Hospital In Ghana Research Articles

Patients' satisfaction with the quality of care upon implementation of electronic health records system at the 37 Military Hospital, Ghana.

Background: To resolve delays faced by patients when accessing health services, the electronic health records system (EHRs) was introduced as part of the health management information system (HMIS) to enhance the quality of care. Objective: This study assessed patients' satisfaction with the quality of care upon the implementation of the electronic health records system at the 37 Military Hospital in Ghana. Methods: The study adopted a cross-sectional study design using a quantitative method. A simple random sampling method was applied to recruit 228 outpatients who were seeking healthcare at the time of data collection to respond to a structured questionnaire. A Chi-square test and logistic regression analysis were used to assess the association between the dependent variable and independent variables. A p-value of 0.05 at a 95% confidence interval was used as the threshold for statistical significance. Results: The results showed a high quality of care with respect to attention to patients' needs (M=3.68, SD=0.525), the responsiveness of health providers to emergencies (M=3.81, SD=0.651), the efficiency of services rendered (M=3.78, SD=0.576), timeliness of healthcare (M=3.78, SD=0.576), patient-provider communication (M=3.42, SD=0.683) and general patients' care (M=3.86, SD=0.528). Similarly, the results showed high patient satisfaction in relation to waiting time for services (M=4.32, SD=0.93), adequacy of attention from health providers (M=3.29, SD=0.98), health provider-patient relationship (M=3.63, SD=1.05) and level of service provision after the implementation of EHRs (M=3.89, SD=0.95). Efficiency of services rendered (OR=0.36, 95% CI; 0.276, 0.653, p < 0.05), timeliness of healthcare (OR=0.42, 95% CI; 0.153, 0.693, p < 0.05),and general patients' care (OR=0.43, 95% CI; 0.023, 0.678, p < 0.05) were strong predictors of patients' satisfaction. Conclusion: The study demonstrated patients' overall satisfaction with the operation of electronic health records systems. The study recommends that the management of the 37 Military Hospital should continuously improve the quality of care of the health services to ensure sustained patient satisfaction

A gist on an obscure neoplasm in Ghana: gastrointestinal stromal tumours

BackgroundGastrointestinal Stromal Tumour is a rare but potentially curable tumour of the gastrointestinal tract accounting for up to 1% of all gastrointestinal tumours. The discovery of Imatinib mesylate, a novel tyrosine kinase inhibitor has improved the chances even for unresectable, recurrent, or metastatic diseases.MethodsThis study sought to document the clinical and pathological characteristics of GISTs from two tertiary hospitals in Ghana that have undergone immunohistochemistry confirmation between 2014 and 2021.ResultsThe median age of the subjects was 50 years with most of them (28.0%) being above 61 years. There were more females than males (64.0% vs. 36.0%). Abdominal mass and abdominal pain made up the majority of the clinical presentations. The majority of the subjects had partial gastrectomy (32.0%) which was followed by wedge resection (28.0%). Appendectomy and sleeve gastrectomy were the least performed procedures (8% each). Four of the 25 patients (16.0%) had resections of involved contiguous organs done with splenectomy being the most common procedure. The majority of GISTs were found in the stomach (68.0%) followed by the appendix (12.0%) and small bowel (12.0%). Gastrointestinal bleeding (55.8%) and abdominal pain (38.5%) were the most reported symptoms. Free resection margins were observed in 84.0% of the subjects and only 3/25 (12.0%) experienced tumour recurrence.ConclusionGIST is a potentially curable tumour that once was obscure but currently gaining popularity. Surgical resection offers the hope of a cure for localized disease while targeted therapies is a viable option for recurrent, metastatic, or unresectable tumours.

