bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Alcohol Use Disorder Among Workers
Authors: Dordoye E.K. , Asare J.B.
Published: July 2023

Objective: Alcohol use disorder (AUD) is a common but usually undiagnosed and untreated condition. Persons with the condition tend to maintain their jobs until it severely incapacitates them. The ten years lag between frequent use of alcohol and development of AUDsignificantly contributes to this and until organizations actively screen and manage persons with the disorder, it continues to negatively affect productivity. The aim of this study was to determine the prevalence of AUD in an engineering company and establish a case for employee assistance program (EAP) for the management of AUD.Method: Staff of the company were systematically sampled and administered a questionnaire which involved the Alcohol Use Disorders Identification Test (AUDIT) questionnaire. A cut off score of 8 was used as a positive screen for AUD.Results: Thirty-five (9.4%) out of 373 staff screened positive for AUD and half of them were between 31 and 40 years. Men were twice as likely to have AUD compared to females. Muslims were 2.4 times more likely to have AUD compared to Christians and juniorstaff were 4 times more likely to be diagnosed with AUD compared to senior staff.Conclusion: AUD is common among industry workers and therefore human resource policies are necessary for early detection and treatment for improved productivity and employee motivation.
Arthroscopic Anterior Cruciate Ligament Reconstruction in Ghana: A 2-Year Outcome Assessment
Authors: Konadu-Yeboah D. , Peter Konadu P. , Okrah H. , Kusi K. , Sobotie J. , Gudugbe S. , Boadi T.S. , Pokuaa M.
Published: July 2023

Objective: The goal of this study was to evaluate the treatment outcomes of arthroscopic anterior cruciate ligament reconstruction among patients at the Komfo Anokye Teaching Hospital, (KATH) in Ghana.Methods: A prospective cohort study. We enrolled consenting patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction at the KATH over a 3-year period, from January 1, 2015 to December 31, 2018 and followed up each study participant for 2 years. Post-operative assessments were performed at 2, 6, 12, 24 weeks, 1year and at 2 years, to record outcome variables such as range of motion, pain, swelling and laxity of the affected knee as well as excessive discharge from the surgical site, suggestive ofinfection. Tegner Lysholm knee scores were obtained for each patient at 2-years following surgery. The follow-up was concluded in 2020.Results: Over the 3-year period, 40 primary arthroscopic ACL reconstructions were performed in 40 patients. Most of the patients were young adult males who sustained a tear of the anterior cruciate ligament following a fall from a standing height. Out of this number, 31 had isolated ACL tear, 4 had ACL tear associated with LCL tear and 3 had ACL tear with associated meniscal tear. Two of the participants had ACL, PCL and LCL tear and a complex medial meniscal tear, with associated posterolateral corner rotatory instability. ACL reconstructions that were performed within 12 months following injury had higher mean Tegner Lysholm score of 7 (range of 5-9), than those carried out later than 12 months after injury. Overall, 37 of the patients (93%) had good to excellent outcome at 2 years post-operatively. Three of the patients who were competitive athletes before injury had returned to competitive sport within 1 year of surgery. There was one case of surgical site infection giving an infection rate of 2.5% and one case of graft rupture that requiredrevision ACL reconstruction.Conclusion: Arthroscopic ACL reconstruction is feasible at the study site with low complication rate and provides good to excellent outcome in 93% of patients. The procedure is generally safe and effective in restoring knee function following an ACL tear. Patientreported outcomes are superior when reconstruction is performed within 12 months of injury compared to later reconstructions.
Trends in Direct Causes of Maternal Deaths as Seen at The Korle-Bu Teaching Hospital Mortuary (1995 –2014): A Retrospective Autopsy Study
Authors: Der E.M. , Gyasi R.K. , Naporo S. , Adu-Bonsaffoh K. , Alhassan A.R. , Seffah J.D.
Published: July 2023

Objectives: Our main research aim was to describe the relative proportions and trend of direct causes of maternal death over a period of 20-years in the largest tertiary hospital in Ghana.Material and methods: This was a descriptive retrospective review of cases of maternal death for which autopsy examination was conducted at the KBTH mortuary from 1995 to 2014. Data on direct maternal deaths were collected on the age, local of death (coronerand permission), the anatomical site and diagnosis: 1) obstetric haemorrhage, (including abruptio placentae, placenta praevia, uterine atony, and retained products of conception, etc); 2) abortion, 3) hypertensive disorders in pregnancy (pre-eclampsia, eclampsia), 4) ruptured ectopic gestation, 5) ruptured uterus in labour, 6) amniotic fluid embolism, and 7) genital tract sepsis.Results: There were 1,846 maternal deaths of which 86.4% were classified as direct maternal deaths (P<0.0001). The mean age was 28.72 ±6.47 years. The majority, 1,346 (84.4%) were coroner cases (p< 0.0001). Abortion (27.4%), hypertensive disorders in pregnancy(27.3%), and obstetric haemorrhage (27.0%) were the common causes. There was a general declined in the trend of maternal deaths over the 20-year period, particularly those due to abortion, obstetric haemorrhage, ruptured tubal gestation and ruptureduterus in labour. However, deaths due to hypertensive disorders in pregnancy showed a relative rise over the period.Conclusion: Abortion, hypertensive disorders in pregnancy and obstetrics haemorrhage, were the major causes of maternal deaths. There was a general decline in the trend of maternal deaths over the study period.
Case Report of Bipolar Disorder with Substance Use Disorder; Comorbidity or Confounders?
Authors: Dordoye E.K. , Gyapong J.O.
Published: July 2023

