Komfo Anokye Teaching Hospital Research Articles

Whole-Genome Sequences of Two Multidrug-Resistant Acinetobacter baumannii Strains Isolated from Patients with Urinary Tract Infection in Ghana.

Multidrug-resistant Acinetobacter baumannii is a major nosocomial pathogen. We describe the whole-genome sequences of two multidrug-resistant Acinetobacter baumannii strains isolated from hospitalized patients in the intensive care unit at Komfo Anokye Teaching Hospital in Ghana. The isolates carry multiple resistance genes, including those for β-lactams, sulfonamides, aminoglycosides, and tetracycline.

Reproductive Factors and Risk of Breast Cancer by Tumour Subtypes Among Ghanaian Women: A Population-Based Case-Control Study

Background: Women of African ancestry have a higher proportion of early-onset and oestrogen receptor (ER) negative cancers compared to women of European ancestry. Differences in risk factor distributions and associations by age at diagnosis and ER status might explain this disparity. Methods: We analysed data from 1,126 women with invasive breast cancer and 2,106 population controls aged 18-74 years recruited from three hospitals in Ghana from 2013-2015. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for menstrual and reproductive factors using polytomous logistic regression models adjusted for potential confounders. Findings: Among controls, the medians for age at menarche, parity, age at first birth and breastfeeding/pregnancy were 15 years, 4 births, 20 years, and 18 months, respectively. For women >50 years, parity and extended breastfeeding were associated with decreased risks: >5 births vs. nulliparous, OR 0·40 (95% CI 0·20-0·83), and 0·71 (95% CI 0·51-0·98) for >19 vs. <13 breastfeeding months/pregnancy, which did not differ by ER. In contrast, for earlier onset cases (<50 years) parity was associated with increased risk for ER-negative tumours (p-heterogeneity by ER=0·02), which was offset by extended breastfeeding. Similar associations were observed by intrinsic-like subtypes. Less consistent relations were observed with ages at menarche and first birth. Interpretation: Reproductive risk factor distributions were different from European populations, but exhibited aetiologic heterogeneity by age at diagnosis and ER status similar to other populations. Differences in reproductive patterns and subtype heterogeneity are consistent with racial disparities in subtype distributions. Funding: Intramural program of the National Cancer Institute. Declaration of Interest: Authors have no conflicts of interest to declare. Ethical Approval: The study was approved by the Special Studies Institutional Review Board of the National Cancer Institute (Rockville, MD, USA), the Ghana Heath Service Ethical Review Committee and institutional review boards at the Noguchi Memorial Institute for Medical Research (Accra, Ghana), the Kwame Nkrumah University of Science and Technology (Kumasi, Ghana), the School of Medical Sciences at Komfo Anokye Teaching Hospital (Kumasi, Ghana), and Westat (Rockville, MD, USA). All participants provided written informed consent.

Survival Analysis of Birth Defect Infants and Children with Pneumonia Mortality in Ghana

Despite the global decline in infant and child mortality rate, Ghana has failed to record any substantial improvement. In this study, we investigated the effects of some selected risk factors on infant and child survival in Ghana. This study used data from Komfo Anokye Teaching Hospital. 295 infants and children were followed up and time to first occurrence of death was recorded for each infant and child. The life table and Kaplan-Meier methods and the Cox proportional model were used for statistical analyses. The log-rank test statistic was used to test for difference in the survival curves. The results showed that the risk of death among those with birth defects or pneumonia was relatively higher and there is statistically significant difference in the risk of dying between infants with birth defects and those with no birth defects. Also, there is statistically significant difference in the risk of death between children with pneumonia and those with no pneumonia. Our analyses showed that birth defects, preterm birth, accidents, and pregnancy complications are significant risk factors of infant survival. Also, pneumonia, preterm birth, accidents, and diarrhoea are significant risk factors of child survival. Maternal care services should be made available and accessible and mothers should be educated on the importance of maternal care services utilization in order to reduce or mitigate the risk of infant and child mortality. Also, initiating the immunization activities with PCV-13 and Rota-Virus Vaccines, which will reduce Pneumonia and diarrhoea and will improve survival of infants and children under five, should be encouraged or implemented.