Multidrug-resistant Gram-negative bacterial colonization in patients, carriage by healthcare workers and contamination of hospital environments in Ghana

BackgroundPatients already colonized with multidrug-resistant (MDR) Gram-negative bacteria (GNB) on admission to critical care units may be an important source of transmission of these bacteria in hospitals. We sought to determine the prevalence of MDR GNB colonization in patients, staff and the ward environment and to assess the risk factors for colonization of patients in wards. MethodsThe study was conducted from April 2021 to July 2021 in a teaching hospital in Ghana. MDR GNB were isolated from rectal, and hand swabs were taken from patients on admission and after 48 h. Swabs from HCW’s hands and the ward environment were also taken. Risk factors for colonization with MDR GNB were assessed using univariate and multivariate analysis. ResultsMDR GNB rectal colonization rate among patients was 50.62% on admission and 44.44% after 48 h. MDR GNB were isolated from 6 (5.26%) and 24 (11.54%) of HCW’s hand swabs and environmental swabs, respectively. Previous hospitalization (p-value = 0.021, OR, 95% CI= 7.170 (1.345–38.214) was significantly associated with colonization by MDR GNB after 48 h of admission. Age (21–30 years) (p-value = 0.022, OR, 95% CI = 0.103 (0.015–0.716) was significantly identified as a protective factor associated with a reduced risk of rectal MDR GNB colonization. ConclusionThe high colonization of MDR GNB in patients, the carriage of MDR GNB on HCW’s hands, and the contamination of hospital environments highlights the need for patient screening and stringent infection prevention and control practices to prevent the spread of MDR GNB in hospitals.

Predictors of the onset of neonatal sepsis at the Neonatal Intensive Care Unit of a tertiary hospital in Ghana: A cross-sectional study.

Neonatal sepsis is a systemic inflammatory response to infection during the first 4 weeks of an infant's life. It is a significant cause of neonatal morbidity and mortality in low- and middle-income countries. This study aimed to determine the predictors of the onset of sepsis at the Neonatal Intensive Care Unit of the Tamale Teaching Hospital, Ghana. A cross-sectional study was conducted among 275 mothers and their singleton neonates diagnosed clinically with sepsis. A univariate and multivariate logistic regression analysis adjusted for maternal occupational status was performed to determine the maternal and neonatal predictors of early-onset (EOS) and late-onset sepsis (LOS), respectively. Single motherhood (AOR = 1.882, 95% CI = 0.926-3.822, p = .08) and home delivery (AOR = 3.667, 95% CI = 0.584-23.026, p = .17) were predictors of EOS, with single motherhood being the predictor for LOS (AOR = 2.906, 95% CI = 0.715-11.805, p = .14) in a univariate analysis. When maternal occupation was adjusted for in a multivariate analysis, single mother (AOR = 2.167, 95% CI = 1.010-4.648, p = .04) was the main predictor of EOS, with low neonatal birth weight being the main predictor of LOS (AOR = 0.193, 95% CI = 0.038-0.971, p = .04). Maternal marital status is a significant predictor of both EOS and LOS, with predictors of EOS being lower gestational age and low birth weight, while for LOS, low birth weight is the main predictor. Findings from this study can serve as a commencement point for developing predictive models for the onset of sepsis in neonates in the study facility.

Application of ensemble models approach in anemia detection using images of the palpable palm

Anemia is a public health issue with serious ramifications for human health globally. Anemia particularly affects pregnant women and children from 6 to 59 months old even though every individual is at risk. Anemia occurs when the Hb level is below its normal threshold or when the red blood cells are weakened or destroyed. To discover medical remedies on time, early detection or diagnosis of anemia assist patients to understand their condition.The invasive approach for anemia detection is costive and time-consuming as compared to the non-invasive approach which is reliable and suitable for developing communities where medical resources and personnel are inadequate. This study uses palpable palm images (dataset) collected from 710 participants in selected hospitals in Ghana. The images were extracted, segmented and converted into RGB percentile to train, validate and tested the machine learning models. A hybrid model was developed with the application of ensemble learning models using the R programming language on the R Studio platform. Stacking, voting, boosting and bagging ensemble model techniques were used to build the hybrid models, the stacking ensemble model achieved an accuracy of 99.73 ​%. The study justifies that ensemble models are efficient for medical disease diagnosis or detection such as anemia.

Prevalence and determinants of malaria infection among pregnant women attending antenatal clinic in Ejisu government hospital in Ghana: A cross-sectional study.

