Ghana Medical Journal

Helicopter research: A persistent drawback to equitable collaborative research

2024-07-01T16:58:31+00:00

Collaboration in research has increased over the years with many advances in medical knowledge. With understanding and good faith, many of these partnerships have yielded remarkable results and significantly improved our world. The inequity has resulted in many untoward effects since much of this collaborative research is between persons from richer or high-income countries and poorer or lower-income ones. Helicopter Research or “parachute research” refers to the situation where a more resourced partner in a research collaboration goes into the less resourced partner's location, conducts research, exports the data, and publishes the findings, often with no or very little input from or acknowledgement of the less resourced counterpart. This does not only occur between richer and poorer nations but also even within the same country where the relationship is asymmetrical.

Adherence to routinely prescribed medications among paediatric sickle cell disease patients in Kumasi, Ghana

2024-07-01T12:12:48+00:00

Objective: To measure the adherence to routinely prescribed medications among Sickle Cell Disease (SCD) patients in Kumasi, Ghana
Design: A cohort study involving paediatric SCD patients presenting to the outpatient clinic at the Komfo Anokye Teaching Hospital (KATH).
Setting: The Pediatric SCD Outpatient Clinic of KATH.
Participants: Two hundred SCD patients visiting the outpatient clinic
Intervention: None
Main Outcome Measure: Cost and adherence to Penicillin V, Folic Acid, Hydroxyurea and Vitamins prescribed to SCD patients on routine outpatient visits.
Results: Of the 200 participants, the highest and lowest phenotypes were Hb-SS (162, 80.1%) and Sβ-thal (3, 1.5%), respectively. The adherence rate to routine medications was 13.5% (95%CI: ut9.1% to 19.0%). Patient factors that affect adherence included forgetfulness 98(49%), cost 54(27%), and side effects 28(14%) of medication, and improvement in health 7(3.5%). Hydroxyurea was the costliest to the patients with a median (IQR) cost of GHc 75 (0, 450) or USD12 (0, 73), and the least was folic acid with a median of GHc 6 (0, 42) or USD 1 (0, 7). 44.5% of all medications prescribed were not obtained in full. 83% of those who did not purchase all the medicines attributed this to cost, with 13% indicating they had some at home.
Conclusion: There is low adherence to routine medications used by SCD patients in Kumasi, and this could be because of their relatively high cost. Further studies should be made to assess the non-adherent effects of SCD medications on patients' health.

Factors associated with dual sensory impairment in older persons attending the Geriatric Centre in Southwest Nigeria

2024-07-01T15:39:12+00:00

Objective: This study examined the prevalence of hearing impairment, visual impairment and Dual Sensory Impairment (DSI) and the risk factors among older persons
Design: A Cross-sectional study where respondents were recruited by systematic random sampling.
Setting: A tertiary institution at the Geriatric Centre, University College Hospital, Ibadan, Nigeria.
Participants: A total of 388 older persons aged more than 60 years were recruited
Interventions: A semi-structured pretested questionnaire was used over three months.
Main outcome measures: Association between ageing, low income, poor quality of life, functional disability, and dual sensory impairment.
Results: The mean age of the respondents was 70.2±6.3 years. The point prevalence of HI, VI and DSI were 14.9%, 8.0%, and 1.5% respectively. On logistic regression analysis, the most significant factors associated with HI were having no formal education OR=2.564(1.091-6.024) and previous hospital admission OR=3.473(1.856-6.499), for VI; increasing age OR=1.080(1.022-1.141) and poor income OR=2.941(1.263-6.897) and DSI; increasing age OR=1.224(1.054-1.421).
Conclusion: Few (1.5%) older adults experienced DSI in our setting. The association between sensory impairments, age, and socioeconomic factors of poor education and income suggests the need for visual and hearing screening in older adults, particularly those with medical and socioeconomic issues, for early detection.

