bluuebunny/crossref_metadata_2025 huggingface dataset:
Postgraduate Dental Education in Ghana: Past, Present and Future
Authors: Hewlett S.A. , Amoah G.K. , Donkor P. , Nyako E.A. , Abdulai A.E. , Nartey N.O. , Parkins G.A. , Amponsah G.
Published: July 2023

The origins of formal postgraduate dental education in Ghana may be traced to 1986, when three dental surgeons, who had passed a Ministry of Health qualifying examination, were enrolled in the department of Oral and Maxillofacial Surgery of the Korle-Bu Teaching Hospital. This was to enable them prepare for both the primary examinations of the Royal College of Surgeons of England and the West African College of Surgeons. Twenty-six years later, the Ghana College of Physicians and Surgeons, which is only ten years old, has produced sixteen Members and recently, two Fellows. The West African College of Surgeons (WACS), on the other hand, is yet to produce its first batch of Ghanaian Fellows by examination following training in Ghana, although it has been holding examinations since 1988. With the establishment of two dental schools in Ghana, and the resultant improvement in retention of dental graduates in the country, the need and demand for postgraduate dental education has become pressing. No known review of postgraduatedental education has been carried out in Ghana. This paper seeks to give a historical overview of postgraduate dental education in Ghana and to describe its current status.
Dr. Benjamin William Quartey-Papafio
Authors: Editor-In-Chief
Published: July 2023

From the past.
Bubonic Plague Epidemic of 1908
Authors: Editor-In-Chief
Published: July 2023

Bubonic plague epidemic of 1908
The Anaesthetist: A Perioperative Physician
Authors: Aniteye Ernest
Published: July 2023

Editorial
A Review of National Programme Data on the HIV Epidemic in Ghana: 2005-2010
Authors: Addo N.A. , Yawson A.E. , Addo A.S. , Dornoo B.T. , Seneadza H.N.A.
Published: July 2023

Introduction: Enormous national efforts have gone into combating the HIV epidemic in Ghana. This study reviewed data from the National AIDS/STI Control Programme over the period 2005-2010, in terms of time, place and person characteristics of the epidemic.It focused on past and current efforts at combating the epidemic and what future efforts are required.Methods: It was a descriptive review of data from HIV sentinel surveys (HSS) and annual reports of the National AIDS/STI Control Programme (NACP) from 2005 to 2010. The review was conducted in 2011. The analysis described reported HIV and AIDS cases in thegeneral population, median prevalence of HIV among pregnant women (15-49years), and AIDS related mortalities. Also, number of clients on ART, and those lost to follow up was analyzed. These characteristics were disaggregated by sex, age groupings, location andby administrative regions. Department of Community Health, University of Ghana Medical School, College of Health Sciences, Korle-Bu,Accra, Ghana.Results: The review demonstrated an increasing trend in the annual new HIV+ cases. However, the median HIV prevalence amongst pregnant women over the period was declining. There were clear age and regional or urban/rural differences in HIV prevalencein the country. National coverage for ART was 26% in 2009 and 35.2% in 2010. Number of clients on ART lost to follow up increased over the period, especially from 2008 onwards; it was 4.9% in 2008 and 9.2% in 2009. Over the entire review period (2005-2010), number of patients lost to follow up was over a hundred fold.Conclusion: Ghana has made good progress in combating the HIV and AIDS epidemic, however there are challenges. National coverage of ART was low, and patients lost to follow up were high. The unmet need for ART though comparable to that of otherAfrican countries, poses major challenges to Ghana’s quest to reverse the HIV epidemic. Policy measures to increase ART coverage and limit loss-to-follow up are still paramount.
Asymptomatic Bacteriuria and Drug Susceptibility Patterns of Mid-stream Urine Specimens Among Pregnant Women at Booking in a Private Hospital in Kumasi, Ghana
Authors: Addo V.N.
Published: July 2023

Background:Urinary tract infections (UTIs) are common during pregnancy. Asymptomatic bacteriuria(ASB) can lead to the development of cystitis or pyelonephritis if left untreated and could eventually result in very serious sequelae.Objectives: To determine bacterial isolates and drug susceptibility patterns of mid-stream urinary specimens among pregnant women who were asymptomatic for UTIat their first antenatal attendance (booking).Subjects and methods: A retrospective review of urine results of antenatal attendants with no symptoms of UTI at booking from January 2010 to December, 2012 was done. As part of routine investigations at booking women provided mid-stream urinary specimens and bacterial isolates and drug susceptibility patterns were determined.Results: The total number of women was 453 and significant bacteriuria was found in 45/453(9.9%) . The commonest bacterial isolates were Staphylococcus aureus18/45 (40%) and E. coli 15/45 (33.3%). All the bacterial isolates were sensitive to nitofurantoin and theleast sensitivities were to erythromycin 13/45 (28.9%) and ampicillin 11/45 (24.4%).Conclusion: All pregnant women should be screened for bacteriuria at booking since the asymptomatic ones may have significant bacteriuria which could later result in serious infections and poor pregnancy outcomes. The choice of antibiotics used should bebased on maternal factors and the gestational age.
Consent to Medical Treatment: a Doctor’s View on how the Ghanaian Courts May Resolve Consent Related Information Disclosure Disputes
Authors: Adwedaa E.
Published: July 2023