Malaria in pregnancy is a global public health problem with the majority of its impact seen in sub-Saharan Africa. Pregnant women with malaria infection are at risk of adverse maternal outcomes. In Ghana, malaria in pregnancy accounts for about 17.6% of outpatient department attendance. Ashanti region is among the three regions with the highest malaria prevalence in pregnancy, particularly in the Ejisu Municipality. The study, therefore, assessed the prevalence and determinants of malaria infection among pregnant women seeking antenatal care at the Ejisu Government Hospital in Ghana. A cross-sectional study design with a convenience sampling technique was used to select 140 respondents for the study. Primary data such as age and residence of respondents were collected using a questionnaire and secondary data such as gestational age and Sulphadoxine Pyrimethamine (SP) administration were collected from clients' maternal health record booklet. Bivariate and multivariate logistic regression analysis were used to assess the association between the malaria infection and the independent variables, and a p-value of < 0.05 was considered statistically significant. The overall prevalence of malaria in pregnancy was 24 (17.1%). Most of the respondents had received counselling and health education 126 (90%), two or more doses of SP 95 (87.2%), Insecticide Treated Net (ITN) 99 (70.7%) and were sleeping under ITN 104 (74.3%). Multivariate logistic regression analysis showed a statistically significant association between malaria infection and sleeping under ITN (AOR = 0.05; 95% CI = 0.01-0.28, p< .001), the use of insecticide mosquito spray (AOR = 0.27; 95% CI = 0.09-0.84, p = .045) and reason for not using ITN due to the use of other preventive measures (AOR = 0.06; 95% CI = 0.01-0.61, p = .017). There was a high prevalence of malaria infection among study respondents despite the high usage of preventive measures for malaria in this study. It is therefore crucial that stakeholders in malaria control identify effective strategies to curb malaria transmission globally.

Brain-derived neurotrophic factor is associated with cardiometabolic risk factors in HIV patients on combination antiretroviral therapy in Ghana

BackgroundBrain-derived neurotrophic factor (BDNF) has been implicated in the development of cardiometabolic risk factors in some populations. However, few studies have investigated the role of BDNF and cardiometabolic risk factors in HIV patients despite the plethora of evidence linking HIV infection with the dysregulation of circulating BDNF levels. We investigated the association between serum BDNF and cardiometabolic risk factors in HIV patients in a primary hospital in Ghana. We recruited 450 participants, comprising 150 combination antiretroviral (cART)-treated HIV patients, 150 cART-naïve HIV patients, and 150 non-HIV controls. Data on sociodemographic parameters and medical history were collected using a structured questionnaire. Fasting venous blood samples were collected to measure plasma glucose levels, lipid profiles, and BDNF. Metabolic syndrome (MetS) was defined using the joint interim statement criteria.ResultsCompared to untreated HIV patients and uninfected controls, the proportion of participants having MetS was high in cART-exposed HIV patients (26.8% vs 21.1% vs 52.1%, respectively, p < 0.001). Generally, BDNF levels were higher in uninfected controls compared with untreated and cART-exposed HIV patients [7.1 (3.4–13.3) vs 4.9 (2.7–9.6) vs 5.6 (2.9–8.9) ng/ml, p = 0.025]. In participants without MetS, square root-transformed serum BDNF was lowest in cART-exposed HIV patients, followed by untreated HIV patients, with uninfected controls having the highest (1.8 ± 0.8 vs 2.4 ± 1.2 vs 2.9 ± 1.2 ng/ml, p < 0.001). MetS was associated with serum BDNF levels in only the cART-exposed HIV patients [OR (95% CI) = 2.98 (1.64–5.41), p < 0.001]. In cART-exposed HIV patients, an increase in BDNF was associated with increased likelihood of having impaired fasting glucose [2.49 (1.51–4.11), p < 0.001], high systolic blood pressure [1.64 (1.1–2.46), p = 0.016], and hypertriglyceridemia [2.73 (1.65–4.52), p < 0.001], as well as decreased likelihood of having low HDL cholesterol levels [0.32 (0.19–0.56), p < 0.001].ConclusionIn our study population, MetS was higher in cART-exposed HIV patients. HIV patients have low levels of serum BDNF, especially those without MetS. BDNF was associated with MetS and its components in HIV patients on cART management.

