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Background: There is a paucity of data on enteral and parenteral (EN and PN) nutrition support (NS) provided by nutrition and dietetic practitioners in adult acute care settings in Ghana. Furthermore, gray literature suggests that Ghanaian clinical nutrition professionals (CNPs) are seldom involved in advanced nutrition care teams. Objectives: To assess the knowledge, attitudes, and practices of Ghanaian CNPs regarding EN and PN. Methods: An online cross-sectional survey was administered to Ghanaian CNPs ahead of a professional development workshop on EN and PN Support. Participants were asked questions about initiation and timing of NS, and knowledge on availability of commercial formula. A 5-point Likert scale was used to assess self-efficacy in using EN and PN. To assess practical knowledge on EN and PN, participants were asked to identify whether EN or PN was indicated for seven short case scenarios. Open-ended questions were used to assess reasons for participant self-ratings. Results: A total of 76 dietitians, nutritionists, students, and interns completed the survey. For EN, self-efficacy scores were lowest for the calculation of enteral goal rate, and goal volume (mean 3.20 ± 1.27), and writing of EN prescriptions (mean 3.07 ± 1.29). Self-efficacy scores for the formulation of alternative formulas in lieu of commercial formula were the highest (3.63 ± 1.36). For PN, self-efficacy scores for all domains were lower than 3, with the lowest scores observed for writing PN prescriptions (2.19 ± 1.14) and determining micronutrient additives (2.12 ± 1.04). We identified limited training and lack of practical exposure to NS, limited ability to effectively monitor tube feeds, and prohibitive cost and limited availability of EN and PN formula among the barriers impacting self-efficacy scores. Conclusion: Given the vital role that CNPs play in the delivery of EN and PN, it is important to develop professional training programs especially focused on PN to bridge knowledge and practice gaps.

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OBJECTIVE: To evaluate the association of malaria and HIV with pre-eclampsia by evaluating their prevalence among pregnant women. METHODS: Using a case-control study design, we randomly sampled the antenatal records of 125 pregnant women with clinician-diagnosed pre-eclampsia (cases) and 125 others without pre-eclampsia (controls) who visited Atua Government Hospital in the eastern region of Ghana between June 2014 and January 2017. All selected records had available routine HIV and malaria test results and were analyzed statistically. RESULTS: In all 250 records, 122 (48.8%) were HIV positive and 35 (14.0%) had malaria. Of the 122 HIV-positive pregnant women, 29 (23.8%) were cases and 93 (76.2%) were controls; of the 35 women with malaria, one was in the case group (1/35, 2.9%) and the other 34 (97.1%) were in the control. Group. Pregnant women with pre-eclampsia had lower odds of HIV infection (odds ratio [OR] 0.10, 95% confidence interval [CI] 0.06-0.19: adjusted AOR 0.07, 95% CI 0.04-0.13, P < 0.001). Similarly, pregnant women with pre-eclampsia had lower odds of having malaria infection (OR 0.02, 95% CI 0.00-0.17, P = 0.025; adjusted OR 0.00, 95% CI 0.00-0.01, P < 0.001). CONCLUSIONS: Women with pre-eclampsia had lower odds of HIV and malaria infection in pregnancy.

Asunto(s)

Infecciones por VIH , Malaria , Preeclampsia , Femenino , Embarazo , Humanos , Mujeres Embarazadas , Prevalencia , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/diagnóstico , Preeclampsia/epidemiología , Preeclampsia/diagnóstico , Estudios de Casos y Controles , Ghana/epidemiología , Malaria/complicaciones , Malaria/epidemiología , Gobierno , Hospitales

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This study evaluated physicians' perception and diagnosis of intestinal parasitic infections (IPI) in patients with gastrointestinal (GI) symptoms. This cross-sectional survey used a Google form questionnaire distributed online. Demographic and clinical practice information was solicited, including if "IPI was considered as a diagnosis in the last patient seen," "if stool investigation was requested among the last patients seen," and physicians' perception of the burden of IPI in the country. Using Pearson chi-square and multivariate logistic regression analysis, we tested the significance of the associations of the job cadre of the physicians and their perception of the IPI burden with consideration of IPI as a diagnosis in the last patient seen, request for stool investigation in the last patient seen, and overall frequency of the request for stool investigation. Ultimately, 184 physicians responded. The majority agreed to "often seeing patients with GI symptoms" (156, 84.7%), "not considering IPI among the last patient seen" (106, 57.6%), and "not requesting stool investigation among the last patient seen with symptoms" (136, 73.9%). House officers (81, 44.2%) constituted the highest proportion of physicians who considered IPI as a diagnosis among the last patient seen (39, 48.1%, p = 0.05). Most physicians (138, 75%) considered IPI as a burden in Ghana. They constituted significant proportions of the physicians who considered IPI as a diagnosis among their last patients seen (65, 83.3%, p = 0.02) and were twice more likely to consider IPI as a diagnosis among the last patients seen than their colleagues who did not consider IPI as a burden in Ghana (AOR 2.26, p = 0.04). The consideration of IPI as a diagnosis among patients with GI symptoms and request for stool investigations was low among physicians in this study. Further engagements with physicians in Ghana are needed to help improve their diagnosis of IPI in patients with GI symptoms.

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BACKGROUND: Polyparasitic infection is a possibility in areas where parasites are endemic, especially among children. This study looked at the prevalence of polyparasitic infections among children in the Volta Region of Ghana. METHODS: This was a cross-sectional study, among 550 primary school children (aged 6-14 years) in 3 districts in the Volta Region. Questionnaires were administered, and blood, stool, and urine samples were collected. Blood samples were screened for Plasmodium falciparum with rapid diagnostic test and microscopy, together with hemoglobin estimation. Stool and urine samples were microscopically examined using wet mount and sedimentation methods to detect intestinal parasites and Schistosoma haematobium, respectively. Pearson χ2 test was used to evaluate the association between parasitic infections and socioeconomic variables, and multivariate logistic regression to evaluate paired associations among parasites. RESULTS: The most prominent infection among the children was P. falciparum (present in 383 children [69.6%]), followed by S. haematobium (57 [10.36%]). There was low prevalence of intestinal protozoa (present in 11 children [2%]), Ascaris lumbricoides (7 [1.27%]), and hookworm (5 [0.91%]). A total of 62 children had polyparasitic infection, with P. falciparum and S. haematobium having significant paired association (both present in 46 children [74.19%]; adjusted odds ratio, 2.45; P = .007). CONCLUSION: The prevalence of polyparasitic infection was low in this study, and significant coinfection was seen with P. falciparum and S. haematobium.