Many doctors may be unaware of how the courts may rule on disputes on ‘consent to medical treatment’ in Ghana. The knowledge of how the courts may resolve an allegation of failure to obtain consent brought by a patient against a doctor may help doctorsimprove on how they communicate with their patients and consequently improve patient care. The primary purpose of consent for medical treatment is respect for individual autonomy. There is no evidence that the Ghanaian society values respect for individual autonomy any less than anybody in any other culture. There are no specific legislations in Ghanaian law or reported cases fromGhanaian courts that establish how a ‘valid or informed consent is defined in Ghanaian law. The Ghanaian legal system operates the ‘common law’. If a patient brings a claim alleging that his doctor did not seek his consent prior to treatment or that the informationprovided to him prior to granting his consent was inadequate, the Ghanaian court’s approach to resolving it is likely to be patient focused and similar to the approach used in other common law jurisdictions. Good doctor-patient communication is therefore, veryimportant.
Airway Assessment by Non-anaesthetists
Authors: Amponsah G.
Published: July 2023

Patients who may require surgery, visit our hospitals daily. Various forms of anaesthesia are given for these surgeries, which include local, regional and general anaesthesia. General anaesthesia may involve the use of devices to maintain a secure and safe airway.The improper management of the airway is still an important cause of morbidity and even mortality in anaesthetic practice. This paper seeks to give guidelines for the non-anaesthetist to be able to identify patients whose airway may be difficult to manage duringsurgery, since the surgeons see the patients first, long before the anaesthetist does. These airway assessment guidelines have been given based on the various surgical specialties such as general surgery, maxillofacial and neurosurgery. Specific surgicaldisorders which have a relatively high percentage of difficult airway have been discussed. They include goitre, mediastinal masses, abscesses and burns around the head and neck. Medical conditions such as diabetes mellitus with expected difficult airway have also been discussed. A simple algorithm has been added as an additional guide. The paper ends with recommendations which include the establishment of difficult airway database and the running of regular workshops for anaesthetists and non-anaesthetists as a means of maintaining skills in the management of the airway of the surgical patient and thus improve on their outcome.
Diagnosing Anaemia: an Overview
Authors: Dei-Adomakoh Y.A. , Ekem I. , Segbefia C.I. , Atiase Y.
Published: July 2023

The World Health Organisation (WHO) provides a definition for anaemia in both adults and children based on haemoglobin values determined in the laboratory. However, not all patients with haemoglobin values lower than these thresholds warrant investigation. The decision to investigate those with minor abnormalities must be based on clinical judgement, and from what is known about theindividual's previous blood counts. Anaemia is therefore said to be present when the blood haemoglobin (Hb) value is below the reference value for the age, sex and place of residence (altitude) of the individual. Anaemia is a public health problem in mostdeveloping countries including Ghana and therefore important to thoroughly investigate these patients. This paper discusses the different types of anaemia and provides a simple overview of issues related to the investigation of different types of anaemia. It shouldserve as a guide for the practicing doctor in Ghana and elsewhere.
Prospective Evaluation of Hospitalized Patients with Atrial Fibrillation in Senegal
Authors: Mboup M.C. , Kane A. , Jobe M. , Ndiaye M.B. , Bodian M. , Mbaye A. , Diao M. , Sarr M. , Bâ S.A.
Published: July 2023

Introduction: The purpose of this study was to determine the prevalence, complications and therapeutic strategy in the management of atrial fibrillation.Patients and methods: This was a prospective, descriptive study conducted at the Cardiology Department of the Aristide Le Dantec University Hospital in Dakar, Senegal which included all patients with atrial fibrillation, admitted between September 2006 and June 2007. We studied the clinical, para-clinical variables as well as the therapeutic strategy adopted. For the comparison of parameters we used the student t-test with significant values considered when p<0.05.Results: One hundred patients with atrial fibrillation were admitted during the study period giving a prevalence of 14.2% among admitted cases. The average age of our study cohort was 47.7±18.4years. In our study population, there was heart failure in58%, stroke in 15%, left atrial thrombus in 2% and acute is chemia of the leftleg in one patient. Transthoracic echocardiography showed dilated left atrium in 61% of patients, left ventricular systolic dysfunction in 25 of patients and two cases of left intra-atrial thrombus. Valvular heart diseases was found in 53% of cases. Anticoagulation therapy with low molecular weight heparin and with vitamin Kantagonist was given in 80% and 95% of patients respectively. Pharmacological cardioversion and direct current (DC) cardioversion were performed in 11% and 22% of patients respectively.Conclusion: Atrial fibrillation was more prevalent in young adults with rheumatic valvular heart disease, with rate control the most commonly used therapeutic strategy. The findings justify the need for primary prevention.
Impact of Free Maternal Care Policy on Maternal and Child Health Indicators in Ghana
Authors: Sefogah P.E. , Gurol I.
Published: July 2023