MON-266 PATTERN OF RENAL DISEASES AT KOMFO ANOKYE TEACHING HOSPITAL, KUMASI-GHANA: A 13-YEAR REVIEW

Renal diseases is one of the common and rising problem among Sub-Saharan African especially Ghana. The increase in the prevalence of renal disease is characterized by late presentation, under reporting, poor literacy level of most patients and inability to afford renal replacement therapy. The main aim of this study was to review the clinical presentation, diagnosis, treatment and outcome of patients with renal disease at Komfo Anokye Teaching Hospital (KATH), Kumasi-Ashanti Region of Ghana, over a 13 years’ period, 2005–2017.

Profile of unnatural mortalities in Northern part of Ghana; a forensic-based autopsy study

IntroductionBereavement is usually difficult to come to terms with. However, sudden, violent or traumatic death can be particularly hard to accept for any family, group or nation as a whole.A retrospective study of all autopsies on unnatural and traumatic deaths of medico-legal importance was made at the Komfo Anokye Teaching Hospital from 2008 to 2016. MethodsInformation on cause of death and other relevant detail as well as demographics were extracted from the Autopsy Log Book of the department of pathology, Komfo Anokye Teaching Hospital where data on cause of death from autopsy findings and other relevant data were gathered and kept secured. The data was then analyzed using SPSS version 22. ResultsFindings from the study showed that Road Traffic Accidents (RTA) contributed to 58.51% of the total forensic death cases of a total of the 1470 registered unnatural deaths. Males accounted for 75.37% of deaths as compared to 24.63% for females. The mean age for the various cause of unnatural deaths was 34 years. The age ranges from a minimum of 0.02 year (1 week) to a maximum of 97 years with median age of 33. The modal age is 30 years with 75 cases. 1108 males and 362 females were involved, resulting in a gender ratio of 3:1. The age group 30–39 recorded the highest percentage of deaths due to Hanging, Gunshots, RTA and Falls with 22.45%, 34.69%, 21.75% and 25.44% respectively. Children aged ≤9 recorded the highest number of deaths due to chemical poisoning and drowning with 25.5 8% and 40.00% of cases respectively. People in the extremes of ages (≤9 and ≥ 70) recorded the least number of death cases by percentage. ConclusionRoad traffic accident is therefore the leading cause of unnatural traumatic deaths as it accounted for more than half of all unnatural traumatic death cases reported within the study period. Men, especially the youth are also more prone to violent unnatural deaths compared to women in general. It is shown that, men die more in the various categories than women. Males are likely to die on the average, 3 times more than the females by any of the causes of deaths.

Prevalence and the evaluation of culture, wet mount, and ELISA methods for the diagnosis of Trichomonas vaginalis infection among Ghanaian women using urine and vaginal specimens

BackgroundThe services of most clinical laboratories in Africa regarding the diagnosis of Trichomonas vaginalis are largely dependent on the urine direct wet-mount method. However, the exclusive use of urine-based detection may not be appropriate. The culture method is considered the “gold standard” for the diagnosis of T. vaginalis. However, this method has a relatively longer turn-around time and is limited by non-viable organisms in the specimen. This study assessed the prevalence of T. vaginalis and its associated risk factors and evaluated its diagnosis using urine and vaginal samples from symptomatic female out-patients by culture, direct wet-mount, and ELISA method respectively.MethodsThis cross-sectional study was conducted at the Obstetrics and Gynaecology department of the Manhyia District hospital (MDH) and Komfo Anokye Teaching Hospital (KATH), Ghana. Ghanaian sexually active female adults between the ages of 18 and 50 years old were recruited for this study. Vaginal (HVS) and urine samples were collected from each participant, and T. vaginalis infection was assessed based on culture, direct wet mount, and ELISA methods.ResultsThe prevalence of T. vaginalis infection based on the ELISA method, HVS culture, and HVS wet mount were 7.2%, 5.0%, and 1.7%, respectively. Urine culture presented with a 0.6% prevalence rate while urine direct wet mount detected no positive case. There was no statistically significant association between demographic and clinical characteristics and T. vaginalis infection, except for subjects presenting with abdominal pain [OR = 5.42, 95% CI (1.35–21.73), p = 0.017]. Using HVS culture as the reference, ELISA performed best compared to the other methods assessed in this study, presenting with the highest sensitivity [88.9%, 95% CI (54.0–99.8)], specificity [97.1%, 95% CI (93.1–98.9)], AUC (93.0%), and accuracy (96.7%).ConclusionThe prevalence of T. vaginalis infection is high among women in Ghana. With the exception of abdominal pain, there is no significant association between demographic and clinical characteristics and T. vaginalis infection. In the event where the culture method is unavailable or when rapid diagnosis is required, antigenic detection using ELISA is the most accurate for the diagnosis of T. vaginalis infection in women compared to urine wet-mount/culture and the HVS wet-mount method.

