdominal distention. Additionally, they had severe life-threatening symptoms including right hypochondria pain and shallow breath in case no.2 and intestinal obstruction in case no.3, an acute surgical complication which could not be resolved by conservative management. All three patients had successful antepartum myomectomy using a new flap techinique not previously described in the literature on reported cases of myomectomy during pregnancy. All the patients recovered successfully from the operation and their pregnancies continued to delivery of their babies at term by caesarean section. Cases no.1 and 2 presented in this report were managed in health facilities in Tamale, Northern Region in 2019. Case no.3 was managed in Accra at the Greater Accra Regional Hospital in 2022. Conclusion: Pregnant women may present with life threatening complications of leiomyomas, antepartum myomectomy can be considered and successfully performed to improve quality of life or prevent maternal mortality. The procedure for the myomectomy in such situation may not be routine but a special approach is required to avoid fatal complications for both mother and foetus.

Effect of one-to-one versus group counseling on uptake of postpartum contraception in selected hospitals in Ghana: A prospective cohort study.

To compare the effect of one provider to one client counseling and one provider to a group client counseling on the uptake of postpartum contraception. This was a hospital-based prospective cohort study among women attending a postpartum clinic at Korle-Bu Teaching Hospital and Greater Accra Regional Hospital. Postpartum mothers were recruited daily from April 1, 2017 to November 28, 2017. Mothers from this cohort that used a contraceptive method within a year postpartum were determined at 3, 6, 9, and 12 months after recruitment. A P value of less than 0.05 was considered statistically significant for all analyses. Of 982 women surveyed, contraceptive uptake among women who received one-to-one counseling was 306/600 (51.0%) and that for women who received group counseling was 48/382 (12.6%) (P< 0.001). Factors associated with contraceptive uptake during postpartum period were: one-to-one counseling (adjusted odds ratio [aOR] 7.05, 95% confidence interval [CI] 4.94-10.07), mothers' age (aOR 0.95, 95% CI 0.91-0.98), being single (aOR 0.54, 95% CI 0.35-0.85), cohabiting (aOR 0.39, 95% CI 0.22-0.69), and previous use of contraception (aOR 1.55, 95% CI 1.12-2.15). One-to-one counseling was associated with a significantly greater uptake of contraception during the postpartum period compared with group counseling. Other factors associated with uptake were age, marital status, and history of contraceptive use.

Assessment of the Nutritional Status of Babies with Neonatal Jaundice in Ghana

Neonatal jaundice is a public health concern responsible for a relatively high rate of infant morbidity and mortality. Therefore, it is prudent to put in place effective risk-reduction strategies and detect and treat new born jaundice effectively. Optimum nutrition has been shown to be crucial to health and well-being. This study, therefore, sought to investigate the nutritional status of babies that report to three referral hospitals in Ghana (Korle-bu Teaching Hospital, Greater Accra Regional Hospital and the Tamale Teaching hospital). It was a multi-center nested, case-control study involving 120 cases and 120 controls of neonates in the three referral hospitals in Ghana. The study revealed that babies with neonatal jaundice in Ghana mostly have a normal nutritional status, even though they lose about 5% of their birth weight. More mothers of healthy babies (88.3%) did exclusive breastfeeding, compared with mothers of babies with neonatal jaundice (76.7%). It was also revealed that the three referral hospitals implemented the Baby Friendly Hospital Initiative’s ten steps to successful breastfeeding as a measure to prevent suboptimal feeding, which could lead to an increase in bilirubin levels. Assessment and interventions to prevent weight loss should therefore be paramount for babies with neonatal jaundice. Keywords: Malnutrition, Neonatal jaundice.

