Ho Teaching Hospital Research Articles

Neonatal and Young Infant Sepsis in a Regional Hospital in Ghana

Background: Neonatal sepsis is a global health problem that mainly affects low- and middle-income countries. We have previously shown that early neonatal mortality is high at the Ho Teaching Hospital (HTH) of Ghana. We sought to determine the prevalence of neonatal sepsis, sepsis-related mortality, and bacterial species patterns in neonatal and young infant sepsis in this hospital. Methods: A hospital-based study was conducted in the hospital’s neonatal intensive care unit (NICU) from March to June 2018. Blood samples from 96 babies clinically diagnosed with or at risk of sepsis were cultured using the BACTEC 9050® machine. Clinical data including gravida, parity and antibiotic medication before delivery of mother and delivery type, gestation, birth weight and antibiotic medication status were collected for analysis. MALDI-TOF MS identified bacterial isolates, and their identities were confirmed via tuf gene sequence typing. The data were analyzed using GraphPad Prism 8.0.2. Results: Blood cultures were positive in 28 of the babies, with 14 and 12 representing early-onset and late-onset neonatal sepsis, respectively, and two cases of unknown sepsis type. Of the bacterial species that caused sepsis in the babies, coagulase-negative staphylococcus (CoNS) was the most prevalent isolate in 22 cases, followed by Klebsiella pneumoniae in two and Staphylococcus aureus, Streptococcus agalactiae, the Acinetobacter species, and Escherichia coli in the rest (one each). Of the CoNS, S. haemolyticus and S. epidermidis were the most prevalent species, found in eight and six cases, respectively. Thirteen neonates died, of whom seven had positive blood cultures, and two were referred. A case fatality rate of 7/26 was estimated. Neonatal mortality caused by Gram-negative bacterial infection was higher than that caused by Gram-positive bacteria. Conclusions: These data suggest a significant burden of sepsis among neonates and young infants and are associated with substantial morbidity and mortality at the HTH. There is a need to investigate risk factors associated with the increased sepsis rate in this hospital to inform measures to reduce the neonatal sepsis rate.

Factors influencing the utilization of Focused antenatal care services during pregnancy, a study among postnatal women in a tertiary healthcare facility, Ghana.

AimTo assess the factors that influence the utilization of FANC services among pregnant women.MethodologyA cross‐sectional quantitative study conducted among 210 postnatal women in Ho Teaching Hospital. Data were entered into Microsoft excel, cleaned and transported to SPSS and analysed. Cross tabulations were used to explore associations between variables.ResultsThe respondents indicated that FANC would enable them to receive comprehensive ANC (74.8%). Higher parity was significantly associated with low utilization of FANC (p = .028). Long distance to the health facility, seeking permission to use FANC was significantly associated with low utilization of FANC (p < .001). Fear associated with witchcraft was associated with low FANC utilization (p < .001).

High prevalence of intestinal helminthic infection among children under 5 years in a rural Ghanaian community: an urgent call for attention

Intestinal parasitic infections presents a significant public health concern in developing countries. The study determined the prevalence of intestinal parasitic infection of children under 5years. A cross-sectional prospective study was conducted at Dodi Papase, a town in the Kadjebi district of the Oti region of Ghana. Stool samples were collected from 152 children under 5years and examined for the presence of intestinal parasites using Kato-Katz technique. Additionally, venous blood samples were collected from participants into EDTA tubes and analyzed for their hemoglobin concentration using the Sysmex XS-500i automated hematology analyzer All laboratory analyses were done at the Ho Teaching Hospital Laboratory. Overall prevalence of intestinal helminthic infections was 44.08% (67/152). Ascaris lumbricoides, Trichuris trichiura and Hookworm recorded 20.39%, 10.53% and 13.16% prevalence respectively. Children aged 4years recorded the highest prevalence of intestinal parasitic infections vis-à-vis 50.00% A. lumbricoides and 37.50% Hookworm while children below age 2years recorded the lowest. T. trichiura infection was highest among children below age 2years (44.44%) and lowest among children aged 4years. This study recorded an overall parasitic infections of 44.08%. This therefore calls for periodic screening, anti-helminthic treatment of these children as well as intensified education on attitudinal/behavioral change on improved personal and environmental hygiene in order to help control the menace of intestinal parasitic infections.