Predominant Complications of Type 2 Diabetes in Kumasi: A 4-Year Retrospective Cross-Sectional Study at a Teaching Hospital in Ghana.

Background and objectives: Diabetes mellitus type 2 (T2DM) has been associated with several microvascular and macrovascular complications. However, studies regarding the predominant complications of T2DM in Ghana have not been conducted. This study evaluated the prevalence and predominant complications of T2DM and assessed the sociodemographic factors associated with the development of diabetes-related complications in Kumasi, Ghana. Materials and Methods: This was a retrospective cross-sectional study conducted at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. A total of 1600 Ghanaian T2DM adults were included in this study. Patients’ clinical data from 2012 to 2016 were retrieved from the hospital’s archive. Results: The prevalence of macrovascular and microvascular complications of T2DM was 31.8% and 35.3% respectively. The prevalence of neuropathy, nephropathy, retinopathy, sexual dysfunction, diabetic keto-acidosis (DKA), and hypoglycemia were 20.8%, 12.5%, 6.5%, 3.8%, 2.0%, and 0.8% respectively. Sexual dysfunction was significantly associated with the male gender compared to females. Being employed: Informal (aOR = 0.479, p < 0.0001), and Formal (aOR = 0.475, p = 0.0008) was associated with lower age- and sex-adjusted odds of developing T2DM-related complications while having T2DM for 5–10 years (aOR = 1.550, p = 0.0009) and more than 10 years (aOR = 2.755, p < 0.0001) was associated with increased odds of developing complications. Conclusions: Microvascular complication is the most predominant among T2DM in Kumasi, Ghana. The most prevalent T2DM-related microvascular complication in Kumasi, Ghana is neuropathy. Sexual dysfunction is associated with male compared to female T2DM patients. Being employed reduces the chance of developing T2DM-related complications while increasing DM duration increases the risk of complications.

Evaluation of Metabolic Syndrome and Its Associated Risk Factors in Type 2 Diabetes: A Descriptive Cross-Sectional Study at the Komfo Anokye Teaching Hospital, Kumasi, Ghana.

Background. Metabolic syndrome (MS) is a collection of cardiovascular risk factors comprising insulin resistance, dyslipidemia, obesity, and hypertension, which may cause further complications in diabetes. Although metabolic syndrome (MS) is increasing in incidence in diabetics and leading to significant cardiovascular diseases and mortality, there is dearth of data in Ghana. This study investigated metabolic syndrome, its prevalence, and its associated risk factors in type 2 diabetes at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Methods. The study involved 405 diabetic patients attending the Diabetic Clinic of the Komfo Anokye Teaching Hospital (KATH) Kumasi, in the Ashanti Region of Ghana. A well-structured questionnaire was used to obtain demographic background such as their age and gender. Anthropometric measurements were obtained using the Body Composition Monitor (Omron ® 500, Germany) which generated digital results on a screen and also by manual methods. Fasting venous blood was collected for the measurement of biochemical parameters comprising fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), high density lipoprotein cholesterol (HDL-c), and triglyceride (TG). Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Results. Out of the total of 405 participants, 81 were males and 324 were females, and the estimated mean age was 58.5 ± 9.9 years. The female patients exhibited higher mean waist circumference (WC) and mean hip circumference (HC) as well as an approximately higher body mass index than males (28.3 ± 5.1, 26.5 ± 4.2 for the female and male respectively). Overall, the prevalence of metabolic syndrome observed among the study population was 90.6%. Conclusions. The prevalence of metabolic syndrome observed among the study population was 90.6%, with a higher percentage in females than males. High triglyceride levels and high waist circumference were the main risk factors for MS in the diabetic population.