Nursing staff involvement of children in care activities: A cross-sectional study

BackgroundNurses’ involvement of children in their care is essential to quality pediatric care. Various international guidelines stress the need for children's involvement in decisions and activities affecting their care and lives; widely known among them is the United Nations Convention on the Rights of the Child. This convention gives children the right to participate in decisions and activities that affect their growth and development. ObjectiveThis study assessed the level of nursing staff involvement of children in care activities and the benefits they perceived from this involvement. DesignDescriptive cross-sectional study. SettingUnits of Evangelical Church of Ghana Hospital, Kpandai rendering services for children. ParticipantsA total of 116 nursing staff members were invited to participate; 97 (84%) responded. The term "nurses" in this study includes unlicensed nursing assistants, as well as licensed professional nursing staff. MethodsDescriptive statistics were used to analyze participants’ demographic characteristics and the nurses’ perceived benefits derived from children's involvement in care activities. A Chi-square test was used to analyze associations between nurses’ demographic data and the level of nurses’ involvement of children in care activities at a significance level of p< 0.05. ResultsA majority (56.7%) of the nurses poorly involved children in their care activities. They either involved children to some extent or did not involve children at all. Nurses’ age and gender predicted involvement. Older nurses aged 30 and above (56.4%) were more likely to involve children in care activities than those under 30 (26.1%) [p=0.003]. Female nurses (31.7%) were marginally less likely to involve children in their care activities than their male colleagues (51.8%) [p=0.049]. Most of the nurses agreed to several impactful benefits of involving children in care activities, thus benefiting children, caregivers, and health professionals. ConclusionThe overall level of nurses’ involvement of children in care activities was poor. Policy documents to safeguard children's rights in healthcare involvement must be developed and implemented from the national down to the hospital level to safeguard children's rights to healthcare involvement.

Incidence patterns of childhood cancer in two tertiary hospitals in Ghana from 2015 to 2019: A retrospective observational study

BackgroundAccurate epidemiological data are vital in estimating the burden of disease in a country. Little is known about the incidence of childhood cancer in Ghana. This study describes the incidence patterns of cancer in children below 14 years and 11 months from 2015 to 2019 at the only two main pediatric cancer referral centers in Ghana: Korle Bu Teaching Hospital (KBTH) and Komfo Anokye Teaching Hospital (KATH). MethodData on the incidence of cancer in children below 14 years and 11 months were collected retrospectively between 1st January 2015 and 31st December 2019 from patients’ medical folders at KBTH and the cancer registry at the pediatric units of KATH. Descriptive statistics were used to describe the data. Incident rates expressed as age-specific rates (ASRs) per 100,000 person-years using population estimates for age groups and sex in each year, were determined by age groups (0–4, 5–9, 10–14 years and 11 months), sex, region of residence and cancer types based on the International Childhood Cancer Classification, third edition. ResultsThe total ASR per 100,000 person-years from 2015 to 2019 was 9.36 based on 1073 cases observed. The ASR increased from 1.6 per 100,000 person-years in 2015–2.41 in 2017, thereafter decreasing to 1.45 in 2019. The ASR was higher in male children (2.10 per 100,000 person-years), children between 0 and 4 years (0.27 per 100,000 person-years), and children living in the Greater Accra region (4.17 per 100,000 person-years). The most prevalent cancers were lymphomas (2.17 per 100,000 person-years) and leukemia (1.88 per 100,000 person-years). ConclusionThe study provides baseline information on the incidence patterns of childhood cancer from 2015 to 2019, addressing a critical gap in childhood cancer epidemiology in Ghana.

Catheter-Related Bloodstream Infections among patients on maintenance haemodialysis: a cross-sectional study at a tertiary hospital in Ghana