Objective: Bipolar disorder commonly presents with substance use and there is the diagnostic challenge of one being a sequela of the other or the two being co-morbid conditions. The distinction is important as the effective treatment of the primary condition can lead to a concomitant remittance of the other. A misdiagnosis and a consequent ineffective treatment on the other hand, can lead to worsening prognosis of both conditions in the person. This aims at bringing attention to this diagnostic dilemma and the need to hone skills for proper diagnosis and eventual effective treatment.Case Presentation: Ms. KK is a 28-year-old divorcee and Human Resources Manager who presented with gregariousness, sleep difficulty and smoking of marijuana for two months. She had resumed smoking of marijuana after some 6 months break. She admitted to suicidal ideation and behaviours even though she also had many big plans to transform mental healthcare in Ghana. She was admitted a year earlier as schizophrenia for less than a week after which she had a divorce. Ms. KK was referred for management of substance induced psychosis to include residential rehabilitation. She was managed after review for bipolar disorder with substance use disorder. She was treated with long-acting second generation antipsychotic and she quit smoking with the remission of her mood symptoms after two months.Conclusion: Mood disorders can occur with substance use disorder as a co-morbid condition or part of the symptomatology of mood disorder. Substance use disorder can also present with mood symptoms or unmask mood disorders. When the correct diagnosis of aprimary mood disorder, bipolar disorder in this case, with co-morbid substance use disorder is made, effective treatment of the mood disorder can remit substance use.
Medical Education and Residency Training - The Need to Move with The Times
Authors: Abantanga F.A.
Published: July 2023

Editorial
Prevalence, Testing and Treatment Patterns of Malaria; A Hospital Based Five-Year Analyses by Age in Kwaebibirem, Eastern Ghana
Authors: Asare B.A.
Published: July 2023

Objective: Malaria, caused by single-celled microorganisms of the plasmodium group, is a mosquitoborne infectious disease that affects humans and other animals. Objectives prioritizing control and elimination led to the T3 policy (i.e., ‘Test, Treat and Track’) encouraging scale up of diagnostic testing, treatment and surveillance. This study analyses the prevalence of malaria infection andassesses health institutional compliance with policy directives for testing before treatment of all clinically suspected malaria cases.Methodology: A 5-year record review of malaria morbidity, 2014-2018, was completed with the DHIMS-2 web-based database using a cross sectional study design.Results: Despite a downward trend that decreased with increasing age through adolescence, higher proportions of hospital clients aged ≤ 28 days to 17 years were subjected to confirmatory malaria tests. This remained comparatively low among adults. The highest yield of positive malaria tests was observed among patients aged 1 month to 17 years. Malaria’s morbidity burden remained highest among hospital clients aged 1 month to 15 years of age while the highest proportion of hospital clients treated without priorconfirmatory tests was observed among the ages of 18 to 70 years and above. Proportion of patients treated for malaria without prior confirmatory tests therefore increased with increasing patient age.Conclusion: Isolated cases of presumptively treated malaria suggest that universal compliance with the first T of the T3 policy is yet unattained, potentially invalidating quality of the other Ts.Recommendations: Correlates for presumptive treatment should be investigated to facilitate acceleration towards attainment of universal compliance with the T3 policy.
Assessment on the Knowledge, Attitude and Practice of Covid-19 Protocols Amongst Medical Workers in Jos, Plateau State
Authors: Shehu M. , Izang A.M. , Shehu H.
Published: July 2023

Objective: To assesses knowledge, attitudes, and practice on COVID-19 amongst medical HCW in Plateau State Specialist Hospital (PSSH) Jos.Methodology: The study population consisted of all medical health care workers in Plateau State Specialist Hospital (PSSH) who consented to the study. The study was a cross-sectional study and consecutive sampling was employed. The knowledge, attitude and practice of COVID-19 amongst HCW was assessed using a pretested questionnaire which was analyzed using SPSS version 22.Results: The nurses had the highest percentage of 58%, followed by doctors with 31%. The major source of information was television with 68%, followed by google with 9%. The knowledge of the medical HCW in PSSH was good with over 80% of the number ofquestions on knowledge answered correctly with the mark over 70%. Their attitude was fair with 62% of the number of questions gotten correctly with a score of over 70%. Similarly, their practice was also fair with 66% of the questions gotten correctly with over 70%. However, one of the questions on practice was poor with only 45% of the workers answering it correctly. Therewas a significant association between the attitude and the Job cadre of medical HCW of PSSH.Conclusion: The knowledge of medical HCW in PSSH on COVID-19 was good. Their attitude and practice were fair. There was a significant association between their knowledge and job cadre. The study showed that there is an attitude and practice gap
Periodontal Health Status of Pregnant Women Attending Three Ante-Natal Clinics in Accra, Ghana
Authors: Goka R.Y. , Nyako E.A. , Sackeyfio J. , Hewlett S. , Ndanu T.A. , Konadu A.B. , Ankoh S.E.
Published: July 2023