Correlation of sonographically-determined residual urine volume with lower urinary tract symptoms in adult males at a tertiary hospital

2024-07-01T15:52:42+00:00

Objective: To determine the correlation between the severity of LUTS as measured by the International Prostate Symptom Score (IPSS) and PVR urine volume measured by transabdominal ultrasound in patients with LUTS, and to determine the correlation between ‘feeling of incomplete bladder emptying and sonographically measured PVR urine volume.
Design: Correlational cross-sectional study
Setting: Ultrasound Unit of the Radiology Department and Urology Clinic of Korle Bu Teaching Hospital
Participants: Male patients (n=256) aged 40 years or older who presented to the urology department of Korle Bu Teaching Hospital with LUTS and gave their written consent were enrolled. The presence and severity of LUTS were evaluated using the IPSS. The PVR urine was measured using a real-time transabdominal ultrasound scan.
Main outcome measure: Severity of LUTS and Residual urine volume
Results: The mean PVR urine volume was 84.5ml. Most respondents (57.3%, n=146) had PVR urine volume below 50ml, with 27% (70 patients) having PVR urine volume above 100ml. PVR urine volume and total IPSS showed no statistically significant correlation. All age groups of respondents scored above 4 for Quality of life (QoL). ‘Intermittency’ is the IPSS symptom, which showed a statistically significant correlation with PVR urine volume. PVR urine volume did not correlate statistically with the ‘feeling of incomplete emptying’.
Conclusions: There was no statistically significant correlation between the total IPSS and PVR urine volume. Thus, residual urine volume does not correlate with the severity of LUTS. The ‘feeling of incomplete emptying’ does not correlate with PVR urine volume.

Sexual behaviours and contraceptive use among undergraduates in a Nigerian University.

2024-07-01T16:02:53+00:00

Objectives: The study was conducted to describe the sexual behaviours and contraceptive use, as well as factors associated with being engaged in sex among Nigerian undergraduates.
Design: A descriptive cross-sectional study.
Setting: The study was conducted in a university of education in Ogun State, Nigeria.
Participants: Four hundred undergraduates were selected sequentially through a stratified sampling method.
Main outcome measures: Being sexually active, multiple sexual partners, and contraceptive use.
Results: Participants’ ages ranged from 16 to 24 years. Nearly two-thirds (65.5%) were females. About a quarter of them (24.5%) were using psychoactive substance(s). More than two-fifths (44.5%) of them had engaged in sexual intercourse, of which 36% had a history of multiple sexual partners. The mean age at sexual debut was 18.7 ± 2.7 years, significantly lower among males than females (p <0.001). About half (218; 54.5%) of the students were cognisant of contraceptives, and 39.3% of sexually active participants had used contraceptives at some time, with condoms being the most commonly used. Male sex (p = 0.042), older age (p <0.001), higher monthly allowance (p = 0.025), and substance abuse (p <0.001) were factors that made undergraduates more likely to have engaged in sex.
Conclusion: Engagement in sexual activity and unsafe sex were common practices among the Nigerian undergraduates studied. It is recommended that deliberate efforts be made to increase contraceptive awareness and usage.

Prognostic significance of morphology markers of chromosomal instability in acute leukaemia and myelodysplastic syndrome

2024-07-01T16:13:14+00:00

Objective: This study aimed to assess the prognostic significance of various morphological markers of chromosomal instability (CI).
Design: This is a cross-sectional analytical study.
Setting: Single centre study from the Department of Pathology of a tertiary care centre in India.
Participants: The study included samples of bone marrow aspirates (BMA) and biopsies of patients with acute leukaemia (AL) and myelodysplastic syndrome (MDS) performed between June 2019 and June 2021. Inadequate samples were excluded. We included 178 samples from 80 cases.
Interventions: BMA and biopsies slides examined for CI markers like chromatin bridges, multipolar mitosis, nuclear budding, micronuclei, laggards, chromatin string (CS) and nuclear heterogeneity (NH). CI markers were correlated with the type, severity and prognosis of acute leukaemia and MDS.
Main outcome measures: Evaluation of CI markers as prognostic markers in AL and MDS.
Results: We included B-cell ALL (35), AML (11), MDS (04), relapse of AL (12), and remission of AL (116). All CI markers were significantly increased in AL and MDS compared to the remission group. All CI markers were significantly higher in non-responders to therapy than in responders. In regression analysis, the median (IQR) values of CS and NH were significantly higher among non-survivors than survivors.
Conclusion: CI markers of morphology are significantly associated with poor prognosis, including Non-survival of the disease. These markers are easy to identify and cost-effective. We recommend incorporating morphological markers of CI in routine reporting of haematological malignancies to assist in prognostication before reports from sophisticated techniques are available.

