Komfo Anokye Teaching Hospital Research Articles

Breast Cancer Awareness Among Nurses in Kumasi, Ghana: Knowledge, Attitudes and Practice

Background: There is no published data on breast cancer awareness among the Ghanaian population in the country.Objectives: To determine the level of breast cancer awareness of among nurses at the Komfo Anokye Teaching Hospital (KATH) Kumasi.Method: A standard self-administered questionnaire was distributed among the qualified nurses (degree, diploma, and certificate-SRN holders) in the departments of Surgery, Medicine, Obstetrics and Gynaecology and Paediatrics at KATH. The questionnaire sought to investigate the level of knowledge on several aspects of breast cancer among the nurses; these include the symptoms, methods ofdiagnosis, risk factors, and methods of screening for the disease – breast self-examination, clinical breast examination and mammography. The completed questionnaire were retrieved, graded and scored. Results: The response rate was 53.9% (165/306). Mean knowledge score was 68.9%. Ninety respondents (54.5%) knew about one or two out of five risk factors. One hundred and fifty-nine participants (94.5%) thought that breast cancer was a serious disease. One –hundred and thirty-five respondents (81.8%) indicated that they would see a doctor on the same day that they develop breast cancerand 102(61.8%) would accept mastectomy as treatment of the disease. Breast self-examination was practiced by 119 or 72.0% of the respondents. Respondents who were highly knowledgeable of breast cancer practiced clinical breast examination more frequently (27/93); (8/72) (X2 = 9.4, p=0.001). The practice of all three screening methods was less frequent (>5%) among all the participants.Conclusion: In general terms the nurses at KATH have adequate knowledge about several aspects of breast cancer. Knowledge of risk factors, the practice of clinical breast examination and the use of mammography is low.

Emergency Thoracic Surgery in Chest Trauma at the Komfo Anokye Teaching Hospital in Ghana: The Role of Sternotomy and Thoracotomy

Objective: Chest trauma, as blunt or penetrating injury, account for significant amount of all traumatic injuries. They are associated with high mortality of about 75% of all trauma-related deaths, either from direct or indirect consequence of the injury. Nearly 80-85 % of chest trauma is managed conservatively with only about 10-15 % needing emergency surgery.Methodology: A retrospective cohort study of patients presenting with chest trauma and undergoing emergency thoracic surgery at the Komfo Anokye Teaching Hospital from January 2015 to June 2020 was carried out.Results: There were 29 patients, with 82.8% (24) being males. The mean age was 33.8 ± 15.0 years with range of 5-65 years. The leading mechanism of chest trauma was penetrating chest injury, which accounted for 51.7% (15). Eighteen (86%) patients underwent exploratory thoracotomy with 5 (10%) having exploratory sternotomy and the remaining 4% undergoing other procedures. Fourteen (82.1%) patients out of the eighteen who underwent the thoracotomy had a left thoracotomy with four (24.1%) patients having right thoracotomy. The major indication for surgery in acute thoracic trauma was traumatic diaphragmatic rupture (62.1%) followed byimpalement injury (17.2%), traumatic thoracotomy (6.9%), cardiac tamponade (6.9%), massive haemothorax (3.5%), and vascular injury (3.5%). There were no mortality over the 5-year period.Conclusion: The leading indication for emergency thoracic surgery in chest trauma was traumatic diaphragmatic rupture caused mostly by penetrating thoracic injury. Thoracotomy was the major emergency thoracic surgical approach performed.

Management of Hand Injuries: a Six-year Experience from Komfo Anokye Teaching Hospital, Kumasi, Ghana