Why Patients Refuse to Enroll in Hospital-Based Research: Perception of Patients Presenting to KATH Emergency Department

Introduction:Komfo Anokye Teaching Hospital Emergency Department (KATH ED) is a tertiary referral center in Ghana. Anecdotally, patients seeking care at KATH ED do not actively participate in research initiatives.Aim:To find out why patients presenting to KATH ED do not enroll in research studies that are conducted in the department.Methods:The study was a cross-sectional survey of patients presenting to the ED for one month in June 2017. A semi-structured questionnaire was presented to patients presenting to KATH ED from 8:00-20:00 each day. Patients who were interviewed were all patients presenting to the ED for care, including those who had refused to enroll in the ongoing ACESO study. Patients had to be conscious, alert, and with conditions that did not require immediate management.Results:35% of the interviewees (91/260) had been approached to enroll in research studies at some point in the past. 13.5% had refused to enroll in a research study. 45.7% of those who refused to enroll admitted that they were afraid to enroll in a study; 28.6% had inadequate information and 22.9% perceived enrolling in a study would delay their treatment. The Akan language (73%) was most commonly used by research assistants then English (26%), and finally Hausa (1%) to interact with patients. There was a significant association between educational background and explaining a study to a patient before they enrolled. Males were more willing to enroll in an ongoing study compared to females. All age groups correlated significantly with being approached to enroll in a research study and similarly all age groups also correlated with refusing to enroll in a research studyDiscussion:Patients are paramount to hospital research. Efforts must be made to ensure that patients concerns and needs are addressed to ensure increasing participation.

Quality of life among patients with moderate to advanced chronic kidney disease in Ghana - a single centre study

BackgroundThe prevalence of chronic kidney disease (CKD) is increasing worldwide and in Africa. Health related quality of life (QOL) has become an essential outcome measure for patients with CKD and end stage renal disease (ESRD). There is growing interest worldwide in QOL of CKD patients but paucity of data in Ghana. This study sought to assess QOL in patients with moderate to advanced CKD (not on dialysis) and establish its determinants.MethodsWe conducted a cross sectional observational study at the renal outpatient clinic at Komfo Anokye Teaching Hospital (KATH). We collected demographic, clinical and laboratory data. A pretested self-administered Research and Development corporation (RAND®) 36-Item Health Survey questionnaire was administered and QOL scores in physical component summary (PCS) and mental component summary (MCS) were computed. Determinants of QOL were established by simple and multiple linear regression. P value of < 0.05 was considered statistically significant.ResultsThe study included 202 patients with CKD not on dialysis. There were 118(58.5%) males. Mean age was 46.7 ± 16.2 years. The majority, 165(81.7%) of patients were on monthly salaries of less than GHS 500 (~USD 125). Chronic glomerulonephritis was the most common cause of CKD in 118 (58.5%) patients followed by diabetes mellitus in 40 (19.8%) patients and hypertension in 19 (9.4%) patients. The median serum creatinine was 634.2 μmol/L (IQR 333–1248) and the median eGFR was 7 ml/min/1.73m2 (IQR 3–16). The most common stage was CKD stage 5 accounting for 143 (71.1%), followed by CKD stage 4 with 45 (22.4%) of cases and 13 (6.5%) of CKD stage 3. The overall mean QOL score was 40.3 ± 15.4. MCS score was significantly lower than PCS score (37.3 ± 10.8 versus 43.3 ± 21.6, P < 0.001). Multiple linear regression showed that low monthly income (p = 0.002) and low haemoglobin levels (p = 0.003) were predictive of overall mean QOL.ConclusionPatients with moderate to advanced CKD had low-income status, presented with advanced disease and had poor QOL. Anaemia and low-income status were significantly associated with poor QOL.

Knowledge and Health Seeking Behaviour of Breast Cancer Patients in Ghana.