Experiences of patients with end stage renal disease prior to and during dialysis therapy at greater Accra regional hospital

Experiences of patients with end stage renal disease prior to and during dialysis therapy at greater Accra regional hospital

Analysis of first apheresis services in Ghana-Greater Accra Regional Hospital

BackgroundAt the combined American Society for Apheresis (ASFA) annual meeting and World Apheresis Association (WAA) Congress in 2014, it was observed that there were significant disparities with regard to the access of apheresis services within and across developing countries, with only few of such facilities available in Africa; notably South Africa and Nigeria. In 2019, Bone Marrow Transplantation (BMT) Unit-Ghana, acquired an apheresis machine. By the collaboration between BMT-Ghana, the Greater Accra Regional Hospital (GARH) and the Ministry of Health (Ghana), apheresis services is now available in Ghana. The aim of this paper is to present an analysis of apheresis services so far in Ghana. MethodA 12-month period from 2019 to 2021 was examined (less the period of the COVID-19 outbreak when the Unit was virtually at a standstill). The electronic database and hard copies of documented activities were analysed. Basic information on demographics and procedure types and counts was used. ResultsThe retrospective study encompassed data of 43 patients. Two (2) patients came from the West Africa sub-region (Nigeria and Cameroon) with the rest from 6 out of the 14 regions of Ghana (Greater Accra, Western, Central, Eastern, Ashanti, Volta). The essential nature of the apheresis services being the first in Ghana, brought patients as far as 315 km from the hinterlands to the Unit. Ages ranged from 2-52 years with a mean of 16.3 ± 15.3 years. Slightly more females (n = 23, 53%) received services than males (n = 20, 47%). Eighty-six percent (n = 37, 86%) of the patients were sickle cell patients referred to the Unit. Red Blood Cell exchange (RBCx) accounted for 87% (n = 40), of the 46 procedure counts followed by Continuous Mononuclear Cell Collection (CMNC) (n = 4, 9%) and lastly, Therapeutic Plasma Exchange (TPE) (n = 2, 4%). ConclusionGhana can now be counted among African countries offering apheresis services and the GARH is acknowledged as the only hospital in the country with this facility, thus improving patient care significantly.

Epidemiology and Treatment Outcome of Paediatric Forearm Fractures at The Greater Accra Regional Hospital

Objective: To investigate the epidemiology forearm fracture in the paediatric age group and its treatment outcome among patients presenting at the Greater Accra Regional Hospital (GARH).Materials and Methods: Twenty-Four patients with paediatric forearm fractures presenting at the Trauma and Orthopaedic unit between November 2018 and October 2019 were prospectively followed up for six weeks; assessing re-displacement after one and 2 weeks and degree of supination and pronation at the end of the 6th week.Results: A total of 24 children were recruited in this study. The median age of presentation was 5 years with a male to female ratio of 2:1. Sixty seven percent (n=16) of the patients reported to the facility within the first 24 hours of injury. Majority of the injuries (n=22) were as a result of fall on the outstretched hand (FOOSH). The school (n=13, 59.1%) and home environments (n=7, 31.8%) were the common places of injury; other places include recreational areas and footpath. Twenty-three (95.8%) of all patterns of forearm fractures were closed, with the commonest site being the distal third (n=17, 70.8%). Conservative treatment of the fractures sufficedin 19 patients (79.2%); with re-displacement occurring in 3 patients (12.5%). The remaining 5 cases were managed operatively. Functional assessment by way of supination and pronation was excellent in all the patients with no residual deformity.Conclusion: The findings from this study point to the fact that, FOOSH occurring at the school environment is the commonest cause of forearm fractures in the paediatric age group. Conservative treatment sufficed in the majority of cases and remains a viable option ifpatients are carefully selected.

Neonatal Sepsis in a Resource-Limited Setting: Causative Microorganisms and Antimicrobial Susceptibility Profile.