Background: Hand injuries can ruin patients’ ability to work with their hands. This could lead to depression and social isolation. It is imperative that hand injuries be reconstructed to as near normal as possible.Patients and Method: A prospective study was undertaken from January 2005 to December 2010 at the Komfo Anokye Teaching Hospital, Kumasi, Ghana to document the pattern of hand injuries, and the outcome of management. The patients were evaluated clinically. Wound debridement was done; the defects were repaired using reconstructive techniques matched to the type of injury.Result: Ninety-five patients (71 males) were treated. Male: female ratio was about 3:1. Their ages ranged from 2 to 60 years with mean (± SD) of 29.5 (± 12.9). Of the 102 hands injured, 52 were right. The right was the dominant hand in 65%. Both dominant and nondominant hands were injured equally. 5% of the injuries were isolated; 95% were combined. The distribution of mechanisms of injuries was as follows: avulsion, sustained through road traffic accidents (37%), crush injuries (25. 3%), sharp injuries (including spaghetti wrists) (19%) machine mangling (11%), burns (8.4%), blunt injuries (15%), human bites (2.1%), snake bite (1.1%), gunshot (4.2%), and injection injuries (2.1%). Patients’ occupations were: farmers 23%, mechanics (20%), traders (11%), factory workers (5%), followed by 2% each of teachers, electricians and civil servants, and 1% each of drivers and pastors; 5% were unemployed. Ofthe remainder, 16 % were children and 11% students. Surgical procedures performed were groin flap (30%), exploration and repair (24%), skin grafting (21%), debridement alone (13%) cross finger flap (7%). decompression of carpal tunnel,(3%) and terminalisation(2%)Conclusion: Severe hand injuries requiring reconstructive surgery were sustained through road traffic accidents Farmers, traders, mechanics and children are at risk of severe combined hand injuries.

Malignant Skin Tumours in Kumasi: A Five Year Review

Introduction: Ultraviolet radiation is the primary aetiological agent in malignant melanoma (MM), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Its effect on carcinogenesis can be influenced by endogenous and exogenous factors.Objective: To document the clinical and epidemiological features of patients presenting with malignant skin tumours at Komfo Anokye Teaching Hospital (KATH), from January 2009 to December 2013.Patients and Methods: Records of patients treated for malignant skin tumours at KATH were retrieved from the surgical out-patient department and theatre records and analysed.Results: 38 patients comprising 16 males and 22 females were treated for malignant skin disease from January 2009 to December 2013. Their ages ranged from 12 to 84 years (mean 48.4, SD=20.2). Predominant lesions were SCC (17 cases), MM (12 cases), and dermatofibrosarcoma protuberans (DFSP), (four cases). SCC were located on the scalp (eight cases), lower limbs (six cases), upper limb (two cases) and trunk (one). All MM lesions were located on the foot. DFSP lesions were found on the leg (one case), trunk (one case), and shoulders (two cases). Basosquamous carcinoma (BSC) was found on the trunk of an albino. All patients were treated surgically (48 procedures); three SCC patients had radiotherapy; one MM patient had chemotherapy.Conclusion: SCC, MM and DFSP were the main malignant skin tumours managed. Chronic wounds, scars and skin bleaching were the exogenous factors; whilst albinism and xeroderma pigmentosum were the endogenous factors identified. For prevention, earlycase detection, adequate treatment of wounds and sun avoidance are advocated.

Hip and Knee Replacements in Ghana: A 2-Year Prospective Assessment of Outcomes

Objective: Our objective was to assess the outcomes of hip and knee replacements among patients at the Komfo Anokye Teaching Hospital in Ghana.Methodology: We recruited consenting patients who underwent a hip or knee replacement at the KATH over a 3-year period and followed up each study participant for 2 years. Prosthetic joint function was evaluated at 2 years following joint replacement. Complications of surgery were recorded for each patient during the follow-up period.Results: A total of 87 hip and knee replacements were performed in 78 patients over the 3-year period. Of the 78 patients enrolled in the study, 67.9% (53) were females and 32.1% (25) were males. Most, 47.2% (37), of the patients were aged between 61 and 80 years, with those less than 40 years constituting 7.7%. At 2 years follow-up, good to excellent outcome was reported in 95.5% THA, 91.2% hiphemiarthroplasty, and 90% TKA patients. The satisfaction rates were 95.5% THA, 97.0% hip hemiarthroplasty and 90% TKA participants.Conclusion: Women have a higher hip or knee replacement rate (67.9%) than men (32.1%) and the rate of hip or knee replacement increases with age for both men and women. Osteonecrosis of the femoral head is the most common indication for total hip arthroplasty in patients younger than 60 years. The presence of diabetes mellitus and sickle cell disease predicts less favourable patient reported outcomes following a hip or knee replacement. Arthroplasty of the knee or hip provides pain relief and improvement in function with a low complication rate and high patient satisfaction rate.