Background: Maternal and child mortality remain major global public health challenges. Majority of the world’s maternal mortality occur in low–income countries including Ghana, where financial barriers make maternal healthcare inaccessible to many womenduring obstetric emergencies, resulting in avoidable maternal deaths. Ghana implemented a free maternal care policy nation-wide in 2008 .to provide pregnant women antenatal, delivery and postnatal care in public, and accredited private healthcare facilities. This work assesses the impact of the policy on selected Maternal and Child Health (MCH) indicators in Ghana.Methods: Literature on financial barriers to maternal healthcare in Low Income Countries (LICs) was reviewed. WHO databases were searched for MCH indicators for Ghana from 2000-2011, aggregated and trends analysed. Additional data was obtained from Maamobi Polyclinic, Koforidua Regional Hospital (KRH), and the Korle Bu Teaching Hospitals (KBTH). These were statistically analysed for trends to assess the policy’s impact on these indicators.Results: Over four years of implementation, average antenatal coverage increased by 2%, skilled birth attendance 11%; contraceptive prevalence unchanged and unmet need for contraception rose marginally. Under-5 mortality declined by 22%. KBTH recorded increased antenatal (ANC) attendance and decreased annual deliveries that were non-significant. Maternal Mortality Rate (MMR) increased by 89/100,000LB; Caesarean section (C/S) rate rose by 5.5%, fresh still birth (FSB) rate increased and Neonatal intensive careunit (NICU) admissions surged 21%. KRH recorded significant increases in deliveries by 2114; C/S rate by 3% while MMR reduced by 0.56% (562/100,000LB). However, the FSB proportion increased by 13%, ANC attendance reduced by 567, annual deliveries rose by300, C/S rate and FSB increased by 3% and 11% respectively per year at the Maamobi Polyclinic.Conclusion: Encouraging trends were observed in the MCH indicators attributable to the policy. Increasing FSB rates indicate inadequate care quality especially intra-partum monitoring possibly due to over-stretched staff and facilities from rising patient loads.
Nicolau Syndrome: A Case Report of a Rare Debilitating Complication Following Intramuscular Injection of Penicillin
Authors: Dedey F. , Affram N.K. , Amoah Y. , Nsaful J. , Adu – Aryee N.A.
Published: July 2023

Objective: Nicolau Syndrome is a rare, debilitating and sometimes fatal complication resulting from the administration of parenteral medication. It is associated with administration of a variety of medications. It causes a local aseptic ischaemic necrosis of the muscles, subcutaneous tissues and skin. It may be associated with neurological deficits and organ failure. The administration of parenteral medication is common in our health institutions, but this complication seems to be unknown. We would like to increase awarenessabout its existence and the preventive measures to take in order to minimize its occurrence as it can be associated with significant morbidity and even mortality.Case report and interventions: A young man presented with sudden onset of severe pain in the right buttock and the whole right lower limb with associated paralysis after an intramuscular injection of penicillin. He developed a darkened patch of skin at the site of the injection on the right buttock and also on the right leg anteriorly. This progressed to necrosis of the skin, subcutaneous tissue and muscles and osteomyelitis of the right tibia. He also presented with acute renal failure. After serial debridement, wound dressing andantibiotic treatment the wound healed with extensive scarring, the osteomyelitis resolved and the neurological deficit improved leaving a foot drop. His renal function normalized after several sessions of haemodialysis.Conclusion: Administration of parenteral medication can be complicated by debilitating conditions such as Nicolau Syndrome. No specific treatment exists, so it is best prevented by taking the necessary precautions during administration of parenteral medication when indicated.
Kwame Nkrumah
Authors: Editor-In-Chief
Published: July 2023

Kwame Nkrumah
Hepatitis B viral infections: Prevention is Still the Key
Authors: Seffah J.D.
Published: July 2023

Editorial
Challenges of Inguinal Hernia Surgery in Ghana
Authors: Ohene-Yeboah M.
Published: July 2023

Background: In Ghana inguinal herniais a very common cause of considerable morbidity and significant mortality especially in rural communities.Objective : To perform a brief review of the published data on the epidemiology of and the surgical output oninguinal hernia in Ghana.Method : In this review the author presents data from a series of recent publications derived from his work on inguinal hernia in Ghana. Other articles that also have data on inguinal hernia surgery in Ghana were selected in support of or to compliment the publications in possession of the author. The search terms used to select these articles were : inguinal hernia in Ghana, groin herniaepidemiology in Ghana, hernia repair, strangulated inguinal hernia, inguinal hernia surgery output in Ghana in Medline, Pubmed and Embase. All journal articles containing information on inguinal hernia epidemiology and surgical output betweenJanuary 1, 2000 and November 30, 2015 were selected and carefully analyzed for data on inguinal herniaprevalence and repair or operations.Results : Literature on inguinal hernia surgery in Ghana is mostly clinical reports based on analysis of hospital based patients. Two sources of population based data wereavailable but were nearly four decades apart. Based on tis data inguinal henria is veryprevalent in Ghana. However, surgical correction rates are very low leaving many men with longstanding untreated inguinal hernias.Conclusion : Inguinal hernia is very prevalent in Ghanaian men in both urban and rural communities. Access to hernia repair surgery is limited by patient education, health care costs and health facilitycapacity. Intervention is needed to build the capacity for increased hernia repair.
Ectopic Pregnancy in A 28-year-old Woman with CuT IUCD in Situ – A Case Report
Authors: Sefogah P.E. , Hiadzi E.K.
Published: July 2023

