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BACKGROUND: Severe Plasmodium falciparum malarial anemia is still the principal cause of death in children in underdeveloped countries. An imbalance between proinflammatory and anti-inflammatory cytokines is associated with malaria progression. This study evaluated circulating levels of selected inflammatory cytokines among malaria-infected children in Ghana. METHODS: This case-control study was conducted at Tamale Teaching Hospital, Ghana. One hundred and twenty children with malaria and 60 controls, aged 12-144 months were selected from April to July, 2023 for the study. Malaria was diagnosed through microscopy, full blood count was measured using hematology analyzer, and cytokines were measured using enzyme-linked immunosorbent assay. RESULTS: Malaria-infected children had higher tumor necrosis factor alpha (TNF-α) (p < .001), interferon-gamma (IFN-É£) (p < .001), interleukin (IL)-1ß (p < .001), IL-6 (p < .001), granulocyte macrophage-colony stimulating factor (GM-CSF) (p < .001), and IL-10 (p < .001) levels than controls. Participants with high parasitemia had raised TNF-α (p < .001), IFN-É£ (p < .001), IL-1ß (p < .001), IL-6 (p < .001), GM-CSF (p < .001), and IL-10 (p < .001), but reduced IL-3 (p < .001) and TGF-ß (p < .001) than those with low parasitemia. Severe malarial anemic children had elevated TNF-α (p < .001), IFN-É£ (p < .001), IL-1ß (p < .001), IL-6 (p < .001), GM-CSF (p < .001), and IL-10 (p < .001), but lower IL-3 (p < .001) and TGF-ß (p < .001) than those with uncomplicated malaria. CONCLUSION: Parasite density was the principal predictor of the cytokine levels, as parasitemia positively associated with IL-10, GM-CSF, IL-6, IL-1ß, IFN-É£, and TNF-α, but negatively associated with IL-3 and TGF-ß. Malaria is associated with enhanced secretion of pro- and anti-inflammatory cytokines in Ghanaian children. Inflammatory cytokines may be involved in the development of severe malarial anemia in children. However, IL-3 and TGF-ß may offer protection against severe malarial anemia.
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Anemia , Citocinas , Progresión de la Enfermedad , Malaria Falciparum , Humanos , Citocinas/sangre , Anemia/sangre , Anemia/inmunología , Anemia/parasitología , Masculino , Preescolar , Femenino , Estudios Prospectivos , Estudios de Casos y Controles , Lactante , Malaria Falciparum/sangre , Malaria Falciparum/inmunología , Malaria Falciparum/complicaciones , Malaria Falciparum/parasitología , Malaria Falciparum/epidemiología , Ghana/epidemiología , Niño , Parasitemia/sangre , Parasitemia/inmunología , Plasmodium falciparum/inmunología , Mediadores de Inflamación/sangreRESUMEN
BACKGROUND: Malaria in pregnancy (MiP) is a condition that can be prevented by using intermittent preventive treatment using Sulfadoxine-pyrimethamine. However, despite all the effort to reduce the consequences of MiP for the woman, the unborn child, and the neonate, the knowledge of Intermittent Preventive Treatment of Malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) is low in most malaria-endemic countries, including Ghana. Thus, the need to examine knowledge, and attitude of service users of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine. METHODS: The study was a cross-sectional survey of two selected districts in the Volta Region of Ghana. The study participants were randomly selected from communities within Nkwanta North and North Tongu District. In all a total of 438 mothers who have delivered in the past 24 months were selected for the study. The women were interviewed using a structured questionnaire and the bivariate and multivariable logistic regression results presented in tables. RESULTS: The level of knowledge, and attitude were reported as 45.9% and 58.9% respectively. Knowledge of the service user is determined by the level of education of the women. The attitude of the service user is determined by making 4-7 visits during ANC, Gestational age at booking for ANC is 4-7 weeks, income level between 100 to 999, partner educational level above Middle/JHS/JSS, and age of a partner is above 40 years. CONCLUSION: The findings from the present studies highlighted important factor such as number of antenatal visits that affect both knowledge of services and attitude to use IPTp-SP. Therefore, a community-based health promotion programmes to help to increase knowledges and improved attitude on timely and regular antenatal attendance to promote the benefit of IPTp-SP should be encouraged.
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Antimaláricos , Combinación de Medicamentos , Conocimientos, Actitudes y Práctica en Salud , Malaria , Complicaciones Parasitarias del Embarazo , Pirimetamina , Sulfadoxina , Humanos , Femenino , Ghana/epidemiología , Pirimetamina/uso terapéutico , Sulfadoxina/uso terapéutico , Embarazo , Adulto , Malaria/prevención & control , Malaria/tratamiento farmacológico , Malaria/epidemiología , Antimaláricos/uso terapéutico , Estudios Transversales , Complicaciones Parasitarias del Embarazo/prevención & control , Complicaciones Parasitarias del Embarazo/tratamiento farmacológico , Adulto Joven , Adolescente , Encuestas y CuestionariosRESUMEN
BACKGROUND: In Sub-Saharan Africa (SSA), there is a noticeable shift from infectious diseases to chronic non-communicable diseases (CNCDs) based on recent studies. However, other studies suggest that social support can significantly improve self-care, increase knowledge of disease symptoms, and ultimately increase overall well-being in patients with CNCDs. In this study, we investigated the influence of perceived social support on treatment adherence among adults living with CNCDs in the Ho Municipality. METHODS: This was a health facility-based cross-sectional study among 432 adults living with cancer, diabetes, chronic kidney disease (CKD), stroke, and hypertension in the Ho Municipality of the Volta Region, Ghana. We adopted the Multi-dimensional Scale of Perceived Social Support (MSPSS), Medication Adherence Rating Scale and independent items to collect data. Logistic regression models were used to analyze the data with STATA v17.0 at 95% Confidence Intervals with statistical significance set at p<0.05. RESULTS: Majority of the participants (62%) reported high levels of perceived social support. While friends were the main source of support (69.4%), significant others provided the least support (45.4%). Among the dimensions of treatment adherence, participants demonstrated the highest adherence to reviews/check-ups (98.8%), while medication adherence had the highest level of non-adherence (38%). We did not find a significant association between perceived social support and overall treatment adherence, except for individuals with low perceived social support from friends (aOR = 8.58, 95% CI = 4.21,17.52), who were more likely to exhibit high adherence to behavioural and lifestyle recommendations. CONCLUSION: While the majority of respondents reported high perceived social support, there was no significant link between social support and overall treatment adherence. However, individuals with low support from friends showed a notably increased adherence to behavioural and lifestyle recommendations. This underscores the nuanced impact of social support on specific aspects of adherence, highlighting the need for targeted interventions tailored to individual support networks.