Objective:To assess the periodontal health status of pregnant Ghanaian women at different gestation periods.Methodology: A cross-sectional study involving two hundred pregnant women attending the ante-natal clinic at Ussher polyclinics was done. Data was obtained by use of a questionnaire and on-site periodontal examination. Variables determined included the socio-demographic characteristics and Community Periodontal Index of Treatment Needs (CPITN) of study participants. A summary description of variables was presented, and cross-tabulations was used to compare responses among the three trimesters.Results: About one third, (38%) of the study participants were in the third decade of life, with a majority (55%) having had formal education to the basic level. While 72% of women had never seen a dentist, nearly three-quarters (76.2%) had a CPITN of 2 or more.Conclusion: There is a high prevalence of periodontal disease among pregnant women. Healthcare professionals should therefore consider oral healthcare referrals and education for pregnant women.
Clinical Autopsy As An Outcome Measure And Tool For Quality Improvement At The Cape Coast Teaching Hospital
Authors: Akakpo Patrick Kafui , Derkyi-Kwarteng L , Imbeah Emmanuel Gustav , Ulzen-Appiah Kofi , Ansong SYO , Eliason Eliason S , Awuku Awuku YA
Published: July 2023

Objective: We set out to investigate, the relationship between the antemortem clinical diagnosis and the clinical autopsy diagnosis, as a tool to assess the quality of health care in our institution.

Methodology: A retrospective review of clinical records of hospital autopsies done in the Cape Coast Teaching Hospital from 1st January 2011 to 31st December 2014 was conducted. An analysis of the ante mortem diagnosis and the autopsy diagnosis was conducted by the Departments of Internal Medicine and Therapeutics, Community Medicine, and Pathology of the School of Medical Sciences, Cape Coast Teaching Hospital. Discrepancies were identified and classified according to the Goldman criteria as major missed diagnosis and minor missed diagnosis.

Results: Fifty hospital autopsy cases were reviewed. There was no error in 20(40 %) of the cases. Of the 30 cases (60%) had discrepancies and were classified using the Goldman criteria,12 out of the 30 (40%) were major class I type errors, 15(50 %) were major class II type errors and and the remaining 3(10%) were minor class IV type errors. The diseases were categorized into: others (causes of death that could not be categorized under either infections, cancers, cardiovascular disease, pregnancy related and metabolic) 15 (30%), infections 14 (28%) and cancers 10 (20%) were commonly autopsied, and most were from the medical ward.

Conclusion: Significant discrepancies between the ante-mortem clinical diagnosis and the autopsy diagnosis at the Cape-Coast Teaching Hospital were identified. No statistically significant relationship was found between clinical departments and ACD/AD discrepancy or between category of disease and ACD/AD discrepancy.
Barriers To Early Infant Diagnosis And Service Delivery In Two High Hiv Districts In Ghana
Authors: Yawson Alfred E Yawson , Ansah Evelyn Korkor Ansah , Seneadza Nana Ayegua Hagan Seneadza , Baffoe Peter  Baffoe , Ayisi Addo Stephen Ayisi Addo , Aboagye Patrick  Kumah Aboagye , Atweam Dominic K Atweam , Ofosu Anthony Ofosu , Sarpong Charity Sarpong , Awoonor-Williams Koku Awornoo-Williams , Hodgson Abraham Hodgson
Published: July 2023

Objective: Ghana has made significant progress in its efforts to control Human Immunodeficiency virus (HIV) infections, however 31% of HIV exposed infants received early infant diagnosis (EID) services. This paper examines the factors influencing EID service delivery in two high HIV burden districts in Ghana.

Methodology: This study was conducted in two districts in the Eastern region of Ghana, Lower Manya Krobo (LMK) District (high HIV burden with low EID coverage) and New Juabeng Municipality, NJM (high HIV burden with relatively higher coverage for EID). This analysis describes the first phase (exploratory study) of a three-phased implementation research spanning over 24 months. A total of 420 women with children < 2 years in each study area were involved. Key informant interviews and focus group discussions were conducted among mothers and health workers.

 

Data (quantitative and qualitative) were analysed with appropriate statistical measures.

Results: Relatively more women from LMKD knew about the risks for mother-to-child transmission of HIV (83.6% vs. 79.8%) and more women in LMKD had children <2 years tested for HIV. In contrast to findings from the survey, knowledge on EID during Focus Group Discussions was better in NJM than LMKD. Major demand and supply -side barriers and challenges to EID were identified. 

Conclusion: Health system (supply side) and community based (demand side) barriers mitigated against the EID coverage in the two districts. More community sensitisation, improved innovative means of transporting samples and effective tracking of mothers with HIV exposed infants and linking them up to care is recommended.
History of Diagnostic Radiology in Ghana
Authors: Brakohiapa WO , Brakohiapa Edmund K. K. , Asiamah SS , Idun EA , Kaminta A , Dzefi-Tettey K
Published: July 2023