Background: There is a 3–4 percent chance of all pregnancies being ectopic in location. The risk of ectopic pregnancy to a woman using an Intrauterine Contraceptive Device (IUCD) is lower than that in a woman using no form of birth control. However if awoman gets pregnant whiles using the IUCD, the chances of having ectopic is more than 4 percent. Data on the occurrence of ectopic gestation with IUCD in situ is scanty, with no report of any such case in Ghana or West Africa. The objective of this report is therefore to contribute to knowledge on the subject with the view to bring it to attention among clinicians.Case: A 28year old woman (G3P1A+1) who has had copper IUCD in situ for over two years, reported to a health facility in Accra after missing her period for two weeks. She had performed a home-based urine pregnancy test on three separate occasions, and theywere all positive. A trans-vaginal ultrasound scan showed a small cystic lesion in the right adnexa with moderate fluid in the pouch of Douglas. A right tubal abortion was found at laparotomy.Conclusion: Ectopic pregnancy in women with an IUCD is an important major potential complication that can be life-threatening.Adequate counselling by clinicians would create awareness among clients for early reporting of amenorhoea and prompt intervention for desirable outcome.
Infections in surgery
Authors: Editor-In-Chief
Published: July 2023

45th Scientific Meeting Of Ghana Surgical Research Society In Collaboration With TheWest African College Of Surgeons (Ghana Chapter)
Oro-Facial Malignant Tumours in Children
Authors: Nyako E.A.
Published: July 2023

Editorial
Childhood Oral and Maxillofacial Primary Cancer at The Korle-Bu Teaching Hospital, Accra, Ghana
Authors: Parkins G. , Nuamah I.K.
Published: July 2023

Background: There is limited information on the incidence and distribution of childhood malignant oral and maxillofacial tumours. The aim of this study was to carry out a retrospective evaluation of the prevalence and distribution of oral and maxillofacial cancers seen in children at Korle-Bu Teaching Hospital (KBTH), a tertiary hospital.Patients and method: The selection criteria was all patients who were seen at the department 15 years old and younger with an orofacial tumour (benign and malignant), between January 1998 and December 2007. The clinical and histopathological charts of allthese patients were retrieved from the records office of the Oral and Maxillofacial Surgery (OMFS) Department of KBTH. There was no difficulty retrieving the charts. Their age, sex, location of tumour, signs and presenting symptoms and histopathological report were recorded and transferred to a Microsoft Excel* spread sheet and analysed.Results: 118 charts of the patients met the selection criteria. 34 (28.8%) of them were records of patients whose lesions were reported as malignant neoplasms. The mean age was 9.4 years. The male: female ratio was 1:1. Histologically, 73.5% (N=25) of the lesions were diagnosed as lymphoma. 50% (N=17) were Burkitt’s lymphoma (BL). 20.6% (N=7) were rhabdomyosarcoma (RBD). There was one each of osteogenic sarcoma (OSC) and squamous cell carcinoma (SCC). 29 (85.3%) of the children underwent chemotherapy, three children with RBD were treated by surgery and adjuvant radiotherapy.Conclusion: BL is the most common malignant maxillofacial cancer found in Ghanaian children and chemotherapy is the commonest mode of treatment.
Experience with Palliative Procedures for Congenital Cyanotic Heart Diseases in Ghana: A 20-Year Review
Authors: Tamatey M.N. , Sereboe L.A. , Tettey M.M. , Edwin F. , Entsua-Mensah K. , Gyan B. , Aniteye E.A. , Adzamli I.K. , Offei- Larbi G. , Ibrahim U.E.
Published: July 2023

Background:Currently, in the management of congenital cyanotic heart diseases with favourable anatomy, primary correction is the preferred choice. But palliative procedures have still maintained an important role in resource-poor regions of the world.We sought to analyze our institutional results for such palliation over a 20-year period. The purpose of the study was to provide information that would guide both practitioners and referring doctors on the future management of congenital cyanotic heart diseases, and also to provide data for comparative studies in the sub region in the future.Patients and Methods: A retrospective study was carried out in the National Cardiothoracic Centre involving all patients who had palliative procedures for congenital cyanotic heart diseases from January 1992 to December 2011.Results: There were 264 patients, 59% males and 41% females. The case load increased from 2 cases per year in the first year to 34 in the last year of the study. The age range was 4 months – 42 years, with a mean of 7.1 ± 6.9 years. Tetralogy of Fallot comprised 257 (97.4%) of the cases, tricuspid atresia 4 (1.5%), and double outlet right ventricle 3 (1.1%). The modified Blalock-Taussig shunt (MBTS) was performed in 262 (92.2%), and the Waterston shunt in 2 (0.8%) of the cases. The overall complication rate was 11.8%, comprising shunt occlusion 7.6%, bleeding requiring re-exploration 0.8% and early mortality of 3.4%.Conclusion: The modified Blalock-Taussig shunt provided good palliation for congenital cyanotic heart diseases in this environment. We consider it a suitable management alternative when financial and logistic constraints delay primary repair in resource-poor settings.
Stab Suprapubic Catheter Insertion: Indications and Peri-Operative Complications, A Four and Half Year Review at The Korle Bu Teaching Hospital, Accra
Authors: Asante E.K.A. , Mensah J.E. , Klufio G.O. , Kyei M.Y. , Ampadu K.N.
Published: July 2023