Background Breast cancer is a major contributor to cancer-related deaths among women worldwide, despite the numerous measures employed to prevent and manage the disease. This study explored the knowledge and health seeking behaviour of breast cancer patients at the Komfo Anokye Teaching Hospital. Methods A descriptive cross-sectional study was conducted at Komfo Anokye Teaching Hospital in Kumasi, Ghana, from June 2014 to July 2014. Thirty-five participants were purposively selected. The responses to questions about their experiences with breast cancer were determined using indepth interviews. Transcripts were coded and analysed using NVIVO version 10.0. Results Participants' knowledge about signs and symptoms of breast cancer after their diagnosis was high but low for risk factors. Screening for breast cancer through self-breast examination was infrequently performed prior to their diagnosis. The patients' first point of care was generally health facilities. Some patients reported late due to misinterpretation of signs and symptoms, cultural influences and fear of losing their breast to surgery, physician delay, health providers' laxity, and disinterest in breast cancer. Men, for example, husbands, decide on where and when breast cancer patients go for treatment. Conclusion There is poor knowledge of the risk factors for developing breast cancer. Patients resorted to the hospital as first options for cure but were generally delayed in doing so. There is the need to create awareness about breast cancer among the general population.

20 year trends in renal disease mortality in Ghana: A review of autopsies.

Data on the changing levels in renal morbidity and mortality are scant globally. We sought to assess trends in renal disease mortality and attributable causes over a 20 year period in Ghana. A retrospective analysis of 20 year autopsy records of the Pathology Departments of leading teaching hospitals in Ghana, (Korle-Bu Teaching Hospital (KBTH) in Accra and Komfo Anokye Teaching Hospital (KATH) in Kumasi) from January 1994 to December 2013. Data comprising autopsies from in-patients, community cases and coroners' cases were used. We defined primary cause of death as death directly due to renal disease and secondary cause of death as death in which renal disease was a comorbid or contributing factor. Over the period, there were a total of 94 309 deaths, of which 5608 were attributed to renal disease (5.9/100). Mortality rate remained fairly the same from 1994 to 2009 (5.0%), but doubled from 2010 to 2013 (10.8%). Similar trends were observed among males and females during the same period. However, males had slightly higher mortality rates (6.6%; 95% CI: 46.1%-6.8%) compared to females (5.6%; 95% CI: 5.4%-5.8%; P = 0.271). The major leading attributable causes of renal disease death include end stage renal disease 45.0% and acute pyelonephritis accounting for 20.9% of the cases. Hypertensive heart disease accounted for 30.0% of all secondary cause of death while congestive heart disease and septicaemia accounted for 13.0% and 12.0%, respectively. We observed marked increase in the renal disease mortality rate during the last few years predominantly driven by chronic and infectious related renal diseases as a main cause, and hypertensive heart disease and congestive heart failure as the main secondary causes. Measures geared towards prevention, treatment and managing such conditions may impact on the reduction of renal disease mortality rate among Ghanaian populations.

Complications of Falciparum Malaria Infections among Ghanaian Children; from the Healthcare Personnel’s Perspective

Background and Aim: Malaria is known to be the most widespread tropical disease and a chief cause of morbidity and mortality in Africa. This study was conducted to determine some common complications of falciparum malaria in children, from the perspective of healthcare personnel in Kumasi, Ghana.&#x0D; Materials and Methods: This questionnaire-based cross-sectional study was carried out at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. The study population included health care professionals working at the children`s unit of the hospital. About 80 healthcare personnel were recruited to partake in the survey for eliciting views on malaria. Questionnaires were used to capture some symptoms and complications of malaria from the health workers’ point of view.&#x0D; Results: More than half of the healthcare personnel were males (52.5%), and majority of the participants were medical officers. The study participants elaborated on some common malaria symptoms among children. Fever recorded the highest frequency, represented by 98.8%, followed by general malaise (97.4%), nausea and vomiting (93.8%), chills (78.8%) and headaches (72.5%). Prostration (45.0%), hyperpyrexia (38.75%) and hypoglycemia (13.75%) were the most frequently reported complications by the respondents. Majority of the participants reported cerebral malaria (30.0%), severe anemia (23.75%), acute respiratory distress (17.5%) and repeated generalized convulsions (16.25%) to be the most lethal feature of complicated malaria infection in children. The overwhelming majority of the respondents (90.0%) use the WHO 2014 standard (page2) as guide for determining complicated malaria.&#x0D; Conclusion: Prostration with hyperpyrexia and hypoglycemia were the most common features of falciparum malaria from the perspective of healthcare personnel in Kumasi, Ghana.