The history of Radiology in Ghana which began in 1951 has not been fully documented. The establishment of the Ghana College of Physicians and Surgeons, of which the Faculty of Radiology is a part, the West African College of Surgeons, as well as other institutions for radiography training, have played a major role in improving the Radiologist/Population-, Radiologist/Radiographer- and Radiographer/Population ratios in the country.
Credence has also been given to a number of aims and objectives of the Faculty of Radiology of the Ghana College of Physicians and Surgeons such as a) The turning out of Radiologists for 9 out of the 16 regions of the country. b) A vast improvement in the quality and quantity of radiological services to the citizenry by the provision of modern radiological equipment, as well as increased manpower for the various diagnostic procedures. c) The establishment of subspecialties such as Interventional radiology, Neuroradiology and Paediatric radiology.
The article seeks to highlight some of the major achievements and challenges in the delivery of radiological services to the citizenry of Ghana. Some of the challenges facing the specialty such as inadequate equipment in some public hospitals and the lack of maintenance of same are discussed. There is also inequitable distribution of radiologists across the country. Recommendations in the area of increased number of resident’s slots for postgraduate training by the Ministry of Health, as well as the reestablishment of external exposure for trainers to deepen their knowledge for the training of residents have been mentioned.
Anorectal Malformation in a Teenager in Ghana—a Case Report
Authors: Yifieyeh A.C. , Ameyaw E. , Duduyemi B.M. , Amoah M. , Nimakoo B.
Published: July 2023

Anorectal malformation is a congenital anomaly comprising a wide spectrum of diseases, which can affect male and female and can involve the distal anus and rectum as well as the urinary and genital tracts. The late presentation of patients with anorectalmalformations especially in adolescence is known but rare. This is particularly true in females with rectovestibular fistulas. We present the case of a 17- year old female who underwent a posterior sagittal anoplasty on this account with satisfactory outcome.
Influenza Epidemic-1918/19
Authors: Editor-In-Chief
Published: July 2023

Influenza Epidemic-1918/19
Ebola Hemorrhagic Fever: Lessons for Our States
Authors: Seffah J.D.
Published: July 2023

Ebola Hemorrhagic Fever: Lessons For Our States
Burn Injuries in Kumasi: A Ten-Year Review
Authors: Adu E.J.K. , Koranteng A.
Published: July 2023

Objective: To document the clinical and epidemiological features; and the outcome of management of patients with burn injuries at Komfo Anokye Teaching Hospital in Kumasi, Ghana, from January 2003 to December 2012. Patients and Methods: Data on all burn patients managed within the study period were retrieved from the records of the Burns Intensive Care Unit (BICU), theatre and Surgical Outpatient Department (SOPD) and analyzed. Data included name, age, sex, cause ofburn, medical and surgical treatment given, post burn complications and the outcome of the treatment.Results: 1361 patients were treated for burn injuries and their complications at KATH, comprising 707 males and 654 females (M: F = 1.08:1). Ages ranged from 0.25 to 92 years; mean 15.5 (SD 14.1) years, median 11.9 years. About 77% of the patients wereaged 20 years or less; 45% were children aged 10 years or younger. The highest annual admission was 172 patients in 2005; the lowest 104 in 2007. Scalds comprised 60% of the injuries, hot water accounting for 45%. Dry heat was responsible for 37% of the burninjuries. Chemical burns accounted for 28 (2%) injuries which led to loss of vision in two cases and one death; all of which were through assault. Electrical burns accounted for 12 (0.9%) of the injuries and led to six limb amputations and three deaths, all of them workersof electricity companies. A total of 162 patients died of burn injuries, giving an overall mortality of 11.9%. The highest annual mortality of 32 (29%) occurred in 2008, which coincided with 4 major burn disasters. Perioperative deaths occurred in four epileptic patients.Conclusion: Though injuries from hot liquids account for most admissions for burns at KATH, significant morbidity and mortality also result from dry heat. Electrical and chemical burns and epilepsy are increasingly becoming responsible for most burn morbidity.
Improving Emergency Care in Ghana
Authors: Oduro G.D.
Published: July 2023

Improving Emergency Care In Ghana
Respect for Patient Autonomy: A Patient Perspective
Authors: Adwedaa E.
Published: July 2023

There appears to be dissatisfaction by patients in Ghana with the way their doctors communicate with them. The perception is that doctors fail to respect their autonomy by failing to adequately inform them of their health condition and also fail to involve themin their health care decisions. Patients want doctors to use their medical training to promote a partnership in the doctor-patient relationship where the doctor uses his or her superior knowledge and skill in medicine to acknowledge, encourage and support the patient’s right to self-determination in his or her health care. If doctors did that, patients will be more satisfied, the doctor-patient relationship will be enriched, trust between the doctor and his patient will be enhanced and patient care will also be enhanced. Although there may be difficulties for doctors to adopt this approach, those difficulties are not insurmountable.
Basic Laboratory Investigation of the Critically Ill Emergency Patient
Authors: Osafo T.D.
Published: July 2023

Clinical Practice
Cleidocranial Dysostosis- A Case Report
Authors: Yeboah-Agyapong M.A. , Nuamah I.K. , Horgli Y.A.
Published: July 2023

Objective: First report of cleidocranial dysostosis (CCD), a rare genetic disorder, in Ghana. Case report and intervention: The condition presented in a 13 year old boy with most of the classical features. He had cranial features in the form of open fontanelles, underdeveloped paranasal air sinuses and hypertelorism. Thoracic features were severelyunderdeveloped clavicles which allowed him to appose both shoulders in the midline. He had an open bite, several unerupted permanent teeth and several retained teeth most of which were discoloured which was why he was seen at the Dental department. After restoration of some of these teeth the patient was very satisfied.Conclusion: Though the definitive treatment in these patients can be sophisticated major craniofacial surgery, early restoration of malformed teeth can help ease patient’s anxiety and improve quality of life.
Governor Frederick Gordon Guggisberg
Authors: Editor-In-Chief
Published: July 2023