Rectal screening for carbapenemase-producing Enterobacteriaceae in an intensive care unit in India

2024-07-01T16:20:20+00:00

Objectives: To determine the proportion of patients admitted to ICU who are colonised with carbapenem-resistant Enterobacteriaceae (CRE) and to estimate the agreement between colonised patients and patients who developed an infection with CRE.
Design: Prospective surveillance study
Setting: The ICU of a tertiary care hospital in Kerala, India
Participants: All patients above 18 were admitted to the ICU during the study period.
Outcome measures: Patients colonised with CRE and systemic infection with the colonised organism
Results: CRE colonisation was found in 20(8.7%) samples. Among the 20 patients in the study who were colonised with CRE, 5(25%) developed systemic infection due to CRE. History of antibiotic usage and admission to other hospitals in the last 90 days were independent predictors of CRE colonisation.
Conclusion: Five of the 20 patients colonised with CRE developed an infection. Hospital admission and antibiotic usage were the main risk factors associated with CRE colonisation. Antibiotic escalation was suggested for two colonised patients based on their clinical worsening, but they succumbed to the illness. This study led us to modify our infection control practices, which led to isolating patients colonised with CRE.

A systematic review on the effect of the COVID-19 pandemic on childhood immunisation programmes of West African countries

2024-07-04T09:35:46+00:00

Objectives: To investigate the effects of the COVID-19 pandemic on childhood immunisation programmes in West African Countries.
Design: The study was a systematic review of available evidence of the impact of the COVID-19 pandemic on childhood immunisation programmes in West Africa
Setting: An online literature search was conducted using PubMed, Embase, Scopus and Web of Science for all peer-reviewed longitudinal, descriptive, observational, prospective and retrospective studies on childhood immunisation programmes in West Africa published between January 2020 and May 2022
Participants: All West African childhood immunisation programmes.
Interventions: None
Main Outcome Measures: Change in immunisation volumes during the COVID-19 pandemic
Results: 353 studies were identified during the literature search, and eight were included in this review. The studies comprised six quantitative studies, one mixed-method (quantitative/qualitative) study and one qualitative study. Changes to immunisation services ranged between 53% and 52% for MCV and Penta3 vaccines in Guinea, lasting longer than August 2020, to 0.3% and 1% in Liberia for BCG and MCV vaccines lasting no longer than May 2020. Factors contributing to the observed disruptions in vaccine coverage during the pandemic included the fear of contracting the virus expressed by caregivers and healthcare workers and general misinformation about the COVID-19 virus.
Conclusion: While the changes were greater than 50% and lasted longer in some countries, they were brief and short-lived in others, emphasising that the COVID-19 pandemic's effect in each country differed.

Recurrent ischemic stroke post-thrombolysis in an older Ghanaian woman

2024-07-01T16:40:33+00:00

Acute ischemic stroke management has evolved through several paradigms. Currently, thrombolysis is recommended for patients who present within 4.5 hours of acute ischemic stroke. Early neurological deterioration post-thrombolysis, however, may occur through several mechanisms. We report a case of a 66-year-old Ghanaian woman with multiple co-morbidities who presented with sudden onset right-sided weakness and aphasia of 2 hours duration. A diagnosis of acute ischemic stroke was made based on clinical examination and a computerised tomography scan of the brain. She underwent successful thrombolysis with recovery of full neurological function. She, however, developed a second ischemic stroke within 72 hours, with the likely aetiology being large vessel occlusion. This was subsequently managed conservatively. Extensive evaluation and control of specific stroke aetiologies is required for the prevention of stroke recurrence post thrombolysis. Also, the establishment of comprehensive stroke centres which provide neurovascular interventions in sub-Saharan Africa can help reduce stroke mortality and morbidity in eligible patients.