BackgroundCatheter-Related Bloodstream Infections (CRBSIs) are notable complications among patients receiving maintenance haemodialysis. However, data on the prevalence of CRBSIs is lacking. This study was conducted to determine the prevalence and factors associated with CRBSIs among patients receiving haemodialysis in the renal unit of the largest tertiary hospital in Ghana.MethodsA hospital-based cross-sectional study was conducted on patients receiving maintenance haemodialysis via central venous catheters (CVC) between September 2021 and April 2022. Multivariate analysis using logistic regression was used to determine the risk factors that were predictive of CRBSI. Analysis was performed using SPSS version 23 and a p-value<0.05 was statistically significant.ResultsThe prevalence of CRBSI was 34.2% (52/152). Of these, more than half of them (53.9%(28/52)) had Possible CRBSI while 11.5% (6/52) had Definite CRBSI. Among the positive cultures, 62% (21/34) were from catheter sites whilst the rest were from peripheral blood. Gram-negative cultures made up 53% (18/34) of positive cultures with the rest being Gram positive cultures. Acinetobacter baumannii (33.3% (6/18)) was the commonest organism isolated among Gram-negative cultures whilst Coagulase negative Staphylococci (43.7% (7/16)) was the commonest organism isolated among Gram-positve cultures. Gram-negative bacilli were more predominant in this study making up 52.9% of the total bacteria cultured. Sex, duration of maintenance dialysis, underlying cause of End-stage kidney disease, mean corpuscular haemoglobin (MCH), neutrophil count and lymphocyte count were significantly predictive of CRBSI status (p<0.05).ConclusionThere was a high prevalence of CRBSI among patients undergoing haemodialysis. The commonest causative agent was Coagulase negative Staphylococci, however there was a predominance of Gram-negative bacilli as compared to Gram positive cocci. There is a need to set up infection surveillance unit in the renal unit to track CRBSI and put in place measures to reduce these CRBSI.

Health-system drivers influencing the continuum of care linkages for low-birth-weight infants at the different care levels in Ghana

BackgroundLow birth weight (LBW) is associated with short and long-term consequences including neonatal mortality and disability. Effective linkages in the continuum of care (CoC) for newborns at the health facility, community (primary care) and home care levels have a high tendency of minimizing adverse events associated with LBW. But it is unclear how these linkages work and what factors influence the CoC process in Ghana as literature is scarce on the views of health professionals and families of LBW infants regarding the CoC. Therefore, this study elicited the drivers influencing the CoC for LBW infants in Ghana and how linkages in the CoC could be strengthened to optimize quality of care.MethodsA constructivist grounded theory study design was used. Data was collected between September 2020 to February 2021. A total of 25 interviews were conducted with 11 family members of LBW infants born in a secondary referral hospital in Ghana, 9 healthcare professionals and 7 healthcare managers. Audio recordings were transcribed verbatim, analyzed using initial and focused coding. Constant comparative techniques, theoretical memos, and diagramming were employed until theoretical saturation was determined.ResultsEmerging from the analysis was a theoretical model describing ten major themes along the care continuum for LBW infants, broadly categorized into health systems and family-systems drivers. In this paper, we focused on the former. Discharge, review, and referral systems were neither well-structured nor properly coordinated. Efficient dissemination and implementation of guidelines and supportive supervision contributed to higher staff motivation while insufficient investments and coordination of care activities limited training opportunities and human resource. A smooth transition between care levels is hampered by procedural, administrative, logistics, infrastructural and socio-economic barriers.ConclusionA coordinated care process established on effective communication across different care levels, referral planning, staff supervision, decreased staff shuffling, routine in-service training, staff motivation and institutional commitment are necessary to achieve an effective care continuum for LBW infants and their families.

Whom Do I Ask? First-Time Postpartum Mothers in a Developing Economy

Abstract Background There is seemingly no clear path to obtain the relevant information during postpartum as there is limited understanding of the information-seeking behaviour of postpartum women in recent times and difficulty in getting adequate healthcare information in sub-Saharan Africa. In Ghana, numerous studies exist on information needs and information-seeking behaviour in the health sector, but none emphasized both the health information needs and information-seeking behaviour of postpartum women. Aim This study aimed to investigate the health information needs and the information-seeking behaviour of first-time postpartum mothers in the Sunyani Municipal Hospital in Ghana. Methods The study employed a cross-sectional survey which used a quantitative research approach and a convenience sampling technique to sample 139 first-time mothers using a questionnaire that is based on a scientific understanding of how people find and use information. Findings It was revealed that the majority of first-time mothers had experienced the need for health information and had adequate knowledge about health issues but inadequate or moderate knowledge of postpartum health issues. Their most preferred source of health information is the healthcare professional due to their trust in them, and first-time mothers also consulted other informal sources without proper evaluation. Conclusion The state of becoming a mother comes with its challenges, and as such, timely and accurate health information is needed to help curb these challenges. Through training and education, government and authorities can help protect postpartum mothers from harm.