Burn Injuries in Kumasi: A Ten-Year Review

Objective: To document the clinical and epidemiological features; and the outcome of management of patients with burn injuries at Komfo Anokye Teaching Hospital in Kumasi, Ghana, from January 2003 to December 2012. Patients and Methods: Data on all burn patients managed within the study period were retrieved from the records of the Burns Intensive Care Unit (BICU), theatre and Surgical Outpatient Department (SOPD) and analyzed. Data included name, age, sex, cause ofburn, medical and surgical treatment given, post burn complications and the outcome of the treatment.Results: 1361 patients were treated for burn injuries and their complications at KATH, comprising 707 males and 654 females (M: F = 1.08:1). Ages ranged from 0.25 to 92 years; mean 15.5 (SD 14.1) years, median 11.9 years. About 77% of the patients wereaged 20 years or less; 45% were children aged 10 years or younger. The highest annual admission was 172 patients in 2005; the lowest 104 in 2007. Scalds comprised 60% of the injuries, hot water accounting for 45%. Dry heat was responsible for 37% of the burninjuries. Chemical burns accounted for 28 (2%) injuries which led to loss of vision in two cases and one death; all of which were through assault. Electrical burns accounted for 12 (0.9%) of the injuries and led to six limb amputations and three deaths, all of them workersof electricity companies. A total of 162 patients died of burn injuries, giving an overall mortality of 11.9%. The highest annual mortality of 32 (29%) occurred in 2008, which coincided with 4 major burn disasters. Perioperative deaths occurred in four epileptic patients.Conclusion: Though injuries from hot liquids account for most admissions for burns at KATH, significant morbidity and mortality also result from dry heat. Electrical and chemical burns and epilepsy are increasingly becoming responsible for most burn morbidity.

Arthroscopic Anterior Cruciate Ligament Reconstruction in Ghana: A 2-Year Outcome Assessment

Objective: The goal of this study was to evaluate the treatment outcomes of arthroscopic anterior cruciate ligament reconstruction among patients at the Komfo Anokye Teaching Hospital, (KATH) in Ghana.Methods: A prospective cohort study. We enrolled consenting patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction at the KATH over a 3-year period, from January 1, 2015 to December 31, 2018 and followed up each study participant for 2 years. Post-operative assessments were performed at 2, 6, 12, 24 weeks, 1year and at 2 years, to record outcome variables such as range of motion, pain, swelling and laxity of the affected knee as well as excessive discharge from the surgical site, suggestive ofinfection. Tegner Lysholm knee scores were obtained for each patient at 2-years following surgery. The follow-up was concluded in 2020.Results: Over the 3-year period, 40 primary arthroscopic ACL reconstructions were performed in 40 patients. Most of the patients were young adult males who sustained a tear of the anterior cruciate ligament following a fall from a standing height. Out of this number, 31 had isolated ACL tear, 4 had ACL tear associated with LCL tear and 3 had ACL tear with associated meniscal tear. Two of the participants had ACL, PCL and LCL tear and a complex medial meniscal tear, with associated posterolateral corner rotatory instability. ACL reconstructions that were performed within 12 months following injury had higher mean Tegner Lysholm score of 7 (range of 5-9), than those carried out later than 12 months after injury. Overall, 37 of the patients (93%) had good to excellent outcome at 2 years post-operatively. Three of the patients who were competitive athletes before injury had returned to competitive sport within 1 year of surgery. There was one case of surgical site infection giving an infection rate of 2.5% and one case of graft rupture that requiredrevision ACL reconstruction.Conclusion: Arthroscopic ACL reconstruction is feasible at the study site with low complication rate and provides good to excellent outcome in 93% of patients. The procedure is generally safe and effective in restoring knee function following an ACL tear. Patientreported outcomes are superior when reconstruction is performed within 12 months of injury compared to later reconstructions.

Profiling vitamin D, its mediators and proinflammatory cytokines in rheumatoid arthritis: A case-control study.

IntroductionThe active form of vitamin D has immunomodulatory and anti‐inflammatory effect. Vitamin D is implicated in pathogenesis of rheumatoid arthritis (RA) and its deficiency leads to increased inflammation. Moreover, its production is dependent on concentration of calcium, phosphorus, and parathyroid hormone (PTH). Cytokines mediates inflammation in RA synovium. This study evaluated vitamin D, its mediators and proinflammatory cytokines among RA patients.MethodsIn a case–control study, 78 RA patients from Komfo Anokye Teaching Hospital rheumatology clinic and 60 healthy blood donors were recruited. Chemistry analyzer and enzyme‐linked immunosorbent assay kits were used to measure biochemical parameters and cytokines.ResultsWe found significantly higher levels of interleukin (IL)‐1β, interferon gamma (IFN‐γ), and tumor necrosis factor‐α (TNF‐α) in RA patients compared with controls (p < .05). There was a significant positive correlation between intact parathyroid hormone (iPTH) and IL‐10 (r = .30, p < .05) and a negative correlation between IL‐6 (r = −0.28, p > .05), IL‐1β (r = −0.25, p > .05), TNF‐α (r = −0.26, p > .05), IFN‐γ (r = −0.24, p > .05), and iPTH. There was a significant negative correlation between IL‐1β (r = −0.33, p < .05), IFN‐ γ (r = −0.29, p < .05), and calcium.ConclusionReduced PTH, calcium, and phosphorus is associated with higher levels of proinflammatory cytokines which may worsen RA disease condition. Vitamin D is therefore not an independent regulator of proinflammatory cytokines in RA.