Assessment of Hemoglobin Variants in Patients Receiving Health Care at the Ho Teaching Hospital: A Three-Year Retrospective Study.

Background It is estimated that one out of every three Ghanaians has hemoglobin genotype mutation. This change in genetic make-up may result in genotypes such as HbAS, HbSS, and HbSC. Many children in low- and middle-income countries die even before they are diagnosed with sickle cell disease (SCD). In Africa, there are limited data on the incidence and prevalence of SCD and the Volta region of Ghana is no exception. Aim The aim of this study was to determine the prevalence of SCD and to assess the hemoglobin variants among patients attending Ho Teaching Hospital. Methods A retrospective study design was used to extract information from the Hospital Administration and Management Systems (HAMS) on the hemoglobin electrophoresis results and corresponding full blood count results of the SCD and sickle cell anemia (SCA) patients as well as patients who were asked to do Hb electrophoresis irrespective of their sickling status. Data were collected for the period January 2016 to December 2018. Sickle cell disease status was determined using the Hb genotypes from the Hb electrophoresis results. The full blood count was used to categorize the severity of anemia based on the hemoglobin concentration in the SCA and SCD patients. Results A total of 1,523 subjects were included in the study of which the prevalence for sickle cell disease was 16.7%. The SCD genotypes included HbS (6.2%), HbSC (7.9%), and HbSF (2.6%). Hemoglobin C disease (HbCC) constituted 0.3% out of the total prevalence of SCD. The prevalence of anemia was 99.2%, with the severest form in HbS. Also, majority of the SCD patients had severe anemia. Difference in the severity of anemia was found to be significant among both male (P=0.006) and female (P=0.004) participants with SCD. Conclusion Patients receiving health care at the Ho Teaching Hospital had different hemoglobin variants with HbAS recording the highest prevalence. The high incidence of hemoglobin AS implies the possibility of having an increased population of individuals with sickle cell disease in future if measures are not put in place to improve screening, counseling, and education of the public about the health threat SCD poses.

Dyslipidemia and its associated factors in patients with type 2 diabetes mellitus

Dyslipidemia is a major risk factor known to be associated with diabetes and cardiovascular diseases. This study determined the frequency of lipid abnormalities among type 2 diabetes patients. A cross-sectional study using a convenient sampling method was conducted among 125 diabetes patients admitted or attending Ho Teaching Hospital in Ho between February 2019 and March 2019. A structured questionnaire was used to collect data on demographics and health status of participants. Blood samples were taken from participants after 9–12 h of overnight fasting, and their serum lipid profiles were estimated. The frequency of high total cholesterol (TC), low high-density lipoprotein cholesterol (HDL-C), high triglycerides (TG), high low-density lipoprotein cholesterol (LDL-C) and high coronary risk ratio (CR) were 42%, 16%, 3%, 33%, and 78% respectively. The majority of the study participants had low risk atherogenicity, but the frequency of intermediate and high risk atherogenicity was 36% and 22% respectively. Also, most of the study participants were obese. Participants with secondary educational level had the highest frequency of dyslipidemia, while those with no educational background had the least. Dyslipidemia was very pronounced in the participants with elevated TC, TG, LDL-C, and low HDL-C supporting previous assertion that people with type 2 diabetes mellitus are prone to the development of lipid abnormalities.

Practices of pica among pregnant women in a tertiary healthcare facility in Ghana.

AimThis study assessed the practice of pica among pregnant women in the Ho Teaching Hospital.DesignDescriptive cross‐sectional.MethodsSystematic sampling technique was used to recruit 286 pregnant women. Questionnaire was used to collect data. Data entered into Statistical Package for Social Sciences for analysis.ResultOf the 286 pregnant women, 21.2% and 17.8% considered white clay and ice respectively as nutritious. Prevalence of pica was 47.5%, while 44.9% of pregnant women who practised pica reported they feel uncomfortable when they do not eat pica as 63.3% considered intake of pica as harmful. Among women who received education against pica practice, 49.4% have ever taken pica as 50.9% of them with education on effects of pica were currently engaged in the activity (χ 2 = 1.93 p = .17).ConclusionHealth professionals, especially midwives must intensify education on effects of pica among pregnant women.