Background: Suprapubic catheter insertion is a common urological procedure, which is often considered to be simple and safe even in inexperienced hands. The objective of our study was to determine the peri-operative morbidity associated with Stab Suprapubic Catheter Insertion (SSPCI) (i.e. stab suprapubic cystostomy)Patients and Methods: A total of 429 patients who had suprapubic catheter insertion using the stab method (with trocar and sheath) at the Korle-Bu Teaching Hospital, Accra, between January 2010 and June 2014 were identified and their case notes reviewed todetermine the peri-operative complication rate in relation to the categories of doctors who undertook the procedure.Results: The commonest indication for a stab suprapubic catheter insertion was acute/chronic retention of urine secondary to benign prostatic hyperplasia (BPH). The overall complication rate was 3.5% with bowel perforation constituting 0.7% of the complications.Conclusion: Stab suprapubic catheter insertion is a safe and effective bedside procedure for bladder drainage when urethral catheterization fails or is undesirable, and can be performed by all grades of surgeons/medical doctors, in selected patients.Complications associated with the procedure can be reduced to a minimum by strict attention to some technical details.
Anxiety and Depression Among Breast Cancer Patients in A Tertiary Hospital in Ghana
Authors: Calys-Tagoe B.N.L. , Senaedza N.A.H. , Arthur C.A. , Clegg-Lamptey J.N.
Published: July 2023

Background: Breast cancer is the second most common cancer globally and the most frequent cancer among women. It is associated with significant psychological morbidity including anxiety and depression. The extent of this burden has however not been documented in the Ghanaian setting. This study aimed at determining the prevalence of anxiety and depression amongst patients with breast cancer at the Korle Bu Teaching Hospital (KBTH).Design and Subjects: A cross-sectional study was carried out among 120 breast cancer patients using a structured questionnaire to obtain socio-demographic characteristics of patients. The hospital anxiety and depression scale (HADS) was used to assess fordepression and anxiety in these patients. Results: The overall prevalence of depression was 84.2%, while that for anxiety was 92.5%. Forty-four percent of the study participants had both anxiety and depression. There was no significant difference in depression (p=0.796) and anxiety (p=0.999) prevalencebetween post-menopausal (82.9% and 92.1% respectively) and pre-menopausal (86.4% and 93.2% respectively) patients. A significant difference in prevalence of depression alone (p=0.033) and depression in combination with anxiety (0.025) was found between those living with their partners and those living without their partners. Average monthly income was found to be significantly associated withanxiety alone (p=0.014) as well as anxiety and depression combination (p=0.032) but not with depression alone (p=0.101).Conclusion: The prevalence of anxiety and depression are quite high among breast cancer patients at the Korle Bu Teaching Hospital. Anxiety was significantly associated with the average monthly income while depression was associated with the marital status ofpatients. The high prevalence of both anxiety and depression among breast cancer patients makes it imperative for psychotherapy to be incorporated as an integral part of the management of breast cancer patients for the entire duration of the illness but moreespecially during the period immediately following diagnosis
Medical and Dental Council
Authors: Editor-In-Chief
Published: July 2023

Medical and Dental Council
Noguchi Memorial Institute for Medical Research
Authors: Editor-In-Chief
Published: July 2023

Noguchi Memorial Institute for Medical Research
Calcium Supplementation For The Prevention Of Pregnancy Induced Hypertension/Preeclampsia
Authors: Omonua K.I. , Akaba G.O. , Isah A.Y. , Offiong R.A. , Ekele B.A.
Published: July 2023

Background: Pregnancy induced hypertension (PIH) and preeclampsia (PE) contribute significantly to maternal and perinatal morbidity and mortality. The role of calcium supplementation towards preventing PIH/PE however remains unclear.Objective: To assess the efficacy of calcium supplementation in prevention of PIH and PE. Materials and methods: An open label, randomized controlled trial conducted at the antenatal clinic of University of Abuja Teaching Hospital between July 2014 and June 2015. A total of 484 nulliparous women 16 weeks or less gestation and with normal bloodpressures were randomly assigned to either receive 1200mg of calcium tablet daily (N=242) or not to receive calcium tablets (N=242) from 16weeks until delivery. Primary outcome measure was development of PIH or PE and secondary outcome measure was preterm birth.Results: The incidence of PIH was 7.7% among the intervention group compared to 13.7% in the control, p=0.039 and calcium supplementation reduced the risk of PIH (RR=0.56 (95% CI: 0.32-0.98)), but not PE. It also prolonged the duration of pregnancy in women who developed PIH (p=0.02). Incidence of preeclampsia was not significant, RR-0.56 (95% CI: 0.21-1.52) so also was the incidence of preterm delivery between the two groups (RR-0.65 (95% CI: 0.32-1.31)). No serious maternal side effects of treatment were recorded.Conclusion: Calcium supplementation during pregnancy reduced the risk of PIH and thus may have a role in the prevention of PIH amongst nulliparous women. Its role in the absolute prevention of PE was not demonstrated in this study.
Pattern Of Seminal Fluid Parameters And Their Clinical Correlates Amongst Infertile Men In The Niger-Delta Region Of Nigeria
Authors: Ngwu M. , Omo-Aghoja L.O. , Adeyinka A.T.
Published: July 2023