Percutaneous Dilatational Tracheostomy Performed by Anaesthesiologist in a Low Resource Setting: Preliminary Report on 19 Patients

Background: Percutaneous dilatational tracheostomy (PDT) is an established alternative to surgical tracheostomy in intensive care patients deemed to require prolonged ventilation. The procedure is simple, cheap and is associated with less complication. Even though PDT is the preferred technique of tracheostomy in ICU’s in low resource countries like Ghana little is known about this technique. PDT using the percutwist set became available in the ICU of the Komfo Anokye Teaching Hospital recently and we report on 19 consecutive cases done so far.Objective: To determine the outcome of 19 percutaneous dilatational tracheostomy done under bronchoscopic guidance by anaesthesiologists in an Intensive Care Unit.Design: Retrospective study. &#x0D; Setting: Intensive Care Unit of the Komfo Anokye Teaching Hospital, Kumasi, GhanaSubjects and Methods: Nineteen consecutive patients who underwent percutaneous dilatational tracheostomy at the bedsideusing the percutwist set under bronchoscopy guidance. Using the admission/discharge books and the Nurses report book in the ICU, patients’ records were retrieved. The number and success of tracheostomies, and the complications were assessed.Results: There were 19 patients who underwent PDT during the period. 17 (95.24%) of the tracheostomies done were successful with easy ventilation of the lungs In one patient (4.76%) PDT was unsuccessful and was converted to surgical tracheotomy. One patient had a problem with ventilation after the tracheostomy tube was inserted. It was detected that the tube was short and was therefore replaced with a normal endotracheal tube. There was bleeding from the incision site in two of the patients (9.5%). This was controlled with pressure dressing.Conclusion: In a low resource country like Ghana where there is a limited number of ENT surgeons, PDT performed by the anaesthesiologist in the ICU can be an alternative technique to surgical tracheostomy. It is safe and success rate is high if done by skilled Anaesthesiologist in the appropriate patient.

Eighteen-Year-Old Nulliparous Woman with Massive Mucinous Cystadenoma in Pregnancy: Case Report

Background: Ovarian mucinous cystadenoma is rare in adolescents. We report the diagnosis and management of a massive ovarian mucinous cystadenoma in a pregnant adolescent. Case Presentation: An 18-year-old G1PO was referred by a midwife to the Komfo Anokye Teaching Hospital on account of excessive abdominal distension at 25 weeks’ gestation and an ultrasound scan finding of a large non-septate cystic adnexal mass. She, however,reported to the hospital 6 weeks later with a complaint of worsening abdominal distension and discomfort. A transabdominal ultrasound scan revealed single intrauterine gestation and a large non-septate cystic adnexal lesion measuring more than 19 cm in its widest plane. She had a conservative in-patients management followed by emergency caesarean delivery, exploratory laparotomy and unilateral salpingo-ophorectomy at 33 weeks 1 day. The outcome of the delivery was a 1.8 kg female infant with Apgar score of 4 and 6 at 1 and 5 minutes respectively. A 6.8 kg cystic ovarian mass measuring about 40 cm at its widest diameter was removed.Conclusion: Although pregnancy-associated adnexal masses are not uncommon, significant socio-economic challenges may render the diagnosis and treatment of extremely large pelvic masses in pregnant adolescents difficult. The decision to optimize maternal and fetal outcomes is essential in managing rare conditions in marginalized obstetric populations.

