Referral Hospital In Ghana Research Articles

Challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana

IntroductionCervical cancer is one of the causes of female deaths worldwide. Cervical cancer incidence is rising with almost three thousand (2797) women in Ghana being diagnosed with the condition each year, with almost two thousand (1,699) of them dying from its complications Nurses caring for cervical cancer patients are exposed to emotional and psychological distress due to late presentation, the burden of care, patients’ suffering and the alarming number of deaths associated with it. Improving positive patient outcomes require identifying the challenges and support systems available to nursing staff so as to harness these support systems for improving care outcomes.AimThis study explored the challenges and support systems of nurses caring for women with advanced cervical cancer in Accra, Ghana.MethodIn this study, we adopted an exploratory qualitative design. The study was conducted among eleven (11) nurses and nine (9) midwives engaged at the national referral hospital in Ghana who were providing care for patients with advanced cervical cancer for over a year who were purposively sampled. The data was collected using in-depth interviews with a pre-tested semi-structure interview guide from the twenty participants. We recorded the interviews using an audio-tape. The audio files were transcribed verbatim and thematic analysis was undertaken with the aid of Nvivo 10.0.ResultsThe challenges when rendering nursing care faced by participants of this study were exposure to frequent deaths, inadequate resources, and workload. Most participants lamented that they received absolutely no support from their workplace, hence their only form of support was from their family and friends. They also added that most of them were general nurses and midwives with no special training in oncology nursing or palliative nursing.ConclusionNurses and midwives experience resource, knowledge and skill challenges when caring for patients with advanced cervical cancer. However, the nurses and midwives had emotional attachment to their jobs and their patients and were not distracted by their bad experiences. We recommend improving resource allocation for cervical cancer care through the National Health Insurance Authority (NHIA), Ghana and increased training of nurses in oncology and palliative nursing by the Ministry of Health, Ghana to improve knowledge and skills of the nurses and midwives caring for women with advanced cervical cancer to improve their quality of care. Further, hospitals must make it a priority to have more nurses and midwives trained in oncology and end of life care to improve the knowledge and skills of nurses and midwives caring for advanced cervical cancer patients. Also, these findings should trigger policy-level discussions at the Ministry of Health, Ghana on the training of specialized nurses and midwives in cancer and end of life care to help Ghana meet the sustainable development goal targets related to health.

Caesarean section delivery rates and associated factors in a faith-based referral hospital in Ghana: A retrospective analysis.

The global incidence of caesarean section (CS) deliveries has exceeded the recommended threshold set by the World Health Organization. This development is a matter of public health concern due to the cost involved and the potential health risk to the mother and the neonate. We sought to investigate the prevalence, indications, maternal and neonatal outcomes and determinants of CS in private health facilities in Ghana. A retrospective cross-sectional analysis was conducted using data from women who delivered at the Holy Family Hospital from January to February 2020 using descriptive and inferential statistics, with a significance level set at p<0.05. The prevalence of CS was 28.70%. The primary indications of C/S include previous C/S, foetal distress, breech presentation, pathological CTG and failed induction. Significant associations were found between CS and breech presentation (AOR = 4.60; 95%CI: 1.22-17.38) p<0.024, previous CS history (AOR = 51.72, 95% CI: 11.59-230.70) p<0.00, and neonates referred to NICU (AOR = 3.67, 95% CI: 2.10-6.42) p<0.00. The prevalence of caesarean section (CS) deliveries was higher than the WHO-recommended threshold. Major indications for CS included previous CS, fetal distress, and failed induction. Significant risk factors for CS were previous CS history, breech presentation, and neonates referred to NICU.

Clinical epidemiology, determinants, and outcomes of viral encephalitis in Ghana; a cross-sectional study.