Background: Infertility is a foremost reproductive health problem globally, with sub-Saharan Africa nations most affected. The male contributions to this burden have not been properly documented in this environmentMethods: This was a cross-sectional study conducted in Central Hospital Benin City, involving 355 male partners of women with infertility. Specific clinical information was extracted and two semen analyses were conducted two weeks apart.Results: The mean duration of infertility was 4.5 years (SD 2.17), and secondary infertility was the commonest (82.3%). Over half (59.7%) were of low socioeconomic status. Over two-thirds (66.5%) had seminal fluid abnormality; and Oligospermia was thecommonest (22.8%). About two-fifth took alcohol regularly (43.9%), had previous history of urethral discharge (39.4%), or of testicular pain (42.8%). About One-fifth had a past history of mumps-orchitis (20.3%), or smoked cigarette (22.3%). Less than a tenth had varicocele (8.8%), or undescended testes (8.5%); while more than one-tenth reported use of Cimetidine (12.4%), herniorrhaphy (14.7%), scrotal surgery (15.8%), or sexual dysfunction (14.6%). There were significantly more participants with sexual dysfunction, herniorrhaphy, scrotal surgery, undescended testes; mumps orchitis; testicular pains; varicocele; history of purulent urethral discharge; tobacco smoking; alcohol consumption; and use of Cimetidine who have abnormal seminal fluid parameters. However on multivariate logistic regression analysis, history of urethral discharge, undescended testes, and Cimetidine use had negativecorrelation with abnormal semen parameters.Conclusion: The prevalence of male factor infertility in our setting was high with significant association between male infertility and wide range of clinical and psychosocial problems.
Phlebotomy by House Officers
Authors: Adzamli I. , Tettey M. , Sagoe J. , Amoako J. , Dzefi-Tettey K. , Mohammed S.
Published: July 2023

Background: Phlebotomy is a highly complex technique, requiring knowledge and skill to perform. In advanced societies, all phlebotomists undergo a wellstructured training with certification.Objective: This study examines the practice of phlebotomy by house-officers (HO) in Korle-Bu Teaching Hospital, as part of expediency in health service delivery.Methodology: Self-administered questionnaires were obtained from 54 Ghanaian trained HOs (out of a total of 85 HOs) from four main departments of the Korle-Bu Teaching Hospital in December 2010. Data obtained were analysed statistically using SPSS(Version 12; SPSS Inc, Chicago, IL, USA) programme.Results: There were 54 HOs who had worked for a minimum of six months. Thirty-five (64.5%) of them felt that venesection was not their job description. Forty-nine (90.2%) received no formal training and 40 (74.1%) received informal training in phlebotomyduring Medical School. Thirty 32 (59.3%) used the dorsum of the hand as the main site for venesection and 25 (46.5%) did not know avoidable sites during venesection. Fifty-three (98.1%) did not check for allergies to antiseptics and adhesives before performingvenesection. Thirty-seven (68.5%) did not know the names of all the additives in the various sample bottles and 29 (53.7%) did not understand the colour coding of the sample bottles. In addition, 34 (63.0%) did not know the blood volume required for all the varioustests. Twenty-nine (53.7%) did not know that laboratory results of analytes were affected by patient's posture.Conclusion: Training in the Medical School does not adequately prepare the House Officer to carry out phlebotomy competently and efficiently.
An Observational Review Of Determinants Of Perinatal Deaths In Kwahu East, West And South Districts
Authors: Asare Brainard Ayisi
Published: July 2023

Background: Perinatal deaths, largely occurring in full-term pregnancy1, are usually of unknown causes even with statutory routine autopsy performance. Autopsies reveal causes in only 40%4. Data paucity remains a major challenge in developing countries.Objective: The study aimed to identify determinants of perinatal deaths in three Kwahu Districts and assess their preventability.Methodology: An observational study with an unmatched case control design using Health Facilitybased data.Results: Most perinatal deaths occurred at term. Mean gestational age at delivery was 37 and 38.8 weeks for cases and controls respectively. Cases were mainly rural residents with informal occupations and comparatively higher gravidity and parity. Controls hadhigher educational backgrounds. Factors associated with perinatal deaths were Rural residence, OR - 2.7 (95% CI = 2.02 - 3.6), grandmultiparity OR - 2.0 (95% CI = 1.3 - 3.2), mal presentation OR - 2.5 (95% CI = 1.4 - 4.4), Low Birth Weight OR - 2.3 (95% CI = 1.4 -3.8), delayed second stage OR - 8.4 (95% CI = 2 - 27), Hypertensive disease OR - 3.0 (95% CI = 1.8 - 3.6), uterine rupture OR - 2.0 (95% CI = 1.8 - 2.1) and prematurity OR - 3.8 (95% CI = 2.7 - 5.3). Formal occupations OR - 0.4 (95% CI = 0.3 - 0.7), referrals OR - 0.6 (95% CI = 0.4 - 0.7), tertiary education OR - 0.3 (95% CI = 0.2 - 0.5) and adequate ANC OR - 0.5 (0.3 - 0.6) significantly reduced odds of deaths.Conclusions: Perinatal deaths remain preventable with accessible quality ANC, delivery and postnatal services supported by comprehensive, sustainably funded surveillance. The Human Rights Based Approach to programming must be prioritized.
Community Involvement In Child Birth: The Case Of West Gonja District In The Northern Region Of Ghana
Authors: Der E.M. , Azure S.E. , Kumassey A.M. , Yakong V.
Published: July 2023