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Enfermedades no Transmisibles , Apoyo Social , Humanos , Ghana , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Adulto , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/terapia , Enfermedades no Transmisibles/psicología , Enfermedad Crónica/psicología , Anciano , Cumplimiento y Adherencia al Tratamiento/psicología , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Cumplimiento de la Medicación/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Instituciones de SaludRESUMEN
BACKGROUND: In many places in the world, workers in the meat processing industry report high incidence of injuries. Details of such injuries are not well known for Ghana or much of Africa. METHODS: A cross-sectional survey involving 300 workers from three major meat processing facilities in the Kumasi metropolis of Ghana was carried out using a structured questionnaire from April to June 2023. The prevalence, types and outcome of injuries among workers were assessed. Test of association was established by Chi square analysis. RESULTS: Over the prior 6 months, the prevalence of injury was 83.0%. Among the various injury types, lacerations had the highest prevalence (46.0%) followed by musculoskeletal pain (16.7%) bone fractures (14.0%), swelling (13.0%), burns and scalds (7.3%), and dislocations/sprains/strains (6.7%). More than half (58.9%) of injuries sustained were moderately severe (2-7 days of lost work) and nearly half (42.0%) required immediate medical attention. Gender, employment status, wages, availability and use of safety equipment were significantly associated with injuries among abattoir workers. CONCLUSIONS: The incidence of injuries among abattoir workers in Kumasi, Ghana demonstrates a large public health burden requiring attention and improved enforcement through occupational safety interventions.
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Mataderos , Traumatismos Ocupacionales , Humanos , Ghana/epidemiología , Masculino , Femenino , Mataderos/estadística & datos numéricos , Prevalencia , Estudios Transversales , Traumatismos Ocupacionales/epidemiología , Adulto , Persona de Mediana Edad , Adulto Joven , Laceraciones/epidemiología , Encuestas y Cuestionarios , IncidenciaRESUMEN
BACKGROUND: Poor person-centered maternal care (PCMC) contributes to high maternal mortality and morbidity, directly and indirectly, through lack of, delayed, inadequate, unnecessary, or harmful care. While evidence on poor PCMC prevalence, as well as inequities, expanded in the last decade, there is still a significant gap in evidence-based interventions to address PCMC. We describe the protocol for a trial to test the effectiveness of the "Caring for Providers to Improve Patient Experience" (CPIPE) intervention, which includes five strategies, targeting provider stress and bias as intermediate factors to improve PCMC and address inequities. METHODS: The trial will assess the effect of CPIPE on PCMC, as well as on intermediate and distal outcomes, using a two-arm cluster randomized controlled trial in 40 health facilities in Migori and Homa Bay Counties in Kenya and Upper East and Northeast Regions in Ghana. Twenty facilities in each country will be randomized to 10 intervention and 10 control sites. The primary intervention targets are all healthcare workers who provide maternal health services. The intervention impact will be assessed among healthcare workers in the study health facilities and among women who give birth in the study health facilities. The primary outcome is PCMC measured with the PCMC scale, via multiple cross-sectional surveys of mothers who gave birth in the preceding 12 weeks in study facilities at baseline (prior to the intervention), midline (6 months after intervention start), and endline (12 months post-baseline) (N = 2000 across both countries at each time point). Additionally, 400 providers in the study facilities across both countries will be followed longitudinally at baseline, midline, and endline, to assess intermediate outcomes. The trial incorporates a mixed-methods design; survey data alongside in-depth interviews (IDIs) with healthcare facility leaders, providers, and mothers to qualitatively explore factors influencing the outcomes. Finally, we will collect process and cost data to assess intervention fidelity and cost-effectiveness. DISCUSSION: This trial will be the first to rigorously assess an intervention to improve PCMC that addresses both provider stress and bias and will advance the evidence base for interventions to improve PCMC and contribute to equity in maternal and neonatal health. TRIAL REGISTRATION: ClinicalTrials.gov: NCT06085105. Protocol version and date: v2-11-07-23.