Governor Frederick Gordon Guggisberg
The Association Between Chronic Kidney Disease, Hyperuricaemia and Proteinuria in Adult Patients Attending Outpatient Clinics in Banjul, the Gambia
Authors: Nkum B.C. , Micah F.B. , Eghan B.A. , Ankrah T.C.
Published: July 2023

Background: Chronic kidney disease (CKD) is manifested by irreversible worsening renal function and is associated with proteinuria and hyperuricaemia.Objective: To determine the prevalence of CKD, hyperuricaemia and proteinuria and explore the relationship between CKD, hyperuricaemia and proteinuria among outpatients in Banjul, The Gambia.Design: Prospective cross-sectional studySetting: Outpatient clinics of Edward Francis Small Teaching Hospital and Medical Research Council Laboratories in Banjul.Methods: Two hundred and eight consecutive patients with hypertension on treatment and 108 nonhypertensive patients aged over 25years were enrolled. A questionnaire was filled and anthropometric measurements were taken. An oral glucose tolerance test was done. Serum uric acid and creatinine were determined from venous blood samples and proteinuria was determined by urine dipsticks. The estimated glomerular filtration rate (GFR) was calculated using the Cockcroft and Gault equation. CKD was defined and classified by The National Kidney Foundation’s Kidney Diseases Outcomes Quality Initiative guidelines.Results: The results of 300 participants were included in this analysis. The prevalence of hyperuricaemia was 36%, proteinuria 25% and CKD 41% (10.7% of participants had Stage 1, 6.7% Stage 2, 21.7% Stage 3, 1.3% Stage 4 and 0.3% Stage 5). The mean uric acid was 0.33 (0.13) mmol/L, mean creatinine 88.1 (54.1) μmol/L and mean GFR was 103.2 (80.2) ml/min/1.73 m2 .There was a strong and significant association between hyperuricaemia, proteinuria and CKD among these participants before and even after controlling for age, sex, hypertension and diabetes mellitus.Conclusion: The prevalence of CKD, hyperuricaemia and proteinuria in patients attending clinics in Banjul was high. There was a strong and significant association between CKD, hyperuricaemia and proteinuria.
The Sensitivity and Specificity of WHO clinical Staging in Predicting Cd4 Cell Counts in HIV Infected Patients at the Police Hospital in Accra, Ghana
Authors: Otu-Nyarko S. , Asabilla Baba E.
Published: July 2023

Introduction : Initiating an HIV positive client on ART is an important step in the care of PLHIV. Due to a shortage of CD4 machines and reagents, the WHO clinical staging guideline is widely used to determine when to initiate ART in developing countries.Objective : To determine whether WHO clinical staging is predictive of CD4 of 350 in initiation of ART in patients presenting at the Police Hospital ART clinic.Methods : We reviewed the records of clients on ART, from 2010 to 2012 and compared the WHO clinical staging and CD4 counts at their first visit to the clinic. Pregnant women, hepatitis B infected patients and children below fifteen were excluded from the study.Results : Two hundred and five PLHIVs were eligible for inclusion in the study. Sensitivity of the WHO Clinical staging to predict initiation of ART was 44% and specificity 87%. Positive predictive power was 83% and Negative predictive power was 51%.Conclusion : Almost 50% of those needing ART as per CD4 count were classified as WHO stage 1 or 2. This means that about half of those deemed not qualified to start ART by WHO clinical staging actually needed to be initiated on ART. Access to CD4 machines andreagents must be increased to minimize delay in start of treatment for patients.
A Rare Complication: Tracheal Laceration after Routine Intubation at the Tamale Teaching Hospital
Authors: Anabah T.W. , Kampo S. , Arredondo A.
Published: July 2023

Patients Tracheal perforation is a rare complication of endotracheal intubation that usually presents as a linear lesion in the membranous wall of the trachea. It is more prevalent in women (because they have shorter stature and a weaker pars membranosa compared to men), patients 50 years and older and patients less than 160 cm tall. Most common clinical manifestations includesubcutaneous emphysema, pneumomediastinum, pneumothorax, respiratory distress and haemoptysis. We report the case of a young male presenting with tracheal perforation after routine endotracheal intubation. This case was managed conservativelywithout complications. Possible causes for the injury include: over-inflation of the endotracheal tube cuff, intubation by an inexperienced anaesthetist or use of an inappropriately sized tube for the patient. Clinical suspicion must be followed by diagnostic confirmation, which was achieved by direct visualization of trachea rupture on bronchoscopy. We therefore encourage endotracheal tube cuff pressure monitoring during general anaesthesia and direct supervision of an inexperienced anaesthetists during critical events such as induction and intubation.
Neonatal Tetanus in Northern Region, Ghana – A Case Report
Authors: Abdul-Mumin A. , Gumanga S.K.
Published: July 2023

Maternal and Neonatal Tetanus (MNT) has become a rare disease in Ghana following the intensive immunization campaigns over the last few decades. The country was certified as MNT-free by the World Health Organization (WHO) in 2013.We report on 2 cases ofNeonatal Tetanus (NT) seen in the Northern Region of Ghana. Although the mothers of both patients attended antenatal clinics, they were not vaccinated against tetanus. Both patients were successfully managed and discharged from the hospital. These cases call forpractitioners to be mindful of sporadic cases of NT that may present to our facilities.
Effect Of Plasmodium Berghei Parasitaemia On Laboratory Induced Gastric Ulcer In Mice
Authors: Duduyemi B.M. , Olaleye S.B. , Yifieyeh A.C. , Titiloye N.A. , Afihene M.Y. , Ademowo O.G.
Published: July 2023