Viral encephalitis is a rare, yet severe neurological disorder. It poses a significant public health threat due to its high morbidity and mortality. Despite the disproportionate burden of the disease in impoverished African countries, the true extent of the problem remains elusive due to the scarcity of accurate diagnostic methods. The absence of timely and effective diagnostic tools, particularly Real-time Polymerase Chain Reaction, has led to misguided treatment, and an underestimation of the disease burden in Ghana. We conducted a prospective cross-sectional study to determine the viral aetiologies of encephalitis among patients presenting to a major referral hospital in Ghana from May 2019 and August 2022. The study aimed at providing a comprehensive information on the clinical epidemiology, and outcomes of viral encephalitis in Ghana. Clinical samples were collected from patients presenting with signs and symptoms of encephalitis and tested for viral agents using real-time polymerase chain reaction. We assessed the clinical epidemiology, risk factors and outcome of individuals using descriptive and logistic regression analysis. Seventy-seven (77) patients were enrolled unto the study. The participants frequently presented with fever (85.7%), seizures (80.5%), lethargy (64.9%) and headache (50.6%). Viruses were detected in 40.3% of the study participants in either cerebrospinal fluid, rectal or oral swab samples. The most frequently detected viruses were cytomegalovirus (48.4%), enteroviruses (38.7%) and HSV (29.0%). Twenty-one (27.3%) of the patients died while on hospital admission. Gender (OR = 5.70 (1.536-1.172), p = 0.01), and negative polymerase chain reaction test results were identified as significant factors associated with death. Antiviral treatment increased the chance of survival of viral encephalitis patients by 21.8%. Our results validate the crucial role of molecular tools as essential for the rapid diagnosis of viral encephalitis, enabling effective treatment and improved patient outcomes. This study contributes valuable epidemiological and clinical insight into viral encephalitis in Ghana.

Respectful maternity care at caesarean delivery: Experiences of mothers in a primary referral hospital in Ghana

AbstractBackgroundRespectful, dignified care is a human right for all women that impacts skilled birth attendance and outcomes. This study aimed to assess the prevalence of respectful maternity care (RMC) provided at caesarean deliveries in a Ghanaian referral hospital and determine associated factors influencing care provision. We sought to elucidate RMC prevalence and drivers specific to the caesarean experience, to promote rights‐based, patient‐centred caesarean delivery care.MethodsA cross‐sectional study was conducted from June to November 2022, among women who delivered via caesarean section at the hospital. Interviews of participants were conducted using structured questionnaires, capturing respondents' sociodemographic and obstetric features and perceptions of RMC. Quantitative data were summarised using means, medians, frequencies and proportions. Bivariable and multivariable logistic regression models were employed to determine factors associated with RMC at 95% confidence interval (CI) and a p &lt; 0.05.ResultsA total of 308 women were included in the study. The mean age of mothers was 29.9 (±6.8) years. Of the mothers, 67.9% (95% CI: 62.3, 73.0) received RMC and 32.1% reported disrespectful and abusive care. Several factors were associated with higher likelihood of receiving RMC at caesarean delivery, including being married, adjusted odds ratio (aOR) 2.45 (95% CI: 1.17, 5.12), having average monthly income between Ghana cedis 501 and 1500, aOR = 1.94 (95% CI: 1.07, 3.50), having a previous delivery history of spontaneous vaginal delivery only, aOR 2.04 (95% CI: 1.02, 4.08) and receiving anaesthesia from a male anaesthetist, aOR 2.04 (95% CI: 1.22, 3.42).ConclusionThough the majority of women at caesarean delivery received RMC, close to one‐third may attribute a negative caesarean birth experience to disrespectful care. Respectful and abusive‐free care at service delivery should thus be emphasised for healthcare givers and form part of antenatal education.

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.

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.

Prevalence of diaper need and diaper dermatitis and associated risk factors among children aged 1–24 months in a referral hospital in Ghana: A cross-sectional study

Abstract Objectives This research aimed to determine the prevalence of diaper need and diaper dermatitis (DD) and associated risk factors in children aged 1–24 months. Methods Data were collected through face-to-face exit interviews with 456 mothers at a Child Welfare Clinic. A chi-square, correlation, and multivariate logistic regression analyses at a significance level of p &lt; 0.05 were conducted. Results The prevalence of diaper need was found to be 53.5%, with lower odds observed in households with monthly incomes greater than $167 and in children on breastmilk only. Diaper need was higher in parents with no formal education and use of disposable diapers. The prevalence of DD was 27.4%, with lower odds observed in households with monthly incomes greater than $167 and in children less than 6 months old and on breastmilk only. There was a moderately positive correlation between diaper need and DD. Conclusion The researchers recommend affordable alternative diapering methods and educating parents on the importance of frequent diaper changes to improve the prevalence of diaper need and DD. Overall, this study highlights the significant prevalence of diaper need and DD among children and identifies the important associated risk factors.