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Servicios de Salud Materna , Humanos , Kenia , Ghana , Femenino , Personal de Salud/psicología , Atención Dirigida al Paciente , Embarazo , Mejoramiento de la Calidad , Ensayos Clínicos Controlados Aleatorios como Asunto , Satisfacción del Paciente/estadística & datos numéricosRESUMEN
BACKGROUND: Electronic Health Record systems (EHRs) offer significant benefits and have transformed healthcare in developed countries. However, their implementation and adoption in low- and middle-income countries (LMICs) remains low due to challenges and competing interests. Health professionals' perception of EHRs can influence their adoption and continued use. The objectives of this study are to explore the perception of health professionals regarding implemented EHR systems in three hospitals in Ghana and identify factors influencing their perception and satisfaction. METHODS: In this study, we employed a concurrent mixed method design to collect data from study participants from May to June 2023. The quantitative part employed a descriptive-survey and the qualitative (in-depth interview) techniques was applied. After obtaining written informed consent from each respondent, a structured survey questionnaire was filled out by the health professionals from three hospitals. An a priori power calculation was used to determine the sample size for the quantitative component. Two hundred and sixty-three (263) health professionals completed the questionnaire from the three facilities. A purposive sampling technique was used to select fifteen [1] participants for the interviews. A semi-structured interview guide was used for the in-depth interviews. The interviews were audio recorded, transcribed, and coded into themes using QSR Nvivo 12 software before thematic content analysis. RESULTS: Our findings revealed that 213 (80.99%) health professionals perceived the EHRs as beneficial to patients and were generally satisfied. An overwhelming majority, 197 (74.90%) of the health professionals, were satisfied with its use and expressed interest in continuing to use the system. The majority of health professionals viewed the EHRs to have improved their work and workflow processes and provided the desired results. However, few other health professionals were dissatisfied with the system because they viewed the EHRs as frustrating due to unstable internet connectivity and power supply. Other concerns were related to the privacy and confidentiality of patient information. They believe access to patient information should be on a need-to-know basis, and patient information should not be accessible to all other clinicians except those involved directly in their care processes. CONCLUSION: The study revealed that health professionals have a positive perception of the implemented EHRs, are highly satisfied with them, and are interested in continuing to use them. However, health professionals' concerns about the unstable power supply, poor internet connectivity, security, and confidentiality of patient's information need attention, to mitigate their frustrations and boost their confidence in the system.
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Actitud del Personal de Salud , Registros Electrónicos de Salud , Humanos , Ghana , Adulto , Femenino , Masculino , Persona de Mediana Edad , Personal de Salud/psicología , Actitud hacia los Computadores , Encuestas y Cuestionarios , Investigación CualitativaRESUMEN
BACKGROUND: Ticks are vectors of pathogens that affect the health of animals and humans. With the constant trade of livestock across borders, there is the risk of new tick species invasion accompanied by the spread of infectious tick-borne pathogens. AIM: This study sought to determine the diversity of tick species within abattoirs and a slaughter slab as well as identify the pathogens carried by these ticks. METHODS: The ticks were collected from slaughtered cattle, identified and screened for pathogens using PCR and sequencing. RESULTS: A total of 371 ticks were collected from slaughtered cattle across the three sampling sites: Kumasi abattoir (288, 77.63%), Akwatia Line slaughter slab (52, 14.02%) and Suame abattoir (31, 8.35%). The predominant species was Amblyomma variegatum (85.44%) with Rhipicephalus sanguineus (s.l.) (0.27%) as the least occurring species. Total nucleic acid from the tick pools was screened for pathogens based on the nucleoprotein gene region in the S segment of the Crimean-Congo haemorrhagic fever virus (CCHFV) genome, the 295-bp fragment of the transposase gene of the Coxiella burnetii IS1111a element, the 560 bp segment of the ssrRNA gene of Babesia and Theileria, the 345 bp fragment of the Ehrlichia genus 16SrRNA gene and the rOmpA gene (OmpA) of Rickettsia. From the 52 tick pools screened, 40 (76.92%) were found positive for pathogen DNA. The pathogens identified were Rickettsia africae (69.23%), Rickettsia aeschlimannii (7.69%), C. burnetii (5.77%), uncultured Ehrlichia sp. (5.77%), Candidatus Midichloria mitochondrii (3.85%) and CCHFV (3.85%). A significant association was observed among A. variegatum, Hyalomma rufipes, Hyalomma truncatum and occurring tick-borne pathogens R. africae, R. aeschlimannii and uncultured Ehrlichia sp. (p < 0.001). CONCLUSION: The findings show the occurrence of zoonotic pathogens, suggesting an increased risk of infections among the abattoir workers. There is a need to adopt control measures within the abattoirs to prevent pathogen spread.
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Mataderos , Animales , Mataderos/estadística & datos numéricos , Bovinos , Ghana/epidemiología , Enfermedades por Picaduras de Garrapatas/veterinaria , Enfermedades por Picaduras de Garrapatas/epidemiología , Enfermedades por Picaduras de Garrapatas/microbiología , Enfermedades por Picaduras de Garrapatas/parasitología , Ixodidae/microbiología , Enfermedades de los Bovinos/epidemiología , Enfermedades de los Bovinos/microbiología , Enfermedades de los Bovinos/parasitología , Rickettsia/aislamiento & purificación , Rickettsia/genéticaRESUMEN
The Ghana Physicians and Surgeons Foundation (GPSF) of North America sponsors Ghanaian clinical fellows to undertake an eight-weeklong clinical observation with the Yale University School of Medicine and Yale-New Haven Health (YNHH) annually, through the Residents in Training Educational Stipend (RITES) programme. This offers the opportunity to appreciate new perspectives in clinical care to improve Ghana's healthcare standard. The cardiovascular medicine workforce at the YNHH is heterogenous, with significant reliance on non-doctor cadres of health workers who demonstrate competence. This is contrasted from the Ghanaian system which despite having a poorer physician-patient ratio, is heavily dependent on doctors. Technological advancements are minimal in Ghana, posing diagnostic and therapeutic challenges which are otherwise minimised at the YNHH. A strong patient-centred culture, coupled with a coordinated emergency response system that ensures appropriate timely transfers, culminate in good care and outcomes. Ideas on how the experience can be translated to Ghanaian clinical practise in cardiovascular medicine, after participating in the RITES programme, are shared in this paper with an emphasis on task sharing, strengthening emergency response systems and improving technological sophistication through capacity building, mentorship and improved health financing.