Background: Malaria is an important infection in Africa affecting all age groups although its severity depends on the relative immunity of the individual. Malaria has been found to have effects on the gastric mucosa, which include congestion with capillary stasis, necrosis, ulceration and haemorrhage. This study aimed at the effect of malaria parasitaemia on laboratory induced gastric ulcer in mice.Methods: Thirty-six mice divided into 6 groups thus: Group 1. no malaria parasite and ulcer (control); Group 2. Parasite without ulcer; Group 3. Parasite and ulcer; Group 4. Ulcer without parasite; Group 5. Parasite, ulcer and chloroquine treatment; and Grop 6. Parasite,ulcer and Artemether treatment. These were used for the study. The mice were parasitized with 20% innoculum of Plasmodium berghei and ulcer induced with 70% alcohol and pylorus ligation. Parameters such as degree of parasitization, ulcer diameter, gastricacidity and packed cell volume (PCV) were measured in the various groups and comparison made where necessary. The experimental part of the study took 18 days.Results: The severity of ulceration in the group with ulcer and parasite (11 ± 1.72 mm); and group with ulcer but no parasite (3.62 ± 1.6mm) was compared and was significant (p = 0.002). The groups with parasite showed gradual reduction in the packed cell volume (PCV) as the parasite load increased while the group without parasite showed increase in PCV over the time of study. The ulcer diameters in the groups treated with chloroquine (4.83 ± 2.48mm) and Artemether (5.00 ± 0.89) was not statistically significant (p = 0.889). The restoration of PCV was better for the treated group than the untreated group. The pH of the gastric content in the untreated group was lower than the treated groups. The parasite clearance by chloroquine and artemether was significant (p = 0.04) compared to the untreated groups.Conclusion: Malaria parasitaemia has a significant influence on gastric ulceration, PCV and to some extent gastric secretion. Chloroquine and artemether are sensitive drugs to Plasmodium berghei.
An Audit Of The Informed Consent Process At The Surgical Department Of Korle Bu Teaching Hospital, Accra
Authors: Nsaful J. , Umuago R. , Dedey F. , Adjei F. , Clegg-Lamptey J.N.A.
Published: July 2023

Background: Surgeons carry out procedures on patients daily, many of which are invasive and may be associated with some risks and complications. The concept of informed consent in surgical practice was introduced after certain legal issues arose. Today patients areentitled to know and be accorded the right to determine what happens to their bodies. This study set out to determine if there had been any improvement in the informed consent process over the years, taking a closer look at the various aspects of the information given.Method: This was a cross-sectional study carried out at the Department of Surgery, Korle Bu Teaching Hospital. One hundred consecutive post-operative patients were recruited and interviewed on information discussed at various stages during the preoperative period and on the administration of the consent form.Results: Thirty seven (66.0%) out of 56 elective cases felt they had been given enough information to their understanding to enable them give informed consent. Thirty (68.1%) out of 44 emergencies also felt they had been given enough information. Forty (71.4%) ofelective cases were able tell what their diagnosis was but only 23 (41.0%) knew what procedure had been done. Similarly 32 (72.2%) emergency cases were able to tell what their diagnosis was but only 16 (36.3%) knew what procedure had been done.Conclusion: Informed consent in the Department of Surgery of the Korle Bu Teaching Hospital is unsatisfactory and needs to be improved.
Chickenpox In Ghana; Is It Time To Consider Universal Immunization?
Authors: Addai S. , Tette E.M.A.
Published: July 2023

Chickenpox is a very common disease worldwide. It is one of the most frequently reported infectious diseases in North America. Although childhood varicella disease is not usually a life-threatening condition, it can cause major financial and social problems to parents and society from lost working time spent looking after sick children. Besides, there is a large number of unrecognized complications including fatalities from invasive infections. The availability of an effective vaccine, has made universal immunization a cost-effective approach to prevention and minimizing the effects of the disease in some settings. The exact burden of the disease in Ghana and for that matter most of Africa is unknown. Thus, in Ghana, a surveillance system and selective immunization is recommended as more information is gathered on the burden of disease and its impact on Ghana and the rest of Africa.
Breast Cancer In Men
Authors: Vanderpuye V. , Scott A.
Published: July 2023

Breast cancer in males is a relatively rare entity. In the sub-region, several reports indicate a higher incidence rate compared to other regions in the world. For many years, management strategies were derived from evidence based protocols established for managingfemale breast cancer. There are however, differences in the epidemiology, presentation, molecular profiles and response to therapies including chemotherapy, hormonal and targeted therapies. Outcomes even though mirroring female breast cancer may actually exhibit differences dependent on stage, race, prognostic and economic variables. The lack of large randomized trials on this subject has resulted in ad hoc management practices across the globe. With new information from renewed interest in the subject, screening and diagnostic guidelines are being established for high-risk groups and we expect to see improvements in outcomes for patientswith male breast cancer. This article attempts to bring to light a summary of the current interest, recommendations and controversies in the management of male breast cancer.
Antenatal Ultrasound
Authors: Nash Christopher , Coleman Jerry
Published: July 2023