Serum 25-hydroxyvitamin D and hyaluronic acid levels as markers of fibrosis in patients with chronic liver disease at the main tertiary referral hospital in Ghana: A case-control study design.

Liver fibrosis leading to chronic liver disease (CLD) is a major cause of morbidity, mortality and health-care expenditure worldwide. The "gold standard" for diagnosis and staging of liver fibrosis is histological analysis of liver tissue obtained by liver biopsy, an invasive procedure. Therefore, there is the need to identify noninvasive and inexpensive markers for diagnosis and staging of liver fibrosis. This study aimed at evaluating the correlation of hyaluronic acid (HA) and 25-hydroxyvitamin D (25-OH vitamin D) serum levels as markers of fibrosis with histologically staged and graded liver biopsies obtained from CLD patients. This was a case-control study involving 40 CLD patients requiring liver biopsies and 40 controls. Liver biopsies were staged to determine the degree of fibrosis. Serum levels of 25-OH vitamin D and HA were determined using ELISA. Statistical analyses were performed to determine differences in HA and 25-OH vitamin D levels between controls and patients as well as to correlate the biomarkers with the stages of fibrosis. CLD patients showed significant (p < 0.001) increase in the levels of AST, ALT, GGT, compared to the controls. Patients also had significantly (p < 0.001) lower serum 25-OH vitamin D and higher HA (p < 0.001) levels compared to the controls. Additionally, 25-OH vitamin D levels of the CLD patients were significantly different across the stages of liver fibrosis likewise serum HA levels. Furthermore, 25-OH vitamin D levels inversely correlated with the severity of liver fibrosis. A significant negative correlation (r = -0.33, p < 0.05) between CLD patients' HA and 25-OH vitamin D were found. CLD patients had significantly reduced serum 25-OH vitamin D and higher HA. Both markers correlated with the degree of liver fibrosis. These findings have major clinical translatable implication in the use of vitamin D supplementation in the management of CLD in Ghana.

The introduction of nursing led bubble-CPAP in a neonatal unit in Ghana: A 32-month observational report

Neonatal deaths account for nearly 50 % of under-five deaths in Ghana with prematurity as the leading factor. Bubble continuous positive airway pressure (bCPAP) is important in treating respiratory distress (RD) associated with prematurity but its use in Africa is challenging. There is limited equipment to care for vulnerable newborns and insufficiently trained healthcare staff. This 32-month observational study describes the characteristics and outcomes of bCPAP treated newborns as a nursing led intervention at a regional referral hospital in Ghana. In May 2014, bCPAP was introduced to newborn intensive care unit (NICU) nursing staff. Three bCPAP machines and supplies were donated by Medical Technology Transfer and Services (MTTS). A training program provided learning opportunities for US-based and Ghanaian staff. Locally collected data included: NICU census, staffing, admitting diagnosis, birth weight, gestational age, Apgar scores, antenatal corticosteroid administration, days on bCPAP, and survival. From May 2014 to December 2016, 189 newborns received bCPAP. The mean ± SD (range) gestational age was 30.0 ± 4.2 (24–42) weeks, birth weight was 1.5 ± 0.7 (0.5–4.25) kg, and bCPAP duration was 3.2 ± 3.3 (0–14) days. In 155 (82.0 %), the admission diagnosis was prematurity with RD. Survival in this group was higher compared to other diagnostic categories and improved as birthweight increased (p < 0.05). Overall, 57.8 % of bCPAP treated newborns survived, but survival decreased during the last 12 months for newborns < 1.5 kg. This study supports the long-term sustainability of a nursing-led bCPAP program in Africa, but positive outcomes may be compromised by staffing, equipment, and resource limitations.