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Cardiología , Humanos , Ghana , Cardiología/educación , Enfermedades Cardiovasculares/terapia , Atención a la Salud/organización & administraciónRESUMEN
BACKGROUND: Health care is an indispensable element for economic growth and development of individuals and nations. Healthcare service quality is associated with patient satisfaction, ensuring the safety and security of patients, reducing mortality and morbidity, and improving the quality of life. Patient satisfaction with health service is linked to increased utilization following contendness with healthcare received from health providers. There is an increasing public perception of poor quality of care among patients visiting public health facilities in Ghana which translates into service dissatisfaction. Meanwhile, patient dissatisfaction will more likely result in poor utilization, disregard for medical advice, and treatment non-adherence. The study was conducted to assess patients' satisfaction with quality of care at the outpatient departments of selected health facilities in Kumasi, Ghana. METHODS: An institutional-based analytical cross-sectional study was conducted among patients (aged ≥ 18 years) visiting outpatient departments of selected health facilities in Kumasi from October - December, 2019. A systematic sampling technique was adopted to collect quantitative information from 385 respondents using a structured questionnaire. At 95% confidence interval and 5% alpha level, two-level logistic regression models were performed. Model I estimated the crude associations and the effect of covariates was accounted for in Model II. The results were presented in odds ratio with a corresponding 95% confidence interval. All analysis were performed using STATA statistical software version 16.0. RESULTS: Out of the 385 participants, 90.9% of the participants were satisfied with the services they received. Being married [AOR = 3.06, 95%CI = 1.07-8.74], agreeing that the facility is disability-friendly [AOR = 7.93, 95%CI = 2.07-14.43], facility has directional signs for navigation [AOR = 3.12, 95%=1.92-10.59] and the facility has comfortable and attractive waiting area [AOR = 10.02, 95%CI = 2.35-22.63] were associated with satisfaction with health service among patients. Spending more than 2 h at the health facility [AOR = 0.45, 95%CI = 0.04-0.93] and having perceived rude and irritating provider [AOR = 0.14, 95%CI = 0.04-0.51] had lower odds of satisfaction with health service received. CONCLUSION: There is a high patient satisfaction with services received at out-patient departments which is influenced by a multiplicity of factors; being married, and agreeing that the facility is disability-friendly, has directional signs for navigation, and the waiting area is comfortable and attractive. The study findings call for the need to develop and implement health delivery interventions and strategies (i.e. patient-centered interventions, disability-friendly facilities, and sustainability and improvement of quality service) to improve and sustain patient satisfaction levels with health care service. These strategies must be directed towards addressing inequalities in infrastructural development and inputs needed for healthcare delivery in the health system.
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Satisfacción del Paciente , Calidad de la Atención de Salud , Humanos , Satisfacción del Paciente/estadística & datos numéricos , Ghana , Femenino , Estudios Transversales , Masculino , Adulto , Persona de Mediana Edad , Encuestas y Cuestionarios , Adolescente , Adulto Joven , Instituciones de Salud/normas , Anciano , Pacientes Ambulatorios/psicología , Pacientes Ambulatorios/estadística & datos numéricosRESUMEN
BACKGROUND: Malaria in pregnancy (MiP) is a preventable condition leading to maternal and neonatal morbidity and mortality. Invariably, with all the knowledge about the serious consequences of MiP for the woman, the unborn child, and the neonate, the uptake of Intermittent Preventive Treatment of Malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) is low in most malaria-endemic countries, including Ghana. This study sought to examine the uptake and service user predictors of the implementation of IPTp-SP after the policy upgrade in 2014. METHODS: This cross-sectional survey was carried out in two selected districts in the Volta Region. The study participants were randomly selected from communities within Nkwanta North and North Tongu District. A total of 438 mothers who have delivered in the past 24 months were selected for the study. The women were interviewed on their background, knowledge, and attitude toward the use of IPTp-SP using a structured questionnaire. Multiple logistic regression was done to determine the factors that influence the demand for IPTp-SP. The results were presented in the form of tables. RESULTS: The mean number of antenatal care (ANC) attendance was 5 (SD:2.6) visits per client, with 262 (59.82%) of them getting the 3+ doses of IPTp-SP. Also, a significant 44 (10.1%) of the mothers did not receive any dose of IPTp-SP. Respondents who attended antenatal clinics 4-7 times had 7 (CI:3.9-12.3) times higher uptake of 3+ doses of IPTp-SP as compared to others who attended less than 4 visits. Similarly, women who had 8 or more visits had a 16.1 (CI: 5.9-43.6) times higher chance of getting more than 2 doses of IPTp-SP compared with others who had fewer than 4 attendances. CONCLUSION: The uptake of 3+ doses of IPTp-SP is still lower than the global target of 80%. Thus, the need for innovative interventions aimed at improving antenatal attendance and early booking for IPTp-SP are recommended.