Commentary
Adverse Events Following Immunization (AEFI) Reporting in A Rural District in Ghana
Authors: Twene P. , Yawson A.E.
Published: July 2023

Background: Even though vaccines used in routine childhood immunization programmes are safe, adverse events following immunization (AEFI) may occur. These events must be recognized for prompt and effective response. This can contribute to success of the immunization programme and sustain interest of the public in vaccination.Methods: A descriptive cross-sectional study comprising primary and secondary data collection methods were used for the study at Jaman North District in Ghana. The secondary data was extracted from immunization reports using a Microsoft excel spread sheet. The primary data was obtained from respondents using structured interview questionnaire. Simple random sampling was used to select caregivers and health workers were purposively selected. The data was analyzed using Statistical Package for Social Sciences (SPSS) windows (version 21.0).Results: A total of 140 mothers or caregivers and 47 health workers were studied, with mean age of 27.8 years in each group. The rates of AEFI ranged from 0.02% for pneumococcal vaccine to 0.14% for pentavalent vaccine. In all, 63.8% of the health workers could not define AEFI, and 91.5% of the health workers do not use anaphylactic pack at immunization sessions. Majority (95.7%) of the participants agreed that poor AEFIs monitoring can lead to reduction in immunization coverage. AEFI training for health workers had a strong association (p<0.001) on their ability to identify AEFIs. The study indicated that mothers or caregivers were knowledgeable in many of the indicators of AEFI. In all, 93.7% of mothers or caregivers indicated that attitude of health workers was very good.Conclusion: The study revealed low (<1%) AEFI reporting rate by mothers or caregivers. Only 36.2% health workers had knowledge with respect to definition of AFEI. The study indicated that more than a third of mothers (36%) were of the view that reporting of AEFIscan lead to personal consequences. Increased national efforts at surveillance for AEFI is imperative.
Outcomes In Elective Induction Of Labour With μg Intravaginal Misoprostol In Postdate Singleton Live Pregnancy At Korle-Bu Teaching Hospital
Authors: Kaboré S.Y. , Nuamah M.A. , Koranteng I.O. , Akoto-Ampaw E. , Nkyekyer K.
Published: July 2023

Background: Induction of labour is indicated when the risk associated with expectant management of labour is higher. The most common indication for labour induction is postdate pregnancy and induction for this indication has been shown to reduce perinatal death. Misoprostol is the most commonly used drug for labour induction at the Korle-Bu Teaching, the leading national referral centre in Ghana. Method: To assess the outcomes in Elective Induction of Labour using 50 μg of intravaginal misoprostol in postdate singleton live pregnancies at Korle-Bu Teaching Hospital. This was a prospective cohort study carried out to measure the rates of vaginal deliveries and factors affecting vaginal deliveries during labour induction. One hundred and sixteen pregnant women of at least 41 weeks gestation. Women were included and followed up from the first insertion of misoprostol to delivery.Results: Eighty-six patients (74.1%) had vaginal delivery and 30 (25.9%) were delivered by caesarean section. Among those who delivered vaginally, 77 (89.5%) delivered within 24 hours. There was a significant association between mode of delivery and Bishop Score (P=0.002). The highest Apgar score at the first minute was 7 in 55 babies (47.4%) and the lowest was 3 in 2 babies (1.7%).Conclusions: The high rate of vaginal delivery and absence of induction related perinatal mortality confirmed the effectiveness and safety of misoprostol in postdate singleton live pregnancy at Korle-Bu Teaching Hospital.
The Impact Of Malaria Parasites On The Placenta And Perinatal Outcome At Korle Bu Teaching Hospital, Accra, Ghana: A Case Control Study
Authors: Nuamah H.G. , Nuamah M.A. , Kwansa-Bentum B. , Tetteh-Quarcoo P.B. , Ahenkorah J. , Korankye E. , Torto M. , Ntumi M. , Samba A.
Published: July 2023

Objective: Malaria remains a complex and overwhelming health problem affecting vulnerablegroups such as pregnant women and their infants in Ghana. Malaria during pregnancy does not only pose a threat to the mother but can cause serious structural damages to the placenta and subsequently affect the pregnancy outcome. The aim of the study was to investigate the impact of Plasmodium parasites on the placenta and perinatal outcome of women delivering at Korle Bu Teaching Hospital. A better understanding of the impact of malaria parasites on the placenta morphology and prenatal outcome is crucial for better management of pregnant women  and their babies.Methods: The study involved testing blood collected from postpartum placentas and examining the placental tissue for Plasmodium parasites, after which they were classified as study group (Plasmodium positive) or control (Plasmodium negative). The patients in the study group with similar gestational and maternal age were matched with patients from the control group. The morphological characteristics of the placenta and the perinatal outcome of the two patient groups were compared using an unpaired t-test.Results: Sixteen (16, 13.6%) out of 118 women tested positive for Plasmodium parasites on the maternal side of the placenta by both rapid diagnostic test and microscopy and /or tested positive for malarial parasite during pregnancy, whiles the rest (102, 86.4%) had nohistory of malaria in the index pregnancy and tested negative. The mean placenta weight was significantly reduced in the study group (difference: -102.0g; 95% Confidence Interval [CI]: 424.4g, 486.6g) who delivered during early term (p=0.02). Patients in the study group, who delivered during late term, had a significantly reduced mean placenta diameter (difference: -2.5cm; 95% CI: 20.0cm, 21.4cm) (p=0.003) and delivered infants with lower mean birth weight (difference: - 0.693kg; 95 CI: 3.268kg, 3.475kg) (p<0.001).Conclusion: Malaria during pregnancy does not only pose a threat to the mother but to the fetus and our results add evidence that malaria parasites cause alterations to certain morphological characteristics of the placenta which subsequently affect the birth weight as the pregnancy progresses to late term.
Optimising Outcome Of Health Care Delivery: The Role Of Research In Policy Decision Making In (CCTH) Ghana
Authors: Editor-In-Chief
Published: July 2023