Nutritional status of children with sickle cell disease

PurposeThis study aims to assess the nutritional status of children with sickle cell diseases using anthropometric measurements, biochemical markers and dietary intakes.Design/methodology/approachThe study was conducted in 100 children of 3-12 years of age with sickle cell diseases (SCDs) at the Komfo Anokye Teaching Hospital in the Kumasi Metropolis of Ghana. Weight, height and age of participants were used to calculate body mass index-for-age. The mid-upper-arm-circumference-for-age, weight-for-age (percentiles) and height-for-age (percentiles) were compared with standards growth charts for children. Biochemical measures such as serum albumin and ferritin, as well as full blood count, were assessed. Dietary intake was assessed using 24-h dietary recall and food frequency questionnaire.FindingsFrom the study, 73 and 37 per cent of the children with SCD recorded inadequate intake of iron and vitamin E, respectively, when compared to the recommended daily allowance. Out of the 100 participants, 37 per cent were underweight and 22 per cent were stunted. There was significant difference (p&lt; 0.05) in underweight (weight-for-age) prevalence by gender. A multiple variate regression showed a significant association between zinc (r2= 0.763,p&lt; 0.05) and haemoglobin levels.Originality/valueThe evidence in this paper is relevant for treatment, health education and nutritional counselling of parents with children who have SCD.

Incidence and determinants of diabetes-related lower limb amputations in Ghana, 2010\u20132015- a retrospective cohort study

BackgroundDiabetes-related lower limb amputations (LLA) are associated with significant morbidity and mortality. Although the incidence has decreased over the past two decades in most High-Income Countries, the situation in Low-Middle Income Countries (LMIC), especially those in sub-Saharan Africa (SSA) is not clear. We have determined the incidence and determinants of diabetes-related LLA in Ghana.MethodsThis was a tertiary-care-based retrospective cohort study involving patients enrolled in the diabetes clinic of Komfo Anokye Teaching Hospital, Ghana from 1st January 2010 to 31st December 2015 after a median follow-up of 4.2 years. Demographic characteristics and clinical variables at baseline were recorded. The primary outcome was new diabetes-related LLA in each year under study. Cox proportional hazard regression models were used to describe the associations of diabetes-related LLA.ResultsThe mean age at enrolment for the cohort was 55.9 ± 14.6 years, with a female preponderance (62.1%). The average incidence rate of diabetes-related LLA was 2.4 (95% CI:1.84–5.61) per 1000 follow-up years: increasing from 0.6% (95% CI:0.21–2.21) per 1000 follow up years in 2010 to 10.9% (95% CI:6.22–12.44) per 1000 follow-up years in 2015. Diabetes-related LLA was associated with increased age at enrollment (for every 10 year increase in age: HR: 1.11, CI: 1.06–1.22, p < 0.001), male gender (HR: 3.50, CI:2.88–5.23, p < 0.01), type 2 diabetes (HR 3.21, CI: 2.58–10.6, p < 0.001), high Body Mass Index (HR: 3.2, CI: 2.51–7.25 p < 0.001), poor glycemic control (for a percent increase in HbA1c, HR:1.11, CI:1.05–1.25, p = 0.03), hypertension (HR:1.14, CI:1.12–3.21 p < 0.001), peripheral sensory neuropathy (HR:6.56 CI:6.21–8.52 p < 0.001) and peripheral vascular disease (HR: 7.73 CI: 4.39–9.53, p < 0.001).ConclusionThe study confirms a high incidence of diabetes related-LLA in Ghana. Interventions aimed at addressing systemic and patient-level barriers to good vascular risk factor control and proper foot care for diabetics should be introduced in LMICs to stem the tide of the increasing incidence of LLA.