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Antimaláricos , Combinación de Medicamentos , Malaria , Complicaciones Parasitarias del Embarazo , Pirimetamina , Sulfadoxina , Humanos , Femenino , Pirimetamina/uso terapéutico , Pirimetamina/administración & dosificación , Sulfadoxina/uso terapéutico , Sulfadoxina/administración & dosificación , Ghana/epidemiología , Embarazo , Adulto , Antimaláricos/uso terapéutico , Malaria/prevención & control , Malaria/tratamiento farmacológico , Malaria/epidemiología , Estudios Transversales , Complicaciones Parasitarias del Embarazo/prevención & control , Complicaciones Parasitarias del Embarazo/tratamiento farmacológico , Adulto Joven , Adolescente , Atención Prenatal , Conocimientos, Actitudes y Práctica en Salud , Encuestas y CuestionariosRESUMEN
Objective: To describe the profile of Streptococcus pneumoniae, identify research gaps, and provide in-depth insights into various aspects related to the pathogen. Methods: Google Scholar, PubMed, and ScienceDirect were searched for all studies on the pneumococcus in Ghana that reported on specimen collected, population and sample size, carriage prevalence, incidence of pneumococcal diseases, age of the study population, types of test performed, serotypes identified, antimicrobial susceptibilities, or molecular analysis on the pneumococci for data extraction. Results: Overall, a total of 7954 results were obtained from the three-database search, and of this, 24 articles were selected after screening. A total of 924 isolates were accounted for by serotyping/serogrouping. The prevalence of pneumococcal carriage in Ghana ranges from 11.0% to 51.4% in the population depending on the age (≤ 24-80 years), sickle cell disease (SCD), human immunodeficiency virus (HIV) status, or health of the study population, and penicillin (Pen)-nonsusceptible isolates ranged from 17% to 63%. The prevalence of pneumococci found as the etiologic agent of diseases among Ghanaians ranges from 3.4% for otitis media to 77.7% for meningitis. Overall, the 13-valent pneumococcal conjugate vaccine (PCV) (PCV-13) carriage serotypes accounted for 28.4% of the reported pneumococcal isolates. PCV-13 invasive serotypes accounted for 22.4% of the reported isolates. The non-PCV-13 carriage serotypes accounted for most (43.9%) of the reported isolates. In the pre-PCV-13 era, the nontypeable (NT) (5.5%) and other nonvaccine types (NVTs) (6.4%) were reported as being predominant. The non-PCV-13 serotypes accounted for 4.4% of the reported isolates in invasive pneumococcal disease (IPD) cases. Multidrug resistance (MDR) ranged from 7.8% to 100%. Conclusion: Predicting the invasiveness of pneumococci using molecular typing is the way to go in the future as this will provide answers to the extent to which capsular switching is contributing to the pneumococcal disease burden in Ghana almost a decade after introducing PCV-13. Continuous monitoring of antibiotic resistance patterns at both phenotypic and genotypic levels, along with serotyping and molecular typing, should be a standard practice in the surveillance of pneumococcal disease burden in Ghana.
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Infecciones Neumocócicas , Vacunas Neumococicas , Streptococcus pneumoniae , Humanos , Ghana/epidemiología , Streptococcus pneumoniae/patogenicidad , Streptococcus pneumoniae/aislamiento & purificación , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/microbiología , Prevalencia , Serogrupo , Adulto , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Serotipificación , Femenino , Antibacterianos/farmacología , Antibacterianos/uso terapéuticoRESUMEN
Introduction: Helicobacter pylori (H. pylori) infection is endemic in Africa. It is a major aetiological factor in the development of peptic ulcer disease and distal gastric cancers. Existing data shows that clinical outcomes are dependent on the virulence of the infecting strain, host´s susceptibility, and environmental factors. In Ghana, a previous study showed that the majority of symptomatic individuals harboured cagA and vacA virulent strains. The main objective of this study was to characterize and assess the significance of other virulence factors, specifically iceA and babA2 in Ghana. Methods: H. pylori iceA and babA2 genes were investigated in dyspeptic patients at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. The study employed a cross-sectional design consecutively recruiting patients with upper gastrointestinal symptoms for endoscopy. Nucleic acid was extracted from gastric biopsies using a commercial kit (QIAGEN DNeasy tissue kit). H. pylori babA2 and iceA genes were amplified using extracted deoxyribonucleic acid (DNA) and primers by polymerase chain reaction (PCR). Results: majority, (71.1%), of the study participants, were H. pylori positive when tested with urease-campylobacter-like organism (CLO). In total, 46 H. pylori urease CLO-positive samples were randomly analyzed by PCR for iceA, of which, 12 (26%) and 7 (15%) were found to have iceA1 and iceA2 respectively. Of the CLO-positive samples, 9 were randomly analysed for babA2 by PCR. Three samples were babA2 positive and 6 were babA2 negative. Conclusion: in Ghana, although H. pylori is endemic, iceA prevalence is rather low and probably exerts a limited effect on bacterial virulence. Further evaluation would be required, not only to determine association with other virulence factors but more importantly, inter-relationships with wider host and environmental factors that impact on disease pathogenesis.
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Adhesinas Bacterianas , Dispepsia , Infecciones por Helicobacter , Helicobacter pylori , Reacción en Cadena de la Polimerasa , Factores de Virulencia , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Adhesinas Bacterianas/genética , Proteínas de la Membrana Bacteriana Externa/genética , Proteínas Bacterianas , Estudios Transversales , Dispepsia/microbiología , Ghana , Infecciones por Helicobacter/microbiología , Helicobacter pylori/aislamiento & purificación , Helicobacter pylori/genética , Helicobacter pylori/patogenicidad , Hospitales de Enseñanza , Virulencia/genética , Factores de Virulencia/genéticaRESUMEN
INTRODUCTION: In Sub-Saharan Africa alone, about 40-65% of Hepatitis B Virus infections among HCWs were a result of percutaneous occupational exposures to contaminated blood and body fluids of patients. Occupational exposure to blood and body fluids among healthcare workers is on the rise in Ghana. However, the relationship between self-reported exposures to blood and body fluids suspected to be contaminated with the hepatitis B virus and actual serological evidence of exposure remains unknown. The aim of the study however was to assess the self-reported exposure to HBV as against the serological evidence of lifetime exposure to HBV and associated factors among Ghanaian HCWs. METHODS: The study was a cross-sectional analytical survey that involved 340 HCWs who were recruited using a simple random sampling procedure from six cadres of staff from five districts in Greater Accra. The participants were surveyed using a validated instrument and 5mls of venous blood was aseptically withdrawn for qualitative detection of Anti-HBc. SPSS version 23.0 was used to analyze the data to obtain proportions, odds ratios and their corresponding confidence intervals with the level of significance set at 0.05. RESULTS: The response rate was 94% with Nurses and Doctors in the majority with a mean age of 35.6 ± 7.2. Self-reported exposure to HBV was 63% whereas lifetime exposure to HBV (Anti-HBc) prevalence was 8.2% (95% CI = 5.0-11.0%). Females were 60% less likely to be exposed to HBV (aOR = 0.4; 95% CI = 0.1-0.9) than their male counterparts. HCWs without training in the prevention of blood-borne infections had almost three times higher odds of being exposed to HBV in their lifetime (aOR = 2.6; 95% CI = 1.0-6.4). CONCLUSIONS: The findings of this study suggest that self-reported exposure to HBV-contaminated biological materials was high with a corresponding high lifetime exposure to HBV. The female gender was protective of anti-HBc acquisition. Apart from direct interventions for preventing occupational exposures to HBV in the healthcare setting, periodic training of all categories of healthcare workers in infection prevention techniques could significantly reduce exposure to the Hepatitis B virus.