Background Empiric treatment of suspected neonatal sepsis must be based on data on setting-specific causative pathogens and their respective susceptibilities to antimicrobials, as well as universal treatment guidelines. This approach will ensure better therapeutic outcomes and reduce mortality. Objectives The objectives of this study were to determine the bacteriological profile and antibiotic susceptibility pattern of isolated microorganisms responsible for neonatal sepsis in a regional hospital in Ghana. Methods This was a retrospective study that assessed causative microorganisms and antimicrobial susceptibility profiles of neonates suspected of sepsis at the Greater Accra Regional Hospital from January 2018 to December 2019. Blood culture was done using a fully automated BACTEC 9240 blood culture system. Bacteria isolates were identified by Gram staining and conventional biochemical methods. Antimicrobial susceptibility testing was done by Kirby–Bauer's disc diffusion method, and interpretations were carried out according to clinical and laboratory standards. Culture and antibiotic sensitivity reports were obtained and the data subsequently analyzed. Results Of 2514 blood samples collected from neonates suspected of neonatal sepsis, 528 (21.0%) of the samples were found to be culture-positive. The majority of these positive cultures were from male neonates (68.9%). A total of 11 different pathogens were isolated, of which Gram-positive organisms had a preponderance of 72.0% over Gram-negative organisms (28.0%). Staphylococcus epidermidis was the most common pathogen identified, accounting for 60.0% of isolates. The most prevalent Gram-negative bacteria were Klebsiella spp. (13.6%). Most Gram-positive microorganisms showed sensitivity to amikacin, meropenem, vancomycin, and piperacillin/tazobactam. Gram-positive isolates were found to be resistant to ampicillin and penicillin, but moderately susceptible to flucloxacillin. Most Gram-negative isolates were sensitive to meropenem. Conclusion The prevalence of culture-proven sepsis was 21.0%. The most prevalent Gram-negative bacteria were Klebsiella spp. As there is some level of antibiotic resistance observed in the current study, it is necessary for routine microbial analysis of samples and their antibiogram.

Use of WhatsApp messaging technology to strengthen obstetric referrals in the Greater Accra Region, Ghana: Findings from a feasibility study.

In Ghana, the high-risk obstetric referral system is inadequate. Delay is common and patients often arrive to receiving hospitals in compromised states. An effective referral system should include an adequately resourced referral hospital, communication across sectors, accountability, transport, monitoring capability and policy support, which are currently lacking. A pilot program was undertaken to facilitate communication between hospital staffs. Additionally, data was collected to better understand and characterize obstetric referrals in Accra. Thirteen institutions were selected based on referral volume to implement the use of pre-referral treatment guidelines and WhatsApp as a mobile technology communication platform (Platform). Participants included healthcare workers from 8 health centers, 4 district hospitals, the Greater Accra Regional Hospital (GARH), administrators, doctors from other tertiary hospitals in Accra and medical consultants abroad. Facilities were provided smartphones and guidelines on using WhatsApp for advice on patient care or referral. Data were collected on WhatsApp communications among participants (March-August 2017). During this period, 618 cases were posted on the Platform and users increased from 69 to 81. The median response time was 17 min, a receiving hospital was identified 511 (82.7%) times and pre-referral treatment was initiated in 341 (55.2%). Subsequently, data collected on 597 referrals to GARH (September-November 2017) included 319 (53.4%) from Platform and 278 (46.6%) from non-Platform hospitals. Of these, 515 (86.3%) were urgent referrals; the median (interquartile range) referral to arrival time was 293 (111–1887) minutes without variation by facility grouping. Taxis were utilized for transportation in 80.2%; however, referral time shortened when patients arrived by ambulance and with a midwife. Only 23.5% of urgent referrals arrived within two hours. This project demonstrates that WhatsApp can be used as a communication tool for high-risk obstetric referrals and highlights the need to continue to improve urban referral processes due to identified delays which may contribute to poor outcomes.

Determinants of blood glucose control among people with Type 2 diabetes in a regional hospital in Ghana.