Comparing Patterns in Antimicrobial Use During Global Point Prevalence Study at a Single Tertiary Hospital in Ghana: Implications for Antimicrobial Stewardship Programme

BackgroundThe Global Point Prevalence Study (PPS) provides a platform for institutions to register and add clinical information on antimicrobial usage and determine variables related to proper antimicrobial stewardship.ObjectiveTo assess the trends in antimicrobial usage and quality indicators in antimicrobial prescriptions at our hospital.MethodWe retrospectively compared data collected at Komfo Anokye Teaching Hospital (KATH) during the Global PPS in 2015 and 2019. Both surveys took place on a day in September of the respective year. Medical records of all in-patients on admission at 0800 hours on a specific day were reviewed for antimicrobial use in the survey. Data on antibiotic use, including indications for use and the presence of quality indicators, were recorded.ResultsThe total number of patients on admission in 2015 and 2019 were 386 and 630, respectively. The proportion of patients on at least one antimicrobial was 64% (247/386) and 58.4% (368/630) in 2015 and 2019, respectively. Pneumonia was the most common medical condition for which antimicrobial was prescribed for 2015, 30(16.9%) and 2019, 44(23.0%), respectively. There was a decrease in Hospital-acquired infections from 2015, 6.2% (24/386) to 4.8% (30/630) in 2019. The use of biomarkers increased from 4.9% (12/247) to 7.6% (28/368).ConclusionOver 50% of hospitalised patients were on antimicrobials for both years. The inauguration of the antimicrobial stewardship committee at KATH will improve these quality indicators.

A retrospective study on ameloblastoma presentations to Komfo Anokye Teaching Hospital

Introduction : Ameloblastoma is the second most common benign odontogenic tumor, and only odontoma outnumbers it in reported frequency of occurrence.Aim : This study reviewed all ameloblastoma cases reported to the Oral and Maxillofacial Surgery Department of Komfo Anokye Teaching Hospital from 2016 to 2018.Methodology : This was a retrospective descriptive study involving reviewing medical records of all Ameloblastoma cases diagnosed within the study period at the Oral and Maxillofacial Surgery Department of KATH. A data collection sheet was used for data collection that covered patients’ demographics, location of the lesion, radiographic presentation, histological report, and treatment.Results : Thirty-four (34) diagnosed cases of ameloblastoma were recorded within the study period, giving an average of eleven cases (11.3) annually. The mean age of patients was 32.0 years with a male: female ratio of 1:1. All the cases reviewed were located within the mandible, with none in the maxilla. Twenty-four (70.6%) of them were found in the body of the mandible. Multilocular radiolucency is the joint radiographic presentation (24, 71%). Plexiform was the common histological variant (12, 35.3%). Thirty-two (32, 91.2%) patients were treated by resection with wide margins. There was no incidence of recurrence recorded.Conclusions : The results of this study indicate that Ameloblastoma cases in Ghana have similar clinicopathological presentations as commonly reported in the literature.

Barriers to adequate pain control among women with cervical cancer: exploring unmet pain control needs in Ghana

BACKGROUNDPain because of cervical cancer is a significant health issue globally, especially in women with advanced disease. However, little is known about unmet needs for pain control in low-resource settings where the burden of cervical cancer is the greatest.OBJECTIVEThis study aimed to quantify the level of pain that women with cervical cancer in Ghana experience, explore attitudes toward pain and pain medications, and determine the barriers to adequate pain control.STUDY DESIGNA cross-sectional survey was conducted on 100 adult women with a histopathologic diagnosis of cervical cancer presenting for care at Komfo Anokye Teaching Hospital in Ghana. In addition, a descriptive analysis was conducted among all participants and the subgroup of women who reported pain but did not report pain medication use.RESULTSAmong 100 participants with cervical cancer, the mean age was 59.5 years, and the median parity was 6.0 (interquartile range, 5.0–6.0); moreover, most participants presented with inoperable stage II or greater cervical cancer (99 of 100 [99%]). Of 100 participants, 80 (80%) had pain caused by their cervical cancer, with more than half (51 of 100 [51%]) rating their pain as a 3, 4, or 5 on a 5-point scale. Most participants reported pain significant enough to impact their sleep (58 of 99 [58.6%]) and their ability to carry out daily activities (54 of 100 [54%]). Furthermore, 55 of 100 participants (55%) took pain medications in the last week; however, only 5 of 54 participants (9.3%) reported complete improvement in their pain, and most participants (30 of 54 [55.6%]) felt they needed a stronger pain medication. Barriers to adequate pain control included the healthcare provider's focus on pain, with 14.1% of women reporting that their healthcare providers never asked about their pain (14 of 99 [14.1%]). In addition, participants’ attitudes toward pain control demonstrated that 34 of 95 participants (35.8%) believed that they should be able to tolerate their cervical cancer pain without medication. Among participants who ever took pain medication, 16 of 58 (27.6%) were bothered that they took pain medication, and 19 of 58 (32.7%) were concerned that they used too much medication. Most participants were able to afford (51 of 58 [88%]) and access (56 of 58 [96.6%]) pain medications and did not worry their supply would run out (56 of 58 [96.6%]).CONCLUSIONMost patients had significant pain because of cervical cancer, and many of them endorsed needing more pain medications than what they were prescribed. The etiologies of the unmet need for pain control included missed opportunities to discuss pain control at clinic visits and patients’ attitudes toward pain management. Financial and access barriers to obtaining pain medications were minimal.