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Personal de Salud , Hepatitis B , Exposición Profesional , Autoinforme , Humanos , Estudios Transversales , Ghana/epidemiología , Femenino , Masculino , Personal de Salud/estadística & datos numéricos , Adulto , Hepatitis B/epidemiología , Hepatitis B/transmisión , Exposición Profesional/estadística & datos numéricos , Persona de Mediana Edad , Líquidos Corporales/virología , Virus de la Hepatitis B/inmunología , Virus de la Hepatitis B/aislamiento & purificación , Adulto Joven , Anticuerpos contra la Hepatitis B/sangreRESUMEN
BACKGROUND: Over the past two decades, antenatal care (ANC) coverage has increased in most settings across low- and middle-income countries, including Ghana. However, evidence shows that there is a need to focus on both access and quality to improve maternal and newborn health outcomes. We investigated ANC quality among public healthcare facilities in the northern region of Ghana. METHODS: We conducted a facility-based study involving 420 postpartum women, selected randomly from five public health facilities. We collected information on a set of prenatal services that respondents self-reported to have received during their most recent pregnancy. Women who received all the interventions assessed were considered to have received quality ANC. Using multilevel (mixed-effects) regression analysis, we identified the independent factors associated with ANC quality, with healthcare facility as the cluster variable. RESULTS: Of the 420 women, 31.2% (95% CI: 26.9, 35.8) received ANC services of high quality. ANC quality differed significantly by women's background characteristics and ANC use. However, gestational age at first ANC and the number of follow-up visits before delivery were significantly associated with ANC quality: booking the first visit in the second or third trimester reduced the odds of receiving high-quality ANC compared to booking in the first trimester (aOR = 0.15, 95% CI: 0.07, 0.31, and aOR = 0.09, 95% CI: 0.01, 0.83, respectively). In contrast, achieving a minimum of eight ANC follow-ups before delivery increased the odds of receiving high-quality ANC compared to attaining fewer than eight visits (aOR = 4.82, 95% CI: 2.33, 9.99). CONCLUSIONS: A significant proportion of pregnant women in the study setting received suboptimal quality ANC during their most recent pregnancy. ANC quality was primarily associated with the timing of the first visit and the number of follow-up visits before delivery. Timely initiation of ANC and frequent follow-up visits will be crucial in the study's setting for pregnant women to benefit from comprehensive ANC services.
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Atención Prenatal , Calidad de la Atención de Salud , Humanos , Femenino , Ghana , Atención Prenatal/normas , Atención Prenatal/estadística & datos numéricos , Adulto , Embarazo , Adulto Joven , Adolescente , Instituciones de Salud/normas , Instituciones de Salud/estadística & datos numéricosRESUMEN
BACKGROUND: Reactive case detection (RCD) aims to reduce malaria transmission stemming from asymptomatic carriers. Symptomatic individuals diagnosed with malaria at a health centre are followed to their households, where members of the index case and neighbouring households are tested and treated for malaria. An RCD programme was tested in the Ashanti region of Ghana in order to study diagnostic accuracy in the hospital and household settings, assess the prevalence of subclinical infections and possible clustering in index case households, and identify operational challenges for future RCD programmes. Currently, transmission in this region is high, but reactive interventions might become an option once transmission is reduced. METHODS: 264 febrile individuals were enrolled at the Mankranso Government Hospital and tested for malaria using rapid diagnostic tests (RDT). From the pool of RDT-positive febrile index cases, 14 successful RCD follow-ups were conducted, and 233 individuals were enrolled from the index case, neighbour, and control households. The sensitivity of diagnostic tools for clinical and subclinical cases was compared, including RDT, expert microscopy by World Health Organization-certified microscopists, field microscopy, and qPCR. RESULTS: Poor diagnosis and low receptivity to RCD-style follow-ups were major limitations to a successful and effective RCD programme. Field microscopy detected only 49% of clinical infections compared to RDT. 54% of individuals did not agree to a follow-up, and 66% of attempted follow-ups failed. The system effectiveness of RCD, calculated as the product of correctly diagnosed index cases, successful follow-ups, and proportion of asymptomatic infections detected by RDT, was very low at 4.0%. CONCLUSIONS: Due to low system effectiveness and the endemic nature of the disease setting in which asymptomatic prevalence is high and infections are not clustered around index case households, RCD is currently not a feasible option for malaria control in this region. The operational challenges identified through this study may help inform future reactive intervention programme designs once transmission is reduced.