AimsTo assess the determinants of glycaemic control among patients with Type 2 diabetes mellitus (T2DM) presenting at the Greater Accra Regional Hospital, Ghana.MethodsThe study employed semi-structured questionnaires and review of clinical records of patients 16 years and above with Type 2 Diabetes.ResultsThe mean age of participants was 56.6 ± 13.8 years, with majority (71.6%) being females. A total of 161 (59.4%) of patients had poor glycaemic control (HbA1c ≥8.1%; 95% CI: 53.6 to 65.3%). Poor glycaemic control was significantly associated with high body mass index of the patient (AOR 13.22; 95% CI: 1.95 to 89.80), having only elementary education (AOR 5.22, 95% CI 2.12–12.86, p<0.0001) and being on insulin therapy (AOR 2.88; 95% CI: 1.05 to 7.88). On the other hand, seldom coffee intake (AOR: 0.27; 95% CI: 0.11 to 0.64), high physical activity (AOR 1.57, 95% CI 1.06–2.35, p = 0.025) and having a cardiovascular disease (AOR: 0.15; 95% CI: 0.05 to 0.46) appeared to positively influence glycaemic control. Self-monitoring of blood glucose and diet interventions did not appear to influence glycaemic control.ConclusionsThe study results showing that a high proportion of patients attending the Diabetes Clinic with uncontrolled diabetes has serious implications for the management of T2DM diabetes as it suggests that current hospital-based treatment measures are less effective. Comprehensive management of T2DM targeting all the key factors identified in this study and incorporating a multispectral collaborative effort based on holistic approach, combined with non-pharmacological components are strongly warranted.

Classification of Public Health Centres in Accra through a Web-Based Portal Integrated with Geographical Information System (GIS).

A health system is described as a logically organized collection of resources, agents, and institutions that offer healthcare to a specific population based on the finance, regulation, and delivery of health services. Many health centres have been established in Accra, the capital city of Ghana, due to the importance of good health. People in other developed nations can seek adequate healthcare, since information about relevant health centres is readily available. However, there is a paucity of information about the services provided by existing health institutions in Ghana, particularly in Accra. The majority of patients commute to either Korle-Bu Teaching Hospital or Greater Accra Regional Hospital, putting a considerable medical strain on these facilities. In this study, we use a Geographic Information System (GIS) to establish a database for all of Accra's health centres and categorize them according to the services they provide. This research tackled the previously mentioned problem by proposing and developing a web-based map called Geohealth for the classification of public health centres in Accra using GIS to assist users in accessing information and locating health centres. We utilized a mixed-method approach consisting of quantitative as well as Build Computer Science Research Methods. Results of our study show that the majority of the participants and stakeholders in our research are eager to embrace Geohealth. Furthermore, in comparison with existing techniques such as Google Maps, our proposed approach, Geohealth, takes less time to obtain information and locate public health centres in Accra, Ghana.

INVESTIGATION OF THE EFFECT OF SERVICE QUALITY (SQ) ON PATIENT SATISFACTION (PS) IN GHANA USING THE SERVQUAL MODEL: THE CASE OF GREATER ACCRA REGIONAL HOSPITAL (GARH)

The study’s purpose was to investigate the role service quality (SQ) play in achieving patient satisfaction (PS), examine the nature of hospital staff/patience relationship and to explore the challenges faced by healthcare workers in Greater Accra Regional Hospital [GARH], a prime provider of secondary public healthcare in Ghana. The study was based on questionnaires/in-depth interviews completed by 200 respondents selected via convenient sampling. A modified version of the "SERVQUAL” model was used for measuring SQ and consequently PS. Data analysis included descriptive statistics, principal component analyses, exploratory factor analyses with varimax rotation, reliability/validity analyses, and multiple regression analyses. Data elaboration and processing identify main factors affecting the patients’ overall preferences where the findings in particular reveal positive results towards SQ and PS. In this circumstance, findings/recommendations established, should be considered crucial for hospital administrators/policy makers when dealing with decisions affecting SQ assessment.

The financial impact of puerperal infections on patients, carers and public hospitals in two regions in Ghana.