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

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

Clinical presentations and outcomes of ectopic pregnancy at a tertiary referral hospital in Ghana

Clinical presentations and outcomes of ectopic pregnancy at a tertiary referral hospital in Ghana

The Role of Nutrition in the Prevention and Management of Neonatal Jaundice in Ghana

Despite the well-established importance of nutrition in health and wellness, nutrition’s involvement in the management and prevention of neonatal jaundice varies greatly from one guideline to another, to the extent that some guidelines do not include the role of nutrition in the prevention and management of neonatal jaundice. In addition, mothers typically translate their nutrition knowledge into the care of their babies. Hence, it is prudent for mothers to have the requisite knowledge needed to prevent any health condition, including neonatal jaundice. This study, therefore, sought to investigate and consolidate practices that elucidate the role nutrition plays in the prevention and management of neonatal jaundice in Ghana. The study was a multi-center nested, case-control study involving 120 cases and 120 controls of neonates in three referral hospitals in Ghana. Assessment of nutrition knowledge showed that with regards to the WHO (2004 &amp; 2017) infant feeding recommendations, mothers of babies with neonatal jaundice had a higher nutrition score than mothers with healthy babies. During treatment of neonatal jaundice, babies were mostly fed breastmilk only, and, in a few cases, extra fluids were given if the baby is not exclusively breastfed or there is a risk of dehydration during phototherapy. No probiotic supplements were given, and micronutrient supplementation may or may not be given, depending on the prevailing health conditions of the neonate. It is recommended that further assessment should be carried out to identify the effectiveness of the nutrition education given during antenatal and postnatal education sessions at hospitals, clinics, and health centers. Keywords Breastfeeding, Malnutrition, Neonatal jaundice, nutrition education, World Health Organisation (WHO).

Mortality burden due to liver cirrhosis and hepatocellular carcinoma in Ghana; prevalence of risk factors and predictors of poor in-hospital survival.

Liver-related diseases, including liver cirrhosis and hepatocellular carcinoma (HCC), are significant causes of mortality globally. Specific causes and predictors of liver-related mortality in low resource settings require assessment to help inform clinical decision making and develop strategies for improved survival. The objectives of this study were to determine the proportion of liver-related deaths associated with liver cirrhosis, HCC, and their known risk factors, and secondly to determine predictors of in-hospital mortality among cirrhosis and HCC patients in Ghana. We first performed a cross-sectional review of death register entries from 11 referral hospitals in Ghana to determine the proportion of liver-related deaths and the proportion of risk factors associated with these deaths. Secondly, we conducted a retrospective cohort review of 172 in-patient liver cirrhosis and HCC cases admitted to a tertiary referral centre and determined predictors of in-hospital mortality using binary logistic regression and Kaplan-Meier survival analysis. In total, 8.8% of deaths in Ghanaian adults were due to liver-related causes. The proportion of liver-related deaths attributed to HBV infection was 48.8% (95% CI: 45.95–51.76), HCV infection was 7.0% (95% CI: 5.58–8.45), HBV-HCV co-infection 0.5% (95% CI: 0.1–0.9) and alcohol was 10.0% (95% CI: 8.30–11.67). Of 172 cases of HCC and liver cirrhosis, the in-patient mortality rate was 54.1%. Predictors of in-patient mortality in cirrhotic patients were increasing WBC (OR = 1.14 95% CI: 1.00–1.30) and the revised model for end-stage liver disease with sodium (MELD-Na) score (OR = 1.24 95% CI: 1.01–1.54). For HCC patients, female sex (OR = 3.74 95% CI: 1.09–12.81) and hepatic encephalopathy (grade 1) were associated with higher mortality (OR = 5.66 95% CI: 1.10–29.2). In conclusion, HBV is linked to a high proportion of HCC-related deaths in Ghana, with high in-hospital mortality rates that require targeted policies to improve survival.

The Pattern of Hip Fractures Over A Ten-Year Period in A Major Referral Centre in Ghana