A qualitative assessment of perceived barriers to effective therapeutic communication among nurses and patients

BackgroundTherapeutic communication is essential in the provision of quality healthcare to patients. The purpose of this study was to explore the perceived barriers to effective therapeutic communication among patients and nurses at Komfo Anokye Teaching Hospital,Kumasi.MethodsAn exploratory study design was employed using a qualitative approach. A purposive sampling technique was used to select 13 nurses and patients who were interviewed using an unstructured interview guide. Interviews were audio-taped, transcribed verbatim and analyzed using thematic content analysis.ResultsPatient-related characteristics that were identified as barriers to effective therapeutic communication included socio-demographic characteristics, patient-nurse relationship, language, misconception, as well as pain. Nurse-related characteristics such as lack of knowledge, all-knowing attitude, work overload and dissatisfaction were also identified as barriers to effective therapeutic and environmental-related issues such as noisy environment, new to the hospital environment as well as unconducive environment were identified as barriers to effective therapeutic communication among patients and nurses at Komfo Anokye Teaching Hospital,Kumasi.ConclusionNurse-patient communication is an inseparable part of the patients’ care in every health setting; it is one of the factors that determine the quality of care. Several patient-related characteristics, nurse- related characteristics and environmental-related issues pose as barriers to effective therapeutic communication at Komfo Anokye Teaching Hospital,Kumasi and have ultimately; resulted in reducing effective communication at the wards. Therefore, all the barriers must be eradicated to promote effective therapeutic communication.

Hurdles to the Development of the “Surgical Home” in the Low-Resource World

This chapter assesses the current state of practice of anesthesia in a low-resourced hospital and the hurdles envisaged in the development of perioperative surgical home, PSH, at the Komfo Anokye Teaching Hospital, KATH in Ghana. In the PSH model, the patient’s experience of care is coordinated by a Director of Perioperative Services, additional Surgical Home Leadership, and supportive personnel, which constitute an interdisciplinary team. KATH is yet to establish working structures that provide a solid foundation that would make implementation of this model possible. Foundational tenets of the PSH being operating room (OR) managers or directors, interdisciplinary teamwork, well-oriented and motivated staff, appreciation of the key roles of the anesthetist by both patients and surgeons among others are either not well established or nonexistent currently at KATH. While KATH has the basic infrastructure and personnel compared to other low-resourced countries for delivery of safe anesthesia, there exist several important limitations to the successful establishment of the PSH practice. Besides having to operate currently on limited funding, the necessary interdepartmental cohesion and acceptance of the anesthetist to lead any such model present an important hurdle to be surmounted.

Outcomes in medical admissions with hyponatraemia in Ghana – a single-centre study

Introduction: Hyponatraemia is the most common electrolyte abnormality in hospitalized patients and is associated with poor prognosis and high mortality. There is a paucity of data on hyponatraemia in Ghana. We set out to describe the prevalence of this condition, its associations and the outcomes in terms of in-hospital mortality and length of hospital stay. Methods: We conducted a retrospective study of all admissions from October 2017 to April 2018 on the medical ward at the Komfo Anokye Teaching Hospital (KATH). Demographic information, medical diagnoses as well as clinical and laboratory data were documented. Means (± standard deviation) were recorded for normally distributed data, whereas non-normally distributed data were recorded as medians [interquartile range (IQR)]. Chi-squared and Fisher’s exact tests were used to test categorical variables. ANOVA and Kruskal-Wallis tests were used for the analysis of hyponatraemia severity; a p value of < 0.05 was considered statistically significant. Results: Within the study period, 406 patients with hyponatraemia were identified in 1477 medical admissions, a prevalence of 27.6%. Their mean age was 51.5 ± 19.0 years. There were 217 males (53.5%). The mean serum sodium was 128.7 ± 6.5 mmol/L. Two hundred and forty (59%) had mild hyponatraemia, 106 (26%) had moderate hyponatraemia and 60 (15%) had severe hyponatraemia. The most common associated medical conditions were infections (26%), chronic liver disease (17%), hyperglycaemia (17%), chronic kidney disease (16%) and chronic heart failure (8%). In-hospital mortality was 31.8% and varied with the severity of the hyponatremia. The median length of hospital stay was 7 days (IQR 4–10 days) and did not vary with the severity of hyponatraemia. Mortality was associated with serum sodium concentration (p = 0.007) and lower levels of consciousness (Glasgow Coma Scale, GCS, ≤ 13) at presentation (p < 0.001). Conclusions: Hyponatraemia is common in medical admissions in Ghana, and is mostly associated with infections, and chronic liver, kidney and heart diseases. It is associated with high in-hospital mortality, especially when hyponatraemia is more severe or accompanied by relatively low GCS scores.