BackgroundPuerperal infection (PI) is a known maternal health problem globally. However, there is limited information on its economic impact on patients, carers, and public hospitals in lower‐middle‐income countries, such as Ghana.MethodsA prospective case‐control study was undertaken in two regional hospitals to analyze the cost of PI. A total of 667 and 559 participants were enrolled in the study at the Greater Accra Regional Hospital (GARH) and the Eastern Regional Hospital (ERH), respectively. Total, average and marginal costs were analyzed between patients with and without PI.ResultsWithin the study period, the prevalence of PI was 9.1% at ERH and 14.9% at GARH. Overall, patients with PI reported excess length of hospital stay (LOS), corresponding to 46.8% and 33.5% increases in average direct cost at ERH and GARH, respectively, compared with their control groups. In almost all cases, the attributable indirect cost was consistent with productivity loss.ConclusionIn both hospitals, patients with PI reported excess LOS and increased direct and indirect costs. The total cost of PI to society, which is the sum of the direct cost, productivity loss, and hospital cost, was higher in Greater Accra than in the Eastern region.

The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana.

To evaluate the cost-effectiveness of a program intended to reduce intrapartum and neonatal mortality in Accra, Ghana. Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis. A program integrating leadership development, clinical skills and quality improvement training was piloted at the Greater Accra Regional Hospital from 2013 to 2016. The number of intrapartum and neonatal deaths prevented were estimated using the hospital's 2012 stillbirth and neonatal mortality rates as a steady-state assumption. The cost-effectiveness of the intervention was calculated as cost per disability-adjusted life year (DALY) averted. In order to test the assumptions included in this analysis, it was subjected to probabilistic and one-way sensitivity analyses. Incremental cost-effectiveness ratio (ICER), which measures the cost per disability-adjusted life-year averted by the intervention compared to status quo. From 2012 to 2016, there were 45,495 births at the Greater Accra Regional Hospital, of whom 5,734 were admitted to the newborn intensive care unit. The budget for the systems strengthening program was US $1,716,976. Based on program estimates, 307 (±82) neonatal deaths and 84 (±35) stillbirths were prevented, amounting to 12,342 DALYs averted. The systems strengthening intervention was found to be highly cost effective with an ICER of US $139 (±$44), an amount significantly lower than the established threshold of cost-effectiveness of the per capita gross domestic product, which averaged US $1,649 between 2012-2016. The results were found to be sensitive to the following parameters: DALYs averted, number of neonatal deaths, and number of stillbirths. An integrated approach to system strengthening in referral hospitals has the potential to reduce neonatal and intrapartum mortality in low resource settings and is likely to be cost-effective. Sustained change can be achieved by building organizational capacity through leadership and clinical training.

A novel speculum-free imaging strategy for visualization of the internal female lower reproductive system

Fear of the speculum and feelings of vulnerability during the gynecologic exams are two of the biggest barriers to cervical cancer screening for women. To address these barriers, we have developed a novel, low-cost tool called the Callascope to reimagine the gynecological exam, enabling clinician and self-imaging of the cervix without the need for a speculum. The Callascope contains a 2 megapixel camera and contrast agent spray mechanism housed within a form factor designed to eliminate the need for a speculum during contrast agent administration and image capture. Preliminary bench testing for comparison of the Callascope camera to a $20,000 high-end colposcope demonstrated that the Callascope camera meets visual requirements for cervical imaging. Bench testing of the spray mechanism demonstrates that the contrast agent delivery enables satisfactory administration and cervix coverage. Clinical studies performed at Duke University Medical Center, Durham, USA and in Greater Accra Regional Hospital, Accra, Ghana assessed (1) the Callascope’s ability to visualize the cervix compared to the standard-of-care speculum exam, (2) the feasibility and willingness of women to use the Callascope for self-exams, and (3) the feasibility and willingness of clinicians and their patients to use the Callascope for clinician-based examinations. Cervix visualization was comparable between the Callascope and speculum (83% or 44/53 women vs. 100%) when performed by a clinician. Visualization was achieved in 95% (21/22) of women who used the Callascope for self-imaging. Post-exam surveys indicated that participants preferred the Callascope to a speculum-based exam. Our results indicate the Callascope is a viable option for clinician-based and self-exam speculum-free cervical imaging.Clinical study registration ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/record/ NCT00900575, Pan African Clinical Trial Registry (PACTR) https://www.pactr.org/ PACTR201905806116817.