Background: The incidence of hip fractures is projected to increase worldwide and so are the associated morbidity, mortality, and cost of managing patients with hip fractures. There is, however, scarcity of data on trend and incidence of hip fractures in sub-Saharan Africa making planning and management difficult.Methods: This is a retrospective study that involves all hip fractures seen and admitted to Korle-Bu Teaching Hospital in Accra, Ghana from 2007 to 2016. The demographic characteristic (sex and age), mechanism of injury, and the fracture type were documented. Association between age, sex, and mechanism of injury and type of fracture were determined by Chi-square, with p-value&lt; 0.05 as the level of significance.Results: Nine hundred and twenty-nine patients were admitted over the 10-year period. There were 492 (53%) females and 437 (47%) males, a ratio of 1.1:1.0. The mean age was 72.2 ± 14.4 years. Falls which mostly were low energy constituted 726 (78.1%) of cases with 203 (21.9%) resulting from road traffic accidents (RTA). There was an increase in patients with hip fractures from 2007 to 2012 followed by a gradual decline. Approximately 490 (52.7%) and 439 (47.3%) of the cases were extracapsular and intracapsular respectively. There was strong association between age and mechanism of injury (X2 (2) =492.10, p &lt; 0.001, Φ =0.73) and moderate association between sex and mechanism of injury (X2 (1) =37.50, p &lt; 0.00, Φ =0.21). There was no significant association between sex or age and the type of fracture (p&gt;0.05)Conclusions: This study shows a 10-year trend of hip fractures in a major referral hospital in Ghana. It will serve as a baseline information for a nationwide study on the incidence rate of hip fracture in the country. It also has a great implication for future planning and management.

Maternal near-miss and mortality associated with hypertensive disorders of pregnancy remote from term: a multicenter observational study in Ghana

BACKGROUNDMaternal death rates remain high in many low- and middle-income countries. Hypertensive disorders of pregnancy account for 18% of maternal mortality in Ghana. The maternal near-miss approach was designed to evaluate severe (acute) complications in pregnancy, which is useful to detect potential areas for clinical care improvement.OBJECTIVEThis study aimed (1) to determine the incidence of severe maternal complications, maternal near-miss cases, and mortality cases associated with hypertensive disorders of pregnancy remote from term and (2) to assess the health system's performance indicators for the management of hypertensive disorders of pregnancy remote from term in middle-income country referral hospitals.STUDY DESIGNThis study was nested in the ongoing Severe Preeclampsia adverse Outcome Triage study, a multicenter observational cohort study, and included women recruited from December 1, 2017, to May 31, 2020, from 5 referral hospitals in Ghana. Women aged >16 years, admitted to the hospital with hypertensive disorders of pregnancy, with gestational age between 26 and 34 weeks were eligible. Near miss was defined according to the World Health Organization and sub-Saharan African near-miss criteria. Descriptive statistics of pregnancy and maternal and perinatal outcomes up to 6 weeks after delivery of women with severe maternal outcomes were presented for maternal deaths and maternal near-miss casigurees and compared with that of women without severe maternal outcomes. The health system's maternal and perinatal performance indicators were calculated.RESULTSOverall, 447 women with hypertensive disorders of pregnancy were included in the analyses with a mean maternal age of 32 (±5.8) years and mean gestational age at recruitment of 30.5 (±2.4) weeks. Of these patients, 46 (10%) had gestational hypertension, 338 (76%) had preeclampsia, and 63 (14%) had eclampsia. There were 148 near-miss cases (33.1%) and 12 maternal deaths (2.7%). Severe maternal outcomes constituted complications from severe preeclampsia (80/160 [50%]) and eclampsia (63/160 [39.4%]). Concerning organ dysfunction, hematologic and respiratory dysfunctions constituted 59/160 [38.6%] and 23/160 [14.8%] respectively. Nearly all women had a cesarean delivery (347/447 [84%] and 140/160 [93%] in the severe maternal outcome group) and delivered prematurely (83%, with 178/379 [93%] at <32 weeks of gestation). Stillbirth and neonatal deaths occurred in 63 of 455 women (14%) and 81 of 392 women (19%), respectively, constituting a stillbirth ratio of 161 per 1000 live births and neonatal mortality rate of 207 per 1000 live births as there were 392 live births in this cohort. Overall, the intensive care unit admission rate was 12.7% (n=52/409); moreover, 45 of 52 women (86.5%) admitted to the intensive care unit had severe maternal outcomes. The maternal death ratio was 3100 per 100,000 live births, the maternal near-miss–to–mortality ratio was 12.3, and the mortality index was 8%.CONCLUSIONMaternal near miss and maternal and perinatal mortalities were common in women with hypertensive disorders of pregnancy remote from term in referral hospitals in Ghana. Providing appropriate patient-centered and multidisciplinary quality care for these women is crucial in improving pregnancy outcomes. Context-tailored interventions should be considered in the clinical management of complications associated with hypertensive disorders of pregnancy in resource-limited settings. Further research on interventions to improve timely referral and reduce in-hospital delays in care provision is recommended to facilitate emergency care services for women with hypertensive emergencies.