Prevalence and Risk Factors of Preterm Birth Among Pregnant Women Admitted at the Labor Ward of the Komfo Anokye Teaching Hospital, Ghana

Preterm birth is a global epidemic and a leading cause of neonatal mortality in Sub-Saharan Africa. We evaluated the prevalence and risk factors of preterm birth among women attending the labor ward for delivery at a tertiary hospital in Ghana. This comparative cross-sectional study was conducted among a cohort of 209 pregnant women admitted to the labor ward of the Komfo Anokye Teaching Hospital (KATH). Pregnant women who delivered between 28 and 36 completed weeks of gestation were classified as preterm delivery whereas those who delivered after 37–42 completed weeks were described as term. Sociodemographic, clinical, and obstetric data were collected from patient's folder and hospital archives. Categorical variables were analyzed and expressed as frequencies and proportions. We determined the association between obstetric factors and preterm delivery with multiple logistic regressions. Significance level of the strength of association was determined at p-value < 0.05. of the 209 participants, the prevalence of preterm birth was 37.3% (78/209) whereas 62.7% (131/209) delivered at Term. Intrauterine growth restriction (IUGR) [aOR = 2.15, 95% CI = (1.819.55), p = 0.0390], HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome [aOR = 3.94, 95% CI = (1.64–9.48), p = 0.0020], early gestational obesity [aOR = 2.11, 95% CI = (1.31–11.92), p = 0.0480] and preeclampsia [aOR = 4.56, 95% CI = (1.63–12.76), p = 0.004] were identified as independent risk factors of preterm birth. Prevalence of preterm birth was high among women attending labor admission at the Komfo Anokye Teaching Hospital and this was independently influenced by IUGR, HELLP syndrome, early gestational obesity, and preeclampsia. Identifying early signs of adverse pregnancy outcomes would inform the need for management policy to prevent high prevalence of preterm births.

Health-related quality of life among cervical cancer survivors at a tertiary hospital in Ghana.

Cervical cancer is the second most common female cancer in Ghana. The disease and its treatment significantly affect survivors' health-related quality of life (HRQoL). We determined the overall quality of life (QoL) and identified its predictors among cervical cancer survivors after treatment. A hospital-based cross-sectional analytical study was conducted on 153 disease-free cervical cancer survivors who completed curative treatment between January 2004 and December 2018 at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. We used the European Organization for Research and Treatment of Cancer core-30 item (EORTC QLQ-C30) and cervical cancer module (EORTC QLQ-CX24) to assess the survivors' overall QoL. QoL domain scores were dichotomised as affected or unaffected by disease and its treatment. Significant differences between the affected and unaffected groups within each QoL domain were determined using the student T-test. We used Kruskal-Wallis and Dunn's tests to examine the difference in QoL domains between treatment types, with significance based on Bonferroni corrections. Multivariable logistic regression was performed to identify predictors of overall QoL. A p-value of less than 0.05 was considered statistically significant. One hundred and fifty-three (153) women having a mean age of 58.3 (SD 11.4) years were studied. The overall QoL score was 79.6 (SD 16.0), and 74.5% of survivors reported good QoL score within the median follow up time of 41.8 months (interquartile range [IQR], 25.5-71.1 months) after cervical cancer diagnosis. Although the majority (66.0-84.3%) of the QoL functioning scale were unaffected, about a fifth (22.2%) to a third (34.5%) of the subjects had perceptual impairment in cognitive and role functioning. Financial difficulties, peripheral neuropathy and pain were most common symptoms reported as affected. A third of the survivors were worried that sex would be painful, and 36.6% indicated that their sexual activity as affected. The overall QoL scores for survivors who had surgery, chemoradiation and radiation-alone were 86.1 (SD 9.7), 76.9 (SD 17.7), and 80.7 (SD 14.7), respectively (p = 0.025). The predictors of survivor's overall QoL were loss of appetite [Adjusted Odd Ratio (AOR) = 9.34, 95% Confidence Interval (CI) = 2.13-35.8, p = 0.001], pain (AOR = 3.53, 95% CI = 1.25-9.31, p = 0.017) and body image (AOR = 5.89, 95% CI = 1.80-19.27, p = 0.003). About 75% of the survivors had a good overall quality of life. Primary surgical treatment affords the best prospects for quality of life with the least symptom complaints and financial burden. Loss of appetite, pain or diminution in body image perception predicted the overall quality of life of cervical cancer survivors after treatment.