Experiences of Nurses Caring for Children Under Five Years with Burns at a Teaching Hospital in Ghana

Background Nurses provide comprehensive, person-centred care to patients of all ages with any condition to save and protect lives. Caring for children under 5 years with burns involves high-level skills, agility and stable emotions. This study sought to explore nurses’ experience when managing children under five years with burns at the burns unit of a teaching hospital in Ghana. Methods An exploratory, descriptive qualitative approach was used with a purposive sampling method to recruit 15 participants at saturation from the Burns Unit. The interviews were conducted using a semi-structured interview guide. With participants’ consent, their voices were audio-recorded. Data were transcribed verbatim after the researchers listened to the audios several times. Data were analysed using thematic content analysis. Results Narratives of the nurses were represented as emotional experiences, challenges and coping strategies associated with caring for children with burn injury. Mental representation of care task, grief and sadness, helplessness and impatience were identified as the emotional experiences. Increased workload, lack of adequate motivation and shortage of hospital supplies were the main challenges. Teamwork, good working relations, effective work-life balance and emotional detachment were the coping strategies the nurses adopted. Conclusion This study highlighted the experiences of nurses caring for children under five years with burns. The work environment of nurses created stress and increased the burden of care. Nurses need support to recognise and manage their physical, emotional and social responses to their work. In addition, periodic staff training must be promoted to boost staff confidence and enhance their efficiency on the job.

A Multicenter Cross-Sectional Survey of Knowledge, Attitude, and Practices of Healthcare Professionals towards Antimicrobial Stewardship in Ghana: Findings and Implications.

Antimicrobial stewardship (AMS) programs are part of the key activities that contribute to reducing antimicrobial resistance (AMR). Good knowledge, attitudes, and practices (KAP) among healthcare professionals (HCPs) are essential to improving future antimicrobial use and reducing AMR, which is a priority in Ghana. A multicenter cross-sectional survey was conducted in six public hospitals in Ghana among key HCPs to assess their level of KAP towards AMS using a validated self-administered electronic questionnaire. Data analyses included descriptive and inferential statistics using STATA version 14. Overall, 339 out of 355 HCPs responded to the questionnaire, giving a response rate of 95.5%. Most responders were nurses (n = 256, 78.2%), followed by medical doctors (n = 45, 13.3%). The study recorded both poor knowledge (8.9%) and practice levels (35.4%), as well as a good attitude (78.8%) towards AMS. Ongoing exposure to AMS structured training, exposure to continuous professional development training on AMS in the previous year, and the number of years of working experience were predictors of the HCPs' level of knowledge (aOR = 3.02 C.I = 1.12-8.11), attitude (aOR = 0.37 C.I = 0.20-0.69) and practice (aOR = 2.09 C.I =1.09-3.99), respectively. Consequently, concentrated efforts must be made to address current low levels of knowledge and poor practices regarding AMS among HCPs in Ghana as part of ongoing strategies in the National Action Plan to reduce AMR.

B-010 Comparison of Manual Urine Dipstick and Microscopy With Automated UC-3500 and UF-4000 Sysmex UN Series Urinalysis; A Comparative Experimental Research Approach at an Urban Referral Hospital in Ghana

Abstract Background Urine analysis is one of the most common tests for assessing urinary-tract and kidney diseases. In recent years several automated instruments examining urine have been introduced. Though the introduction of automated urine analyzers is expected to reduce the labour involved, turnaround time and potential assay variations, manual urine analysis remains the gold standard or reference method for the analysis of urine. The new Sysmex UN-Series is believed to offer superior performance than other automated systems and manual methods. Methodology A total of 67 routine freshly voided midstream urine samples were analyzed within 1 hour in our study. The results of the automated system were compared with the results of the manual processing which consisted of physical, dipstick chemistry and sediment analysis. Correlation and concordance/agreement between the automated and the manual system were assessed by Bland-Altman plot and Cohen’s Kappa analysis respectively. Results There was a significant fair agreement between the manual analysis and Sysmex UF-3500, in the determination of urine physicochemical parameters (k = 0.193, P = 0.004). Both showed a significant moderate correlation (r = 0.593, P &amp;lt; 0.001) and a significant fair agreement (κ = 0.109, P &amp;lt; 0.001) for specific gravity and pH determination respectively. The best concordance between the two methods was in the nitrates (κ = 1.000, P &amp;lt; 0.001). Both systems recorded strong positive correlation for RBC (r = 0.951 and R2 = 0.904) and WBC (r = 0.91 and R2 = 0.822, P &amp;lt; 0.001) counts. Together, they had a significant good agreement [(65/67(97.0%), κ = 0.734, P &amp;lt; 0.001)] and a significant fair agreement [(48/67 (71.6%) κ = 0.065, P = 0.491)] for cast and bacteria counts correspondingly. Conclusion We conclude that the new automated Sysmex-UN series urine analyzer can be safely used in our laboratory since it demonstrated good performance and compatibility with the manual method. We recommend that microscopy results of the automated platform should be confirmed by manual microscopy, particularly in pathological samples.