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Infecciones Asintomáticas , Pruebas Diagnósticas de Rutina , Malaria Falciparum , Ghana/epidemiología , Humanos , Malaria Falciparum/diagnóstico , Malaria Falciparum/epidemiología , Malaria Falciparum/prevención & control , Infecciones Asintomáticas/epidemiología , Femenino , Masculino , Preescolar , Niño , Adolescente , Pruebas Diagnósticas de Rutina/métodos , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Adulto , Adulto Joven , Lactante , Persona de Mediana Edad , Plasmodium falciparum/aislamiento & purificación , Prevalencia , Sensibilidad y Especificidad , AncianoRESUMEN
Objectives: The radiographic assessment of the head is a crucial part of headache care. A computed tomography (CT) scan enables a more detailed analysis of the condition and more focused care. This study examined head CT scans to determine what kinds of anomalies were present in patients with headaches as their primary complaint. Methods: We evaluated 4 years' worth of CT scan data from head exams conducted at two diagnostic facilities in Ghana's western and central regions. We examined data on 477 patients with a headache as their primary complaint between January 2017 and December 2020. We employed chi-square and Fisher's exact tests (where applicable) to compare head CT diagnoses between age groups, gender, headache subtypes, and brain lesion subgroups. Results: There were 53.5% (n = 255) females and 46.5% (n = 222) males in the study. The average age of patients was 38.67 ± 17.23 years, with an annual rate of abnormal CT diagnoses ranging from 35.9% in 2017 to 45.4% in 2022. Abnormal head CT diagnoses are strongly correlated with age groups and patient gender (p = 0.011 and p = 0.009, respectively). Of the 202 patients, 15.3% and 24.3% were classified as intracranial lesions and extracranial lesions, respectively. Maxillary sinusitis affected nearly 60% of the patients, while tumors and hemorrhages affected 25.2% and 11.9%, respectively. Conclusions: A CT scan of the head is essential to detect abnormalities in nearly 50% of patients suffering from various degrees of headache. Sinusitis, brain tumors, and hemorrhage were common lesions detected. It is crucial to create local standard operating procedures to promote better utilization of this type of imaging service, particularly among patients who have been diagnosed with headaches.
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Cefalea , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Ghana/epidemiología , Adulto , Tomografía Computarizada por Rayos X/métodos , Cefalea/diagnóstico por imagen , Persona de Mediana Edad , Estudios Retrospectivos , Adolescente , Anciano , Adulto Joven , Niño , Cabeza/diagnóstico por imagenRESUMEN
BACKGROUND: Intimate partner violence in pregnancy is a significant public health issue that has several detrimental effects. Pregnant women subjected to intimate partner violence (IPV) have a higher risk for adverse pregnancy outcomes. OBJECTIVE: The aim of the study was to determine the prevalence, patterns and factors associated with intimate partner violence among pregnant women attending a primary care antenatal clinic. METHODS: A quantitative cross-sectional study design was employed to study intimate partner violence among 269 pregnant women in Accra, Ghana between July and October 2021. Participants were selected by systematic sampling technique. The self-reported Composite Abuse Scale was used to assess and classify intimate partner violence. Socio-demographic, clinical (obstetric) and behavioural characteristics were obtained with a structured questionnaire. Associations were determined between independent and dependent variables using the chi-squared test, and logistic regression with adjusted odds ratio (AOR). The statistical significance level was set at a p-value ≤ 0.05. RESULTS: The prevalence of IPV was 11.2%. The prevalence of emotional/psychological abuse, harassment/controlling behaviour, physical abuse, sexual abuse and severe combined abuse were 12.3%, 13.0%, 8.2%, 3.3% and 8.9% respectively. Pregnant women who were employed had reduced odds of experiencing IPV [AOR = 0.16 (95%CI: 0.05-0.47), p = 0.001], however, the past experience of violence [AOR = 4.9 (95%CI: 1.06-22.96), p = 0.042], alcohol use by women [AOR = 7.8 (95%CI: 1.63-37.42), p = 0.01], and partners' alcohol consumption [AOR = 10.0 (95%CI: 3.22-31.26), p<0.001] were associated with increased odds of IPV. CONCLUSIONS: There is a high prevalence of IPV among pregnant women in this study from a resource-limited setting. The factors found to be associated with IPV in pregnancy were the employment status of women, alcohol consumption by women or their partners and a previous history of violence. Healthcare providers in primary care need to recognize IPV as a medical condition that can occur in pregnancy and be ready to assist and manage the victims when it is detected.