ABSTRACTS/ PROCEEDING: 1ST CAPE COAST TEACHING HOSPITAL SCIENTIFIC RESEARCH CONFERENCE
National Surgical, Obstetric And Anaesthesia Planning (NSOAP): A New Imperative
Authors: Seffah J.D.
Published: July 2023

Editorial
Lessons Leanrt Of The First Public Sector ISO 15189 Accredited Laboratory In Ghana
Authors: Attoh S. , Kodjoe I.T. , Boateng C. , Yakubu A.M. , Adusu-Donkor L.X. , Boafo J. , Matey P.N. , Kwao S. , Ani- Amponsah J. , Sarkodie E. , Boaheng K. , Asante-Addo M. , McAddy M. , Hobenu F. , Fatchu R.D.
Published: July 2023

Background: Accreditation of public sector medical laboratories in developing countries such as Ghana have  been described as an almost impossible task despite major efforts to establish and maintain efficient quality laboratory management systems. The Pathology Division of the 37 Military Hospital provides evidence of an efficient approach to accreditation to ISO 15189 in Ghana and the need to make medical laboratory accreditation an integral part of the national healthcare delivery system.Methods: The laboratory adopted the Strengthening Laboratory Management Towards Accreditation (SLMTA) programme. After implementation the laboratory accelerated the process towards accreditation using an approach involving senior management in allaccreditation activities, use of specific teams to focus on key improvement projects coordinated by an efficient mentorship programme. The laboratory was finally assessed by the Southern African Development Community for Accreditation Services to meeting the requirement of ISO 15189.Results: The Pathology Division of the 37 Military Hospital attained accreditation for its Haematology and Chemical Pathology departments making it the first public sector laboratory in Ghana to meet the requirement of ISO 15189. There has been an observedimprovement in confidence of personnel and a culture for quality and meeting standards in support of quality healthcare delivery.Conclusion: ISO 15189 accreditation of medical laboratories is possible for all public sector laboratories in Ghana and the approach is scalable scalable especially for tertiary level laboratories. Accreditation ensures a culture for quality which is critical in supportof quality patient care and must be an important aspect of national healthcare delivery systems.
Need For A Surgical Plan In Ghana
Authors: Swarray-Deen A.
Published: July 2023

Over the past two decades, the global health community has increasingly recognised the need to include surgery, obstetric and anaesthesia care (SOA) in its concept of universal health coverage in any national plan. Surgical conditions (including obstetric conditions) represent a leading contributor to the global burden of disease accounting for a third of all disability-adjusted life years (DALYs) incurred annually. In the study published by the Lancet Commission on Global Surgery (LCoGS), it is stated that about five billion of the world’s 7.5 billion people do not have access to safe and affordable surgical, obstetrics, trauma and anaesthesia care when needed. Among those who are fortunate to have surgery done, 33 million will face catastrophic health expenditure due to payment for surgery and anaesthesia each year. This fact is ever so true for most low-and middle income countries (LMIC) and the Lancet Commission has proposed the use of six core indicators to assess the surgical system of a country. These indicators include specialist surgical workforce per 100,000; number of surgical procedures per 100,000; risk of catastrophic expenditure for surgical care; risk of impoverishing expenditure; postoperative mortality rate and 2-hour access to Bellwether procedures. Of these six indicators, four have been published by the World Bank as World Development Indicators (WDIs).
A Diagnostic Dilemma: Was This Death Not a Case of an Infant with Cytomegalovirus Infection?
Authors: Enimil A. , Oppong E. , Obodai E.O. , Osei-Bonsu A. , Akoto E.O.
Published: July 2023

A 3-month-old female infant was referred to a teaching hospital with a 3-day history of fever, fast breathing, cough and 19 hours of yellowish discoloration of sclera. She was deeply jaundiced and febrile, had hepatosplenomegaly, was microcephalic and thrombocytopenic. Child was worked out and treated for bacterial pneumonia, atypical pneumonia, pulmonary tuberculosis, fungal opportunist infection, and heart failure. She was oxygen dependent throughout the 2 months of admission and deteriorateddespite all interventions. Considerations for viral infection was made later into her admission but delayed farther due to financialchallenges. Immunoglobins (IgG and IgM) for Cytomegalovirus (CMV) came up positive. Child had hypoxic pneumonia of which CMV is a documented cause in this age group and could have benefitted from empiric ganciclovir cover if clinicians had thought of it.There is the urgent need for clinicians to widen the differential list especially when response to conventional treatment is poor. Valid National Health Insurance card holders should benefit from a wider range of laboratory services if our aim to decrease infant mortality will materialize.
HIV /AIDS
Authors: Editor-In-Chief
Published: July 2023

HIV /AIDS