Background: Most obstetric complications are preventable if adequate preparations are made to avoid delays during obstetrics emergencies. The aim of this study was to assess the level of community involvement in preventing complications to mother andnew born during pregnancy and labour.Methods: A cross-sectional descriptive study was conducted in 6 health facilities selected through purposive sampling. A sample size of 210 women was obtained through convenience sampling using structured questionnaires. The data was analysed usingSPSS software (version 23).Discusion: The mean age of the respondents was 28.3 (SD=5.7). The great majority of the women have heard of danger signs of pregnancy (91.9%) and labour (76.2%). The common danger signs of pregnancy were Vomiting (26.0%), bleeding per vaginam (24.0%) and severe waist pain (21.1%). The common danger signs of labour were bleeding per vaginam (32.9%), big baby (23.8%) and retained placenta (11.0%). The major source of information on obstetrics danger signs was health care providers (91.0%) during antenatal visits.The first and second decisions makers during obstetrics emergencies were husbands (85.1%) and mother-inlaws (57.2%), only 2.5% of the respondents can act as the first decision makers. The common support systems available for obstetrics emergencies in descendingorder were; preparation of items for labour (28.6%), care taker at the hospital (19.4%), transportation to place of labour (14.4%) and choice of the place of labour (13.5%). Blood was commonly organized for women from the community with obstetric complications.Conclusion: The study found that the respondents had very good knowledge of the danger signs of obstetrics emergencies. They have good community support systems for women in labour, but only very few of them can take their own decision during obstetricsemergencies.
Emergency Laparoscopic Appendectomy In Ghana: The 37 Military Hospital Method
Authors: Asumanu E. , Yeboah R. , Boadi B. , Opae – Tetteh I. , Teteyfio – Koney C. , Antwi A.A. , Adiali B. , Ayebge V.A. , Idan P.
Published: July 2023

Summary: Emergency laparoscopic appendectomy is evolving as the method of preference for the management of acute appendicitis. Appendicitis is one of the common causes of acute abdomen diagnosed in the emergency unit in Ghana and open appendectomyhas been the preferred method for most surgeons. Increasing patient preference for laparoscopy in Ghana will soon require an increase in the practice of emergency laparoscopic appendectomy in many centres. The number and sizes of ports as well as thesite of placement, together with the technique of appendectomy, determines the uniqueness of the method of laparoscopic appendectomy. A simplified easy to apply method of laparoscopic appendectomy is needed to encourage its use in emergency centres.Methods: The paper describes a 3-port method of laparoscopic appendectomy which combines the principles of open appendectomy and basic laparoscopy. Patient positioning and the operative removal of the appendix is similar to what as is done in open appendectomy. Pneumoperitoneum is achieved by open access through the umbilicus. Two additional ports are placed below the iliac crest for a good cosmetic effect. The amount of consumable used usage is comparable to that of open appendectomy. Discusion: The question of a gold standard procedure for laparoscopic appendix still persists. The key criteria in the choice of any method should be the success rate, affordability, resource availability and suitability. The method described meets the above criteria in a low resource environment. It offers opportunity for the practice of laparoscopic appendectomy in institutions that practice open appendectomy. The sites of port placement makes the method especially suitable for population that are keloid prone. The use of the same principle for mesappendix and appendix excision as in open appendectomy helps improve the learning curve. Modifying the 10mm port into a retrieval bag at the end of the procedure presents gives the same effect as a conventional retrieval bag without an additional risk of infection.Conclusion: The method has an inherent easy learning curve and is expected to help scale up the conversion from open to laparoscopic appendectomy.
Sleep
Authors: Sackey Adziri
Published: July 2023

Commentary
Breast Cancer is Curable
Authors: Clegg-Lamptey J.A.
Published: July 2023

Editorial
A preliminary Study On Living With Low Vision: Emotional And Psychosocial Experiences And Challenges Of Patients In A Tertiary Health Facility In Ghana
Authors: Abaidoo B. , Ackuaku-Dogbe E. , Mokawol R. , Yawson A.E.
Published: July 2023

Background: Low vision usually results in difficulties in independent mobility with associated emotional and psycho-social challenges and impairment in overall quality of life of sufferers. This study explored the psychosocial experiences and challenges of adult low vision patients at the Korle Bu Teaching Hospital.Methodology: A qualitative exploratory research was conducted to explore the psychosocial experiences and challenges of patients at the Low Vision Clinic at the Korle Bu Teaching Hospital, Ghana. Adult low vision patients aged ≥18 years were selected for a face-to-facein-depth interview and a focus group discussion. An interpretive content analysis of the data was performed to identify themes and sub-themes from the respondent’s narrations.Results: A total of 15 participants aged between 24 years and 75 years were involved in the study. There were 9 males and 6 females with a mean age of 50.5± 17.9 years. Themes generated from the study include; emotional reactions, loss of hope in life, social support,low vision rehabilitation and coping strategies. Emotional feeling, depression, fear of eventual blindness, dependency on family and society, difficulties in coping with low vision, loss of hope in life, lack of support from family and friends and reduced quality of life were found to be the most challenging psychosocial issues surrounding the low vision patient in their daily living. Burden of care and cost for rehabilitation of persons with low vision is borne by the individual and not covered by the National Health Insurance Scheme.Conclusion: The NHIS could include basic and less expensive devices for improving the everyday lives of persons with low vision in the benefits package of the scheme. Structured counselling sessions should be included as part of the care package for persons with lowvision and role of the clinical psychologist in the care team is essential.
Assisted Reproductive Technology (ART) - Role, Challenges and Prospects in Modern Ghana
Authors: Takyi Charles
Published: July 2023

Editorial
Covid-19 Pandemic: Evolving Problems And Lessons Learnt
Authors: Editor-In-Chief
Published: July 2023

Editorial
Spontaneous Massive Fetomaternal Hemorrhage
Authors: Oduro Frederick
Published: July 2023