"I did not know it was a medical condition": Predictors, severity and help seeking behaviors of women with female sexual dysfunction in the Volta region of Ghana.

The study's main objective was to describe the prevalence and severity of female sexual dysfunction (FSD) amongst a group of Ghanaian women in the outpatient setting of the predominantly rural Volta region of Ghana. Additionally we determine the predictors of FSD severity and care seeking behaviors of women with the condition. This was a cross sectional study conducted in the outpatient setting of the Ho Teaching Hospital in the rural-savannah, agro-ecological zone of Volta Region, Ghana. FSD was assessed using the Female Sexual Function Index (FSFI) questionnaire. FSD was defined with a cutoff of ≤23 so as not to under-estimate the prevalence in this conservative setting. FSFI score >23 was designated "no FSD". We further categorized women with FSD as having mild (FSFI Total score 18-23), moderate (FSFI Total score <18 to >10) or severe (FSFI Total score ≤10) FSD. Due to sample size restrictions, we combined the moderate and severe FSD groups in our analyses and defined "moderate/severe FSD" as an FSFI Total score < 18. Participants with FSD were further asked to indicate whether or not they sought help for their conditions, the reasons they sought help, and the types of help they sought. We used p<0.05 to determine statistical significance for all analyses and logistic regression models were used to determine crude and age-adjusted effect estimates. FSD Prevalence: Out of 407 women approached, 300 (83.8%) agreed and consented to participate in the study. The prevalence of FSD was 48.3% (n = 145). Compared to those without FSD, over a third of the FSD women resided in rural settings (37.90% vs 20.60%; p = 0.001) and tended to be multiparous, with a significantly greater proportion having at least three children (31.70% vs 18.10%; p = 0.033). FSD Severity: Over a quarter of the sample (27.6%, n = 40) met the cut-off for moderate to severe FSD. In age-adjusted models, lubrication disorder was associated with 45 times the odds of moderate/severe FSD (age-adj. OR: 45.38, 95% CI: 8.37, 246.00; p<0.001), pain with 17times the odds (age-adj. OR: 17.18, 95% CI: 4.50, 65.50; p<0.001) and satisfaction almost 5times the odds (age-adj. OR: 4.69, 95% CI: 1.09, 20.2; p = 0.04). Compared to those with 1-3 children, nulliparous women had 3.5 times higher odds of moderate/severe sexual dysfunction as well (age-adj. OR:3.51, 95% CI:1.37,8.98; p = 0.009). FSD-related Health Seeking Behaviors: Statistically significant predictors of FSD-related care seeking included having FSD of pain disorder (age-adj. OR: 5.91, 95% CI:1.29, 27.15; p = 0.02), having ≥4 children (age-adj. OR: 6.29, 95%CI: 1.53, 25.76; p = 0.01). Of those who sought help, seven in 10 sought formal help from a healthcare provider, with General Practitioners preferred over Gynecologist. About one in 3 (31.3%) who did not seek help indicated that they did not know their sexual dysfunction was a medical condition, over a quarter (28.9%) "thought it was normal" to have FSD, and interestingly, 14.1% did not think a medical provider would be able to provide them with assistance. Sexual dysfunctions are prevalent yet taboo subjects in many countries, including Ghana. Awareness raising and efforts to feminize the physician workforce are necessary to meet the healthcare needs of vulnerable members of Ghanaian society.

Infections of the Skin among Children in Ho Teaching Hospital of the Volta Region, Ghana

Skin infections are common disorders responsible for hospital attendance in the pediatric practice. Unfortunately, the epidemiology of these infections in tertiary facilities is both unstudied and underreported. Therefore, the burden of skin infections among children in Ghana remains indistinct. This hospital-based study sought to evaluate skin infections among children attending the Ho Teaching Hospital (HTH). In this retrospective study, the electronic medical records of children aged 0 to 14 years (12, 170) who attended the HTH’s pediatric unit outpatient clinic between January 1, 2015 and December 31, 2016 were reviewed. All (1, 877) identified dermatological case records from the database were retrieved. They were then double-checked to further affirm demographic information (age and sex) and diagnosis of skin infection with the medical folders to clarify unclear observations. Pearson chi square was used to evaluate the association between the different age group of the children and the types of skin infection as well as comorbidities. Only 1, 887 (15.5%) of all case records reported with a presenting dermatological complaint. Sixty-five percent (65%) of these (1226 of 1887) were diagnosed with a form of skin infection. Sixty-nine percent (69%) of children with skin infection were admitted into the ward for further management. Majority (441, 35.97%) of skin infected children were between 1 - 4 yrs. Impetigo (393, 46.6%) and furunculosis (410, 48.6%) were the most prevalent skin infections compared to herpes (3, 6.5%) and warts (4, 8.7%). The parasitic skin infection recorded in this study was scabies (23, 100%). Gender disparity existed, with female children aged 10 - 14 years significantly having more skin infection than males (