Recognizing and appraising symptoms of breast cancer as a reason for delayed presentation in Ghanaian women: A qualitative study.

BackgroundThe burden of late presentation is well established in women presenting with advanced breast cancer in Africa. This paper aims to explore the reasons for delayed presentation in Ghanaian women with breast cancer.MethodEleven (11) women diagnosed with advanced breast cancer were purposively sampled within three years of diagnosis at the palliative care clinic of the Komfo Anokye Teaching Hospital, Ghana. Participation was voluntary. Data was collected through in-depth interviews using a self-devised semi-structured interview guide. The interviews were conducted in “Twi” (local language), audio-tape recorded and covered the women’s journey from symptom discovery to their intention to seek help. All audio-taped interviews were transcribed based on the meaning of the respondents’ comments. The data was managed using Nvivo version 11 qualitative software. Data was analyzed concurrently with data collection applying the principles of thematic analysis.Key findingsAll the women delayed presentation due to overlapping reasons. Symptom appraisal among the women occurred in two main stages: individual understanding of breast symptom and interactive understanding of the breast symptom. These stages were based on cognitive, psycho-cultural and social factors. The five main themes generated from the data were: symptom experience, knowledge of breast cancer, role of social life and network, coping with a breast symptom and lastly intent to seeking health care. A conceptual model was developed to illustrate the relationships among the key factors and concepts emanated from this study.ConclusionRecognition and appraisal of breast cancer symptom in the eleven (11) Ghanaian women interviewed in this study was poor. For instance, a painless breast lump was considered not serious until a sensory symptom appears. This led women to experience appraisal and time point intervals. To minimize the incidence of late presentation of breast cancer cases in Ghana, adequate educational intervention should be provided for Ghanaian women and their social network, and other stakeholders.

Waist circumference and hip circumference as potential predictors of visceral fat estimate among type 2 diabetic patients at the Komfo Anokye Teaching Hospital (KATH), Kumasi-Ghana

ABSTRACTBackground: Although visceral fat (VF) and its influence on cardiovascular diseases have been extensively studied among diabetic patients, there is a need for an easier, and less expensive but equally good predictor for VF. This study was conducted to assess potential anthropometric measurements that can be directly linked to visceral fat levels among diabetic patients.Method: 405 diabetic patients attending the Diabetic clinic of the Komfo Anokye Teaching Hospital (KATH) in Kumasi-Ghana were recruited. A well-structured questionnaire was used to obtain the demographic background and brief medical history. Anthropometric measurements were obtained by direct measurement and visceral fat levels was measured using the Body Composition Monitor (Omron ® 500, Germany) which generated digital results on a screen.Results: The total participants comprised 81 males and 324 females, with an average age of 58.5 ± 9.9 years. The females exhibited a higher mean waist circumference (101.4 ± 12.3 cm) and average hip circumference (104.6 ± 9.9 cm) than the males. The female participants also had higher body mass index (BMI) (28.3 ± 5.1 kg/m2) compared to males (26.5 ± 4.2 kg/m2). The association between VF and waist circumference was r = 0.631, p ˂ 0.001, followed by hip circumference (r = 0.536; p < 0.001). The significant predictive abilities of waist circumference and hip circumference to identify diabetic patients with high visceral fat were AUC = 0.787; p ˂ 0.001 and AUC = 0.786; p ˂ 0.001, respectively.Conclusion: Waist circumference and hip circumference promise to be potential alternative predictors of visceral fat accumulation in type 2 diabetes.