Commentary
Professor Stephen Addae-Physician, Scientist, Historian
Authors: Editor-In-Chief
Published: July 2023

Professor Stephen Addae-Physician, Scientist, Historian
PENERAPAN SSD-MOBILENET DALAM IDENTIFIKASI JENIS BUAH APEL
Authors: Syahputra Zulfahmi
Published: July 2023

Under conditions that determine whether an apple is good or not, the human eye tends to have a subjective perception due to the color composition factor. Errors often occur because it is done manually. Therefore we need a tool with a system that can choose apples automatically based on their type. So we need a system that can identify the ripeness of apples by implementing SSD-Mobilenet. The purpose of this research is to identify the types of apples using SSD-MobileNet. From the results of the analysis and testing it can be concluded that the test results on data testing with lots of data, namely 50 datasets taken randomly produce an accuracy of 82% and an error of 18%. The number of errors indicates that the classification results are not completely accurate. This can happen due to the lack of training data so that only a few dominant terms are used, causing errors in course costs. However, the results of this accuracy can be used as a reference that assistance using SSD-Mobilenet provides a high value of 82%. So this method can be used to analyze the ripeness of apples.
Meningkatkan Hasil Belajar Siswa SMK Melalui Model Project Based Learning Dengan Media Cisco Packet Tracer
Authors: Lubis Afandi Husin Amin Syahrul , Bahri Syaiful
Published: July 2023

The application of lecture method as a teaching approach has been proven to be one of the factors contributing to low student grades. This is because the lecture method still revolves around the teacher as the primary source of information without actively involving the students. To address this issue, the solution is to implement Project Based Learning as a teaching method. This research utilized a quasi-experimental design. The population of this study consisted of X TKJ class students. Samples were selected using purposive sampling technique, with X TKJ 1 as the experimental group and X TKJ 2 as the control group. Data collection was conducted through tests and observations. Data analysis was performed using t-test and standardized gain test. Based on the research findings, there was a significant improvement in learning outcomes in the experimental group, with an increase of 78.74 categorized as high. Meanwhile, the control group showed a lower improvement in learning outcomes, with an increase of 28.33 categorized as low. Therefore, it can be concluded that students in X TKJ class, who were taught Jaringan Dasar subject using the Project Based Learning method with Cisco Packet Tracer as the media, exhibited higher improvement in learning outcomes compared to students taught with the lecture method.
God's Kingdom Through His Priest-King: An Analysis of the Book of Samuel in light of the Davidic Covenant
Authors: Rutherford J. Alexander
Published: July 2023

Though many studies have probed the significance of the Davidic Covenant (2 Sam 7:1-17) within the biblical canon, few have endeavoured to explore its significance within the narrative of Samuel. The various allusions to the Davidic Covenant woven throughout the books of Samuel suggested to the author of this thesis that it would be profitable to explore the text of Samuel with the following question in mind, “how has the author of 1 and 2 Samuel used the Davidic Covenant to fulfill his narrative purpose?” This thesis presents the findings of such a query: it is argued that by weaving references to God’s promises made to David (collectively known as the Davidic Covenant) throughout his narrative, the author of Samuel reveals God’s will to strip away all human pretension by bringing His promises to fulfillment through the lowly David, whose ascension to kingship and endurance therein is owing all to God. In this way, the author fulfills his purpose to demonstrate God’s sovereign working in history to establish His kingdom on earth through His chosen priest-king, a descendant of David, in fulfillment of the promises He made beforehand. Setting aside historical and text-critical issues for the most part, this thesis presents a close reading of the passages in Samuel where allusions to the Davidic covenant are found, expounding the influence the covenant promises have on the surrounding narrative. Chapter 1 considers 2 Samuel 7, chapter 2 the Davidic Covenant as it appears in the account of God’s promises unfolding (1 Sam 1 – 2 Sam 5), and chapter 3 the Davidic Covenant as it appears in the account of God’s promises being tested (2 Sam 8-24). In the fourth chapter, the threads of this exegesis are brought together in a synopsis of the book of Samuel, presenting an outline of the book and an overview of its overall purpose, themes, style, and canonical placement (thus, a literary-canonical synopsis).
The Trinity and the Bible: How All Scripture Testifies to One God in Three Persons
Authors: Rutherford J. Alexander
Published: July 2023

To write on the Trinity is to enter a minefield of presuppositions-presuppositions of theology, exegesis, grammar, logic, philosophy, etc. However, at the heart of Godʹs self-revelation in the Bible is God’s tri-unity, that God is three, Father, Son, and Holy Spirit. Confessional Christians would identify this claim, that God is Triune, as a necessary condition of true Christian faith. To be Christian is to follow Christ who is the 2nd person of the Trinity. Yet, does following this Christ mean following the 2nd hypostasis who is eternally begotten of the Father, sharing with him his ousia? That is a more difficult question, isn’t it? Indeed, many faithful men and women in my life could not make heads or tails of the latter claim while worshipping and following the Christ of the former. So, what does it mean to be Trinitarian? This book is about that question, what does it mean to be a Christian who worships a triune God, to be ʺTrinitarianʺ? Is the Trinity a doctrine, arrived at through second-order reflection on the Biblical data several hundred years after the canon closed, or is it something else? Is it, perhaps, a presupposition about the reality of God that has shaped the Christain imagination, that has shaped the framework Christians bring to the world, throughout created history?