Predictors of Adherence to HIV Post-Exposure Prophylaxis Protocol Among Frontline Healthcare Workers at the Ho Teaching Hospital, Ghana

Predictors of Adherence to HIV Post-Exposure Prophylaxis Protocol Among Frontline Healthcare Workers at the Ho Teaching Hospital, Ghana

A Retrospective Study of Intestinal Parasite among Patients in the Ho Teaching Hospital, Ghana

Aim: To assess the prevalence of intestinal parasite infections among patients who visit the Ho Teaching Hospital for stool examination from 2012 to 2016.&#x0D; Study Design: Retrospective study.&#x0D; Place and Duration of Study: Ho Teaching Hospital, August 2017 to January 2018.&#x0D; Methodology: The hospital’s laboratory records were reviewed. Patients’ data were recorded using a well-designed data collection tool. Data was analyzed with Statistical Package for Social Science (SPSS) version 20.0.&#x0D; Results: A total of 7045 patients visited the Ho Teaching Hospital laboratory for routine stool examination within the five-year period. From the 7045 patients, 703 of them were infected with at least one of the intestinal parasites. The overall prevalence of intestinal parasite infection for the five-year period was 10.0%. Intestinal flagellates (90.0%) were the most predominant intestinal parasites, and Entamoeba histolytica recorded 5.7%. Hookworm (0.9%) was the most prevailing soil-transmitted helminth. Ascaris lumbricoides (0.1%) and Schistosoma mansoni (0.1%) were the least recorded parasites. Highest infection was among patients within age group 20 to 29 years. However, age groups below 10 years recorded low infection. This study showed that age was a risk factor for acquiring intestinal parasite infection (P≤0.001).&#x0D; Conclusion: Intestinal parasitic infections were recorded among patients who visited the Ho Teaching Hospital. However, most of the patients were infected with intestinal flagellates. Various stakeholders should provide advance techniques in laboratory investigation of stool samples to enhance accurate diagnosis. Sensitization of the public about the dangers of intestinal parasites should also be undertaken by the stakeholders.

Plasmodium falciparum malaria cases detected for prompt treatment by rapid diagnostic tests in the Ho Teaching Hospital of the Volta Region of Ghana

BackgroundPrompt diagnosis and effective treatment of malaria cases with efficacious drugs is an important strategy in the management and control of malaria in endemic populations. As part of a study investigating the factors modulating the development of Plasmodium falciparum gametocytes in the human host, we assessed the rate of RDT positivity of patients in different departments of the Ho Teaching Hospital and the relation with age and anaemia. Materials and methodsEight-hundred and ten individuals attending clinic at various departments within the Ho Teaching Hospital were screened for malaria antigenaemia using RDT as a point-of-entry investigation. RDT positive individuals were immediately treated for malaria whereas RDT negative individuals were treated for other ailments. Haematological analyses were performed for 69 of these patients and the relationship between RDT results and haemoglobin levels were investigated. ResultsThe overall RDT positivity rate was 19.8% (160/810) of all individuals screened. There was no significant difference in the haemoglobin levels of RDT-positive and RDT-negative individuals (p value = 0.272). The highest number of attendees screened was children in the paediatric outpatient department and paediatric ward, 62% (507/810), with RDT positivity rate of 17% (91/507). We found the highest RDT positivity rate of 51% (19/37) in the male medical ward. ConclusionsThis study shows that RDT is a useful tool in promoting prompt diagnosis and management of malaria and though children form a majority of hospital attendees and malaria infections, the frequency of malaria detection may be higher in adults as compared to children.