Cardiac Abnormalities of People Living with HIV: A Comparative Study Between HAART Experience and Treatment Naïve Groups in Ghana.

PurposeThis study determined electrocardiographic and echocardiographic abnormalities of people living with HIV (PLWHIV); comparing the findings of PLWHIV on HAART versus treatment naïve groups.Patients and MethodsIn a prospective cross-sectional study, we recruited 157 PLWHIV on Highly Active Antiretroviral Therapy (HAART) and 28 HAART naïve PLWHIV. Clinical examination, electrocardiography and echocardiography were performed on study participants at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. Sociodemographic data and information about the use of HAART or otherwise was obtained. The Chi and Fisher Exact tests were used to find the significance of difference in proportions of abnormalities between PLWHIV on HAART and treatment naïve groups. Statistical analyses were performed on SPSS version 25.0 and GraphPad Prism version 8.0. P-values less than 0.05 were considered to be statistically significant.ResultsEchocardiographic abnormalities in the HAART and treatment naïve groups were 54.1% and 60.7%, respectively. Electrographic abnormalities in the HAART and treatment naïve groups were 45.9% and 50%, respectively. Sinus bradycardia was the most prevalent ECG abnormality in the treatment naïve. Nonspecific T-wave changes (36.1%) and sinus tachycardia (30.6%) were the most common ECG abnormalities seen in HAART treated group. The common echocardiographic abnormalities were pulmonary hypertension (22.7%), pericardial effusion (22.2%) and left ventricular systolic dysfunction (17.8%). There was no significant difference in the proportions of echocardiographic abnormalities between PLWHIV on HAART and the treatment naïve groups (p > 0.05).ConclusionCardiac abnormalities are common in PLWHIV regardless of treatment with HAART. Echocardiographic and electrographic assessments are highly recommended for all PLWHIV.

Factors associated with late-stage presentation of cervical cancer in Ghana.

To explore factors associated with late clinical presentation among Ghanaian women with cervical cancer. This is a cross-sectional survey using a paper questionnaire. Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. Participants were women presenting for cervical cancer care at KATH. Inclusion criteria were histologically diagnosed cervical cancer and age ≥18 years. The exclusion criteria was age <18. All women presenting from August 2018-August 2019 were recruited. The primary outcome was the proportion of participants presenting with late-stage cervical cancer, defined as stage II or higher. Of 351 total participants, 33.6% were unemployed, 35.3% had no formal education, and 96.6% had an average monthly income of less than five hundred Ghana cedis ($86 USD). Time from symptoms to seeing a doctor ranged from fewer than two weeks (16.0%) to more than twelve months (8.6%). Participants' most common barrier in seeking healthcare was financial constraints (50.0%). Most participants presented at late-stage cervical cancer (95.2%, n=334), with only 4.8% (n=17) presenting at stage I. Of participants presenting with late-stage cervical cancer, the vast majority had never had a Papanicolaou (Pap) smear (99.1%) nor a recent gynecologic exam (99.3%). After adjusting for age, parity, and distance to a healthcare facility, a late-stage presentation was associated with lower income and living in a rural area. In Ghana, 95% of women with cervical cancer seek care at a late clinical stage, defined as stage II or greater, when the cancer is inoperable. None declared.