Maternal birth preparedness and complication readiness in the Greater Accra region of Ghana: a cross-sectional study of two urban health facilities

BackgroundHigh maternal mortality ratios remain a critical public health concern in Ghana. Birth preparedness and complication readiness (BP/CR), which is a component of focused antenatal care, is a safe motherhood strategy intended to promote skilled birth attendance by helping women and their families plan for pregnancy and childbirth, thereby reducing maternal mortality. The objective of this study was to determine the level of BP/CR and to assess factors associated with maternal BP/CR in the Greater Accra Region of Ghana.MethodA cross sectional descriptive quantitative study was carried out among 300 postnatal women attending the Adabraka Polyclinic and the Greater Accra Regional Hospital both within Accra, the capital city of Ghana. Data were collected with a structured questionnaire which assessed socio-demographic, health facility/provider and social support factors and their associations with BP/CR. Levels of BP/CR were assessed using validated tools. Data from 300 women were analyzed using STATA version 15.0. Logistic regression analysis was conducted to establish associations between BP/CR and socio-demographic, health facility/provider and social support factors.ResultsApproximately 234 (78%) of the women were birth prepared. Strong predictors of BP/CR included having ≥4 antenatal clinic visits (aOR 2.63; 95% CI 1.03–6.73), being employed (aOR 4.07; 95% CI 1.49–11.11) and belonging to maternal health promoting clubs or groups during the antenatal period (aOR 3.00; 95% CI 1.07–8.40) .ConclusionBP/CR is generally high among the study population. Predictors of BP/CR are multifactorial and found to cut across all aspects assessed in the study. Therefore, the creation of a BP/CR tool is recommended to routinely monitor trends in maternal birth preparedness in antenatal clinics. This may help to sustain and improve current levels and indicators of BP/CR.

Predictors of Adverse TB Treatment Outcome among TB/HIV Patients Compared with Non-HIV Patients in the Greater Accra Regional Hospital from 2008 to 2016.

Introduction The convergence of TB and HIV dual epidemics is a major public health challenge in Ghana as well as many developing countries. Treatment outcome monitoring is a vital part of the surveillance needed to successfully eliminate TB. The impact of HIV status and demographic and treatment-related factors on adverse TB treatment outcome has not been studied in the Greater Accra Regional Hospital. This study determined factors associated with TB treatment outcome in patients with TB-HIV coinfection and TB-only infection in the hospital. Method A cross-sectional study was carried out in the Greater Accra Regional Hospital. We reviewed TB treatment cards of patients who received treatment for tuberculosis in the hospital from 2008 to 2016. Data on treatment outcome and sociodemographic and clinical characteristics were extracted on TB-only-infected and TB/HIV-coinfected patients. The chi-squared test and binary and multiple logistic regression models were used to assess factors associated with adverse treatment outcome. Results Out of the 758 patient records analyzed, 174 (22.9%) were TB-HIV-coinfected patients. Overall treatment success for all TB patients was 88.1% (668/758). About 11.9% (90/758) of the patients had an adverse treatment outcome, including treatment failure 0.9% (7/758), defaulting 0.9% (7/758), and death 10.0% (76/758). TB-HIV-coinfected patients' treatment success was 78.1% (136/174). TB-only patients' treatment success was 91.4% (532/582). Independent predictors of adverse treatment outcome were found to be as follows: being HIV positive (aOR: 3.85, 95% CI: 2.19-6.75; p < 0.01); aged 65 and above (aOR: 1.76, 95% CI: 1.44-1.54; p = 0.01); and previously failed TB treatment (aOR: 5.02, 95% CI: 2.09-28.87; p < 0.01). Conclusion Treatment outcome for TB-HIV-coinfected patients is below the WHO target. HIV status, age, and category of patient of the TB patients were associated with adverse treatment outcome. Strengthening the TB/HIV collaborative efforts by stakeholders is required for good treatment outcomes.