Abdominal Ectopic Gestation In The Second Trimester At A District Hospital: A Rare Case

Introduction: Abdominal ectopic pregnancies are uncommon forms of ectopic pregnancies. They might be unnoticed until late in pregnancy and are associated with an increased risk of maternal complications and mortality. This is a case report of an abdominal ectopic gestation diagnosed at the first visit to a district hospital in Ghana and how it was managed in a low-resource setting.&#x0D; Case Presentation: A 28-year-old gravida 4 parity 3, presented with 4 months history of amenorrhoea associated with recurrent bleeding per vaginum. Ultrasound showed a slightly bulky uterus with very scanty echogenic material within the endometrial cavity. There was however a right adnexal gestational sac with a live foetus at 19 weeks + 4 days and no free fluid was seen in the pouch of Douglas. The patient was counselled and prepared for an emergency exploratory laparotomy and intraoperative findings showed normal size uterus of about 8 weeks in size with an unruptured right adnexae gestation. The gestational sac was in the region of the right ovary which could not be visualised and attached to the uterus via the ovarian ligament with a normal-looking right tube. Post-operative recovery was uneventful and she was discharged three days later. &#x0D; Conclusion: Abdominal ectopic gestation can pose a diagnostic challenge, particularly in low-resource settings. There is a need for clinicians to have a high index of suspicion and provide timely surgical intervention necessary to reduce complications and mortality associated with the condition.&#x0D;

Over forty percent of women living with HIV report interruption in antiretroviral therapy during intrapartum and early postpartum inpatient stay: findings from five hospitals in Ghana

ABSTRACT Antiretroviral therapy (ART) adherence during and after pregnancy is essential to reduce perinatal transmission of HIV. However, little is known about adherence during the intrapartum and early postpartum inpatient hospital stay. Using secondary data from a hospital-based cohort study focused on the relationship between birthweight and engagement in HIV care, we examined the magnitude of, reasons for, and factors associated with incomplete intrapartum and early postpartum ART adherence among adult women (18 years or older) living with HIV who delivered within the previous two weeks at one of five hospitals in Accra, Ghana. Of the 142 enrolled participants who had complete adherence data and reported being on ART at the time of hospital admission, 43% (61/142) reported missing at least one ART dose during labor, delivery, and postpartum, including almost 20% (28/142) missing 2 or more consecutive doses. Women who reported frequently missing ART doses during pregnancy had higher odds of reporting missed doses during their intrapartum and postpartum hospital stays. Among those with inpatient ART interruption, the most frequently cited reasons were: forgetting medication at home (42%) and challenges of being in or recovering from labor (29%). Maternal perception of infant health at birth, hospital level of care, and frequency of missing HIV medications during pregnancy were associated with incomplete ART adherence during the intrapartum and early postpartum inpatient stay. An enabling clinical environment to facilitate access to ART during inpatient stays may have positive implications for ART adherence.

A socioecological description of the influencing factors to midwives' management of preeclampsia in a Ghanaian tertiary hospital.