Factors associated with viral suppression and rebound among adult HIV patients on treatment: a retrospective study in Ghana

BackgroundViral suppression remains the most desired outcome in the management of patients with Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and this can be achieved by an effective Antiretroviral Therapy (ART). However, some patients who achieve viral suppression may experience viral rebound with dire consequence. We evaluated viral suppression and rebound and their associated factors among adult patients on ART in Kumasi, Ghana.MethodsThis hospital-based retrospective study was conducted at the Komfo Anokye Teaching Hospital in Ghana. We reviewed the medical records of 720 HIV patients on ART. Statistical analyses were performed using SPSS Version 26.0 and GraphPad prism version 8.0. p < 0.05 was considered statistically significant.ResultsProportions of patients with viral suppression and viral rebound were 76.1% and 21.0% respectively. Being diagnosed at WHO stage I [aOR = 11.40, 95% CI (3.54–36.74), p < 0.0001], having good adherence to ART [aOR = 5.09, 95% CI (2.67–9.73), p < 0.0001], taking Nevirapine-based regimen [aOR = 4.66, 95% CI (1.20–18.04), p = 0.0260] and increasing duration of treatment (p < 0.0001) were independently associated with higher odds of viral suppression. However, being diagnosed at WHO stage II (aOR = 7.39, 95% CI 2.67–20.51; p < 0.0001) and stage III (aOR = 8.62, 95% CI 3.16–23.50; p < 0.0001), having poor adherence (aOR = 175.48, 95% CI 44.30–695.07; p < 0.0001), recording baseline suppression value of 20–49 copies/mL (aOR = 6.43, 95% CI 2.72–15.17; p < 0.0001) and being treated with Zidovudine/Lamivudine/Efavirenz (aOR = 6.49, 95% CI 1.85–22.79; p = 0.004) and Zidovudine/Lamivudine/Nevirapine (aOR = 18.68, 95% CI 1.58–220.90; p = 0.02) were independently associated with higher odds of viral rebound.ConclusionApproximately 76% viral suppression rate among HIV patients on ART in Kumasi falls below the WHO 95% target by the year 2030. Choice of ART combination, drug adherence, WHO clinical staging and baseline viral load are factors associated with suppression or rebound. These clinical characteristics of HIV patients must be monitored concurrently with the viral load.

Polymorphism of protein tyrosine phosphatase non-receptor type 22 and protein arginine deiminase 4 gene among Ghanaian rheumatoid arthritis patients: A case-control study.

Rheumatoid arthritis (RA) is an autoimmune disease which affects millions of lives globally characterized by chronic inflammation in the joints of the body. There is no known cause for RA; however, genetic predisposition has been associated with its occurrence. The association between genetic predisposition and RA has been reported largely among Caucasians and Asians. However, few studies with limited data have reported genome-wide association studies of RA in Africa, especially in Ghana. In addition, there is genetic heterogeneity that exists geographically among different populations. This study therefore investigated the association of protein arginine deiminase type 4 (PAD4) and protein tyrosine phosphatase non-receptor type 22 (PTPN22) single nucleotide polymorphisms with susceptibility of RA among Ghanaians. This case-control study included 75 RA patients and 75 healthy controls from the Komfo Anokye Teaching Hospital in Ghana. Validated questionnaires were used to obtain demographic data, and blood samples were collected and processed for DNA and polymerase chain reaction analysis. Statistical analysis was done using SPSS version 25.0. PTPN22 demonstrated a 100% minor allele frequency (GG) in both cases and healthy controls; however, an association could not be made for PTPN22 polymorphism with susceptibility of RA when comparing cases to controls. The homozygous minor allele (GG) of PAD4 was absent in the population. PAD4 polymorphism was absent, while PTPN22 was present in the Ghanaian population. The association between PTPN22 (rs2476601) and PAD4 (rs2240340) with RA susceptibility could not be established, thus may not contribute as risk factors for RA in the Ghanaian population.

Using ethics of care as the theoretical lens to understand lived experiences of caregivers of older adults experiencing functional difficulties.

The lived experiences of caregivers of older adults in Ghana are not well understood. The purpose of this study was to explore and discuss the lived experiences of these caregivers using the Ethics of Care as a theoretical lens and Interpretative phenomenological analysis as the methodological approach. Ten caregivers in receipt of social welfare services on behalf of older adults were recruited from the Social Welfare Unit at the Komfo Anokye Teaching Hospital (KATH) in southern Ghana. The analysis identified five interrelated themes: 1) committing the Self to caregiving; 2) caregiving impacting the Self; 3) motivating factors to caregiving; 4) caregiving burdens, and 5) thinking about personal affairs. Their experiences demonstrate that caregivers value the caregiving relationship, as posited by Ethics of Care, and tend to care for their health and well-being. Caregivers' expression of commitment to caring for older adults is mainly influenced by reciprocity, despite internal and external stressors, and desire to fulfil unmet personal needs. Ethics of care offers an understanding of the lived experiences of caregivers of older adults in Ghana. The findings draw attention to the state to develop specific programs to ensure the health, social and financial well-being of older adults' caregivers.