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Violencia de Pareja , Mujeres Embarazadas , Atención Primaria de Salud , Humanos , Femenino , Embarazo , Violencia de Pareja/estadística & datos numéricos , Violencia de Pareja/psicología , Adulto , Ghana/epidemiología , Estudios Transversales , Atención Primaria de Salud/estadística & datos numéricos , Prevalencia , Mujeres Embarazadas/psicología , Adulto Joven , Adolescente , Encuestas y Cuestionarios , Factores de RiesgoRESUMEN
BACKGROUND: Preterm birth is a process that fundamentally alters parental or caregiver roles, particularly in the early weeks of childbirth. Caregiver experiences can be distressing due to struggles with an unfamiliar and potentially threatening environment of the Neonatal Intensive Care Unit (NICU). These experiences can affect the development of parenting or caregiving roles to a greater extent. Supporting caregivers of preterm infants through education and information sharing can significantly improve neonatal outcomes. This study sought to explore the experiences of caregivers with hospitalized preterm infants regarding the education and information they received from healthcare workers on the care of preterm infants. METHOD: An exploratory descriptive qualitative study that explored caregivers' experiences with the management of preterm infants hospitalized at the Level III Neonatal Intensive Care Unit (NICU) of a tertiary level facility with an annual delivery of almost 7500 and a bed capacity of 26. The study utilized a deductive approach and a purposive sampling technique to recruit 16 caregivers who participated in an in-depth interview using a piloted semi-structured interview guide. The interviews were audio-recorded, transcribed, and analyzed using thematic analysis. FINDINGS: The study identified three major themes, which were (1) preterm infant feeding and keeping infants warm, (2) routine procedures and activities at the NICU, and (3) preparation towards homecare after discharge. Seven (7) sub-themes were generated. Caregivers were satisfied with the education and information they received on infant feeding and keeping the infant ward. They also had adequate education that prepared them for home care of the preterm infant. Caregivers did not receive timely information and education on the health status of their infants and the care processes of the NICU. They felt they were left out as they were not involved in decision-making. Regarding the care of the preterm infant. The inadequate flow of information and use of medical terminologies were a great source of worry and frustration for participants. The study showed that although the NICU staff were willing to offer health education to caregivers, information giving and education were not structured and hence did not address all the needs of the caregivers. CONCLUSION: Healthcare providers caring for preterm infants include caregiver education in their routine NICU activities and procedures. These processes start from the period of admission till discharge. Their education sessions primarily focus on breastfeeding, keeping the infant warm and adequate preparation of caregivers for preterm infant home care. This notwithstanding there are gaps in caregiver education and information on routine procedures in the NICU as well as information on the health needs of the infant. Participants are not fully involved in the decision-making processes and the use of medical terminologies compound caregivers' frustrations and anxieties. It is important to develop structured educational programs tailored to address the information needs faced by caregivers to ensure optimal health outcomes for their preterm infants.
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Cuidadores , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Investigación Cualitativa , Humanos , Recién Nacido , Femenino , Cuidadores/educación , Cuidadores/psicología , Masculino , Ghana , Adulto , Centros de Atención Terciaria , Adulto JovenRESUMEN
BACKGROUND: Mycoplasma genitalium (MG), a sexually transmitted infection (STI), has emerged as a common cause of non-gonococcal urethritis and cervicitis worldwide, with documented resistance to commonly used antibiotics including doxycycline and azithromycin. Data in Ghana regarding the prevalence of MG is limited. METHODS: This retrospective study investigated MG presence and macrolide resistance among patients who previously reported to selected clinics for STI symptoms between December 2012 and June 2020. Samples were screened for MG and mutations associated with azithromycin resistance were investigated using Nucleic Acid Amplification Testing (NAAT) including the Resistance Plus MG® kit from SpeeDx and the LightMix® kit for MG, combined with the Modular Mycoplasma Macrolide from TIB Molbiol. RESULTS: A total of 1,015 samples were screened, out of which MG infection rate by TIB Molbiol and SpeeDx were 3.1% and 3.4%, respectively. The mutation responsible for macrolide resistance was detected in one MG positive sample by both assays. Both diagnostic tests revealed no significant association between MG infection and socio-demographic characteristics, clinical symptoms, gonorrhea, and chlamydia infection status. There was no significant difference in the mycoplasma percentage positivity rate detected using SpeeDx (3.4%) and TIB Molbiol (3.1%). CONCLUSIONS: While not commonly tested as a cause of STI symptoms, MG is widespread in Ghana, exhibiting symptoms and prevalence comparable to those in other countries and linked to antimicrobial resistance. Future research using various molecular techniques is essential to monitor resistance trends and guide future antibiotic choices.
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Antibacterianos , Farmacorresistencia Bacteriana , Macrólidos , Infecciones por Mycoplasma , Mycoplasma genitalium , Mycoplasma genitalium/efectos de los fármacos , Mycoplasma genitalium/genética , Mycoplasma genitalium/aislamiento & purificación , Humanos , Infecciones por Mycoplasma/epidemiología , Infecciones por Mycoplasma/tratamiento farmacológico , Infecciones por Mycoplasma/microbiología , Ghana/epidemiología , Femenino , Masculino , Adulto , Estudios Retrospectivos , Prevalencia , Macrólidos/farmacología , Macrólidos/uso terapéutico , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana/genética , Adulto Joven , Adolescente , Persona de Mediana Edad , Salud Sexual , Azitromicina/farmacología , Azitromicina/uso terapéutico , Mutación , Pruebas de Sensibilidad MicrobianaRESUMEN
HPV vaccination is one of the safest and most effective interventions against HPV-related cancers. From 2013 to 2018, HPV vaccination was piloted in Ghana in preparation for a national program. Yet, at the time of this study, there was no publicly funded HPV vaccination program in Ghana. We explored an existing privately funded HPV vaccination program in Ghana to identify challenges and gaps and to gather insights to inform vaccination practice and national policy. This study used a qualitative case study research design. We conducted semi-structured interviews on experiences, barriers, and challenges in HPV vaccination at the Greater-Accra Regional Hospital between October 1 and November 26, 2023. Participants (N = 16) included HPV vaccinators (n = 8) and program/policy leaders (n = 8). Our thematic analysis focused on HPV vaccination processes, practice challenges, and policy interests. Four main themes emerged from our analyses. Our findings revealed many challenges faced by the HPV vaccination program. These include a lack of guiding policy/framework for the HPV vaccination program, an emphasis on sexual history, cervical screening, and HPV DNA test in determining vaccination eligibility by vaccinators, and a lack of formal provider and recipient HPV education programs. Although many vaccinators advocated for a universal HPV program, some policy/program leaders were reluctant to prioritize HPV vaccination advocacy due to their focus on acute health concerns. A vaccination program without a policy can be limited in quality and efficiency, as there will be no accountability and sustainability measures. We recommend the need to develop standardized guidelines to support evidence-based HPV vaccination practice.