In low-resource settings, midwives are the first contact for women with preeclampsia and lead the coordination of care. Unfavourable preeclampsia outcomes create a burden for women, families, and the health system. It is therefore important to understand the unique context of midwives' practice and the complex factors that influence the delivery of maternal healthcare. This qualitative study explored the perspectives of key stakeholders in a tertiary hospital in Ghana regarding the facilitators and barriers influencing midwives' provision of preeclampsia care using a socioecological model. Semi-structured interviews were conducted with 42 participants comprising senior managers (n = 7) and hospital midwives (n = 35) in 2021. Thematic analysis used Braun and Clarke's six-step method, and the findings were organised within four levels of the socioecological model: individual, interpersonal, organisational, and public policy. Two main themes were identified: 1) Facilitators of preeclampsia management, and 2) Barriers to preeclampsia management. Facilitators were identified at three levels (individual, interpersonal, and organisational) and included midwives' knowledge of preeclampsia; midwives' self-efficacy; midwives' skillset to enhance preeclampsia care; collaborative practice; and strategies for preeclampsia care quality improvement. At the individual level, the barriers were inadequate pre-service preparation, lack of evidence-based midwifery care, and colleagues' work attitudes. Hierarchical decision-making and staff views of women's risk perceptions were identified as barriers at the interpersonal level. At the organisational level, the barriers were: scarce resources and staff shortages, and a lack of midwifery-specific guidelines. Two barriers were identified within the public policy level: the high cost of preeclampsia care and issues with the referral system. Multi-faceted factors play a significant role in midwives' management of preeclampsia. Hence context-specific multi-level interventions have the potential to improve the quality-of-care women in Ghana receive.

Attitude and preventive practices of pressure ulcers among orthopedic nurses in a tertiary hospital in Ghana.

Pressure ulcers (PUs), which affect millions of people worldwide, are among the five most prevalent hospitalized cases causing adverse impairment. Nevertheless, pressure ulcers are largely preventable, and their management depends on their severity. The authors, therefore, explored the attitude and preventive practices of pressure ulcers among orthopedic nurses in a tertiary hospital in Ghana. An exploratory descriptive qualitative approach was employed for this study to help researchers explore the attitude and practices toward PU (Pressure Ulcer). Purposive sampling approach was employed, and data was analyzed using thematic content analysis. The sample size for this study was 30 which was obtained based on saturation. Participants were engaged in face-to-face interviews which were transcribed verbatim. Two themes and eight subthemes were generated from the analysis of this study. The two themes were preventive practices and attitude towards PU. The study identified that there were no specific protocols illustrated on the wards for managing pressure ulcers. Nevertheless, the study participants were keen on preventing pressure ulcers and hence engaged in practices such as early patients' ambulation, early identification of PU signs, removing creases and crumps from patient beds, nutritional management for PU prevention, and dressing of PU wounds. Practices of pressure ulcer management were highly valued by the orthopedics nurses. Hence, the nurses recommended the need for accepted guidelines on pressure ulcer management to be illustrated in the various orthopedic wards in the country.

A qualitative exploration of the spiritual wellbeing of women with advanced cervical cancer in Ghana.

Spiritual wellbeing is one of the most important aspects of human health, alongside physical, psychological and social factors. Religiosity/spirituality can play a critical role in the lives of people experiencing life-threatening illnesses, such as cervical cancer. Most women with cervical cancer in Africa, including Ghana, are diagnosed at the advanced stage. These women lean on their spiritual connections for strength during their illness. Despite the fact that numerous studies have been conducted on the relevance of religiosity/spirituality in the experience of cancer in other jurisdictions, the same cannot be said about Ghana. The study aims to fill this gap in the literature. To explore the spiritual wellbeing of women diagnosed with advanced cervical cancer in Ghana. A qualitative explorative design was employed, with purposive sampling used to recruit 15 women with advanced cervical cancer from a cancer treatment centre of a teaching hospital in Ghana. Individual face-to-face interviews, lasting between 45-90 minutes, were used to gather information. Interviews were audio taped with participants' consent. Data were analysed using thematic content analysis. The following sub-themes were identified within one overarching theme of the spiritual wellbeing of women with advanced cervical cancer: the meaning of illness and acceptance; a sense of hope and religiosity; uncertainty; and the will to live. Many participants believed they were bewitched, and the devil was responsible for their cervical cancer. Healthcare providers should adopt a multi-disciplinary approach and widen their care strategies to include spirituality, to enhance the treatment outcomes of women living with advanced cervical cancer.