Maternal risk factors and neonatal outcomes associated with low birth weight in a secondary referral hospital in Ghana

IntroductionOver the past decade, the incidence of low birth weight (LBW) in sub-Saharan Africa has not seen any decline and this is a matter of grave concern for healthcare providers, policymakers, and researchers. Therefore, this study aimed to assess the incidence of LBW and related maternal risk factors (during pregnancy or delivery) as well as neonatal outcomes. MethodsAn institutional-based retrospective cross-sectional study design was employed to select 1,017 mothers who delivered in the study hospital from January to December 2017 with singleton newborn babies without congenital diseases. Data were analysed using STATA version 14.1 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: Stata Corp LP). Chi-square test of independence was used to test the association between the dependent variable (LBW) and risk factors of LBW. Bivariate and multivariable unconditional logistic regression was used to determine the factors associated with LBW. ResultsThe incidence of LBW was 23.7%. The findings show that being married has a protective effect on LBW [AOR = 0.60 (95%CI: 0.40–0.90), p = 0.013] compared to single mothers. Neonates born between gestational age of 37–42 weeks had 85% lower odds of LBW [AOR = 0.15, (95%CI: 0.10–0.24), p < 0.001)]. Neonates with LBW had a higher risk of low Apgar score in the first minute compared to neonates with normal birth weight [AOR = 0.52 (95%CI: 0.37–0.73), p < 0.001]. Female neonates had 64% higher odds of LBW compared to their male counterparts [AOR = 1.64 (95%CI: 1.19–2.24), p = 0.002]. ConclusionThis study revealed a high incidence of LBW. Women's marital status (single mothers), gestational age (<37 weeks), neonatal sex (female), are independent risk factors associated with LBW, while a higher risk of an Apgar score of less than 7 in the first minute was an independent outcome of low birth weight births. The current study findings contribute to the growing literature on the influence of maternal and neonatal factors on LBW in resource-constrained settings. These findings could guide healthcare providers, hospital administrators, stakeholders, and policymakers to develop and implement appropriate clinical and public health strategies aimed at reducing LBW.

Breast lesions and cancer: histopathology and molecular classification in a referral hospital in Ghana

ABSTRACT Background: Histological diagnosis is crucial to the management of breast diseases. It determines the kind of disease, the treatment modalities, and the outcome of management. Our department receives breast biopsies from the northern sector of Ghana constituting over 50% of the Ghanaian population. This study aimed at elucidating the pattern of disease and associated traditional prognostic indices of breast cases in our department over a period of 9 years. Methods: Information on the demographic characteristics and the histological diagnoses made on all breast cases received and processed in the department were accessed and entered into an Excel spreadsheet. Slides were reviewed and IHC was done on suitable cases. Descriptive statistics were generated using IMB-SPSS version 23. Results: A total of 4276 breast cases were received by the department within the study period, with 97.6% being female. Age ranged (female/male) from 10 to 98/13 to 102 years, with mean ages of 38.2 years (SD ± 16.7) and 41.15 years (SD ± 21.6), respectively. Cases were evenly distributed in both left and right breasts and 4.3% were bilateral. Inflammatory conditions were seen in 7.5% of cases. The most diagnosed benign tumor was fibroadenoma (54%), followed by fibrocystic change (8.1%). Gynecomastia was diagnosed in 66.3% of males. Malignant cases were 38.6%, with invasive carcinoma NST being the most frequent (87.5%). Histological grades were I = 9.4%, II = 41.6%, and III = 49%. Molecular subtypes were luminal A (19.8%), luminal B (9.9%), Her2 (16%), and TNBC (54.3%). Conclusion: Our findings show an increase in breast cancer cases compared to previous studies in our center, suggesting increased awareness and improved diagnosis. However, this increase is consistent with most studies in sub-Saharan Africa.

Clinical characteristics of paediatric autoimmune hepatitis at a referral hospital in Sub Saharan Africa.

Autoimmune hepatitis (AIH) is a progressive inflammatory liver disease of unknown aetiology. The number of reported AIH cases is increasing in the developed countries but the same cannot be said about sub Saharan Africa (SSA). Paediatric AIH diagnosis is usually missed and patients present with decompensated liver disease. Our study highlights the clinical profile of paediatric AIH cases at a referral hospital in Ghana. This is a retrospective review of all cases of children diagnosed with autoimmune hepatitis at the gastroenterology clinic in Korle Bu Teaching Hospital, Accra, Ghana. Data was extracted from the patients' records from April 2016 to October 2019. These children were diagnosed based on the presence of autoantibodies, elevated immunoglobulin G and histologic presence of interphase hepatitis with the exclusion of hepatitis A, B, C and E depending on their clinical presentation, Wilson's disease, HIV, Schistosomiasis and sickle cell disease. Thirteen patients aged between 5 years to 13 years with a mean age of 10 years were diagnosed with AIH. All the patients had type 1 AIH with majority 8 (61.5%) being females. Most of the children presented with advanced liver disease with complications. Three patients had other associated autoimmune diseases. The patients were treated with prednisolone with or without azathioprine depending on the severity of the liver disease. Majority of paediatric AIH presents with advanced liver disease. There is the need for early detection to change the natural history of AIH in SSA.

Thyroidectomy under Local Anaesthesia; Experience from a Tertiary Hospital in Kumasi, Ghana

Objectives: Improvement in anaesthesia has allowed thyroidectomies to be performed mainly under general anaesthesia. There is however a growing interest in performing thyroid surgery under local or regional anaesthesia. The objective of this study was to analyse and share our experience with safety of thyroidectomy under regional cervical plexus block/ local anaesthesia in a tertiary referral hospital in Ghana. Materials and Methods: A retrospective study was conducted on all patients who had thyroidectomy under local anaesthesia from 1st January 2017 to 31st May 2018 in KATH. Data collected were demography, grade of goitre, operating time, and duration of hospital stay, complications and cost effectiveness of the procedure. Data was analysed using Stata version 16.0software. Results: A total of 105 thyroidectomies were done in the study period out of which 16 were done under local anaesthesia. All 16 patients (16 females, 100%) and majority 11 (68.75%) were aged between 30 and 50 years. 11 (68.75) had grade IB goitres. The most frequently performed surgery was thyroid lobectomy 12 (75%) and in 75% of cases the surgery was completed between 60 and 90 minutes. Most patients, 9 (56.25%) were discharged home within 48 hours following surgery. The cost of treatment was averagely 30% less compared to same surgery under general anaesthesia. No complications were recorded in the post-operative period. Conclusions: Comprehensive clinical assessment and careful patient selection for thyroidectomy under local anaesthesia result in good surgical outcomes. The procedure is safe and cost-effective and should be performed by experienced surgeons for the best outcomes.

An ecological approach to understanding stroke experience and access to rehabilitation services in Ghana: A cross-sectional study.

Despite a growing burden of stroke in low-middle-income countries, research on patient's experiences and access to rehabilitation services remains limited. This study explores the experiences of stroke patients in relation to access and use of stroke rehabilitation services, coping strategies and strategies to improve care in Ghana. A cross-sectional study was conducted. A total of 136 adult stroke patients hospitalised and subsequently discharged in three major referral hospitals in Ghana participated in the study. A paper-based questionnaire was used to collect data. Data were inputted into STATA version 12, cleaned and analysed using descriptive statistics and Chi-Square tests. Findings showed that stroke patients experience stroke differently. Early detection (awareness) of stroke symptoms at onset was low (29.4%). Hypertension was the major (58.1%) predisposing risk factor for stroke, followed by diabetes (14.7%). Multiple barriers impede access to outpatient rehabilitation services: high cost of medications (43.4%), transportation constraints (10.3%), long waiting time (6.6%), forgetfulness about appointment (4.4%), limited education on rehabilitation (20.6%), lack of community support (12.5%) and ineffective communication with healthcare providers (5.2%). Recommended strategies to improve access to rehabilitation care included public education on stroke and its associated risk, reduction in the cost of drugs and increased stroke rehabilitation funding by the NHIS, especially for physiotherapy consultation and training support to caregivers on patient care. Given the difference in stroke experience and barriers in accessing rehabilitation care, multi-level health policy and service delivery reforms are needed to improve access to rehabilitation care, including national public awareness campaigns on early signs of stroke and subsidised cost of stroke rehabilitation.