Ghana Medical Journal

Contribution of Apolipoprotein L1 (APOL1) Risk Alleles to Kidney Disease in West Africa: an opportunity for treatment

Dwomoa Adu — 2025-01-10

Chronic kidney disease (CKD) is common in sub-Saharan Africa (SSA) and develops in 10-14 per cent of adults. CKD leads, in many cases, to ill health, kidney failure, and premature death. The increased prevalence of CKD in Africa is in part due to inherited variants in the gene for Apolipoprotein L1 (APOL1). These variants developed some 10,000 years ago, and because they provided protection against fatal sleeping sickness (Trypanosoma brucei rhodesiense), the proportion of individuals with these variants rose to a high level in Africans in SSA. The APOL1 variants are associated with the development of CKD in Africans and people of African descent. The three fold increased risk of end stage kidney disease (ESKD) in African Americans compared to European Americans is now attributed largely to variants in the APOL1 gene in chromosome 22q12 locus, termed G1 and G2. The impact of the gene variants mirrors other evolutionary adaptations found in African populations. In this way, the gene is like the sickle cell gene, which protects people against malaria but can cause crises.

A 5-year retrospective outlook of cardiovascular risk(s), outcome and survival peculiarities among patients in medical confinement; a tropical perspective

Titilope Bamikefa — 2025-01-10

Objective: The study was designed to evaluate the distribution of cardiovascular risk(s), outcome modifiers and survival peculiarities among medically confined patients.
Design: Evaluated admission and discharge summaries of medically confined patients retroactively over 5 years.
Setting: Medical wards, UniOsun Teaching Hospital Osogbo, Osun State, Nigeria.
Participants: Two thousand three hundred and forty (2340) male and female patients aged between 16 and 108 years.
Main outcome measures: Admission pattern, cardiovascular risk distribution, outcome and survival peculiarities.
Results: The mean age of the respondents was 53.2 (18.3) years with male preponderance (52.0%). Non-infectious diseases predominated as the principal causes of medical confinements (82.9%). Cerebrovascular accident (13.5%), acute decompensation of chronic kidney disease (11.6%) and type 2 diabetes mellitus (6.0%) were the prominent causes of morbidity. The median duration of confinement was 6.0 days. The overall crude mortality rate was 14.3%, with the highest case fatality rate (27.2%) among those with neurological morbidities. Clinical outcome was statistically influenced by age (p= 0.004), occupation (p=0.02), duration of confinement (p=0.002) and morbidity stratification into infectious/non-infectious aetiologies (p=0.040) on regression analysis. The number of medical sub-specialties involved (p < 0.001), specialty affected (p<0.001), and yearly pattern of hospitalisation (p< 0.001) had a statistical influence on Kaplan Meier's survival plots.
Conclusion: Hospital confinements underlined by infection/non-infection-related medical causes exhibit variable outcomes. The loop-sided frequencies of its causes remain worrisome because of the unending challenges plaguing effective healthcare delivery in the tropics.

Outcomes and factors associated with severe malaria-related anaemia in paediatric patients in northern Nigeria

Olayinka R. Ibrahim — 2025-01-10

Objective: To determine the prevalence of anaemia, clinical features, hospitalisation outcomes, and associated factors among paediatric patients with severe malaria-related anaemia admitted to a tertiary hospital in northwestern Nigeria.
Design: This was a retrospective study of children with confirmed severe malaria-related anaemia admitted between 2019 and 2022.
Participants: Paediatric patients aged three months to 14 years with confirmed severe malaria-related anaemia
Main outcomes measures: Hospitalization outcomes and associated factors among paediatric study patients.
Results: There were 278 malaria-related anaemia cases with a prevalence of 29.3% (278/948) among malaria cases and 3.4% (278/8,295) among all paediatric admissions. Of 278 patients with malaria-related anaemia, 110 (39.6%) had severe anaemia. The prevalence of severe anaemia was 11.6% (110/948) and 1.3% (110/8,295) from malaria cases and paediatric admissions, respectively. Clinical features were comparable across the levels of anaemia except for the loss of consciousness (p = 0.038). Severe anaemia was more common among under-fives (76/159, 47.8%), p=003, and males (p = 0.013). The crude mortality rate was 6.5% (18/278) and comparable [6.4%, (7/110)] with severe anaemia (p = 0.924). Factors that were associated with hospitalisation deaths included unconsciousness [adjusted odds ratio (AOR) 5.8, 95% confidence interval (CI) 1.800-18.441], hypoxemia AOR [7.3, 95% CI, 1.749- 30.473] and first 24 hours of admission, AOR [18.4, 95% CI 3.430-98.705].
Conclusion: In childhood, severe malaria anaemia remains a greater burden among under five and is associated with high mortality. Unconsciousness and hypoxemia at presentation and the first 24 hours of admission were associated with increased odds of death.

A health facility-based assessment of the ancillary benefit for prevention of anaemia at term of intermittent preventive therapy with sulfadoxine-pyrimethamine in pregnancy

Brainard A. Asare — 2025-01-10

Objective: This study aims to evaluate the ancillary benefit of intermittent preventive therapy with sulfadoxine-pyrimethamine ( IPTp-SP) in preventing maternal anaemia (MA) among parturient women differentially exposed to the regimen.
Design: A health facility-based retrospective analytical cross-sectional study.
Settings: The study was conducted at the Kade Government Hospital’s maternity/labor suit.
Participants: Data from 2,545 parturient women were abstracted from birth registers.
Statistical analysis: Baseline characteristics were described, and stratified analyses assessed their impacts. Differences in mean mHgbc based on IPTp-SP exposure were determined using one-way ANOVA. An unpaired two-sample t-test evaluated the significance of inter-dose group differences. The bivariable analysis examined crude and adjusted risks of anaemia with differential IPTp-SP exposure.
Main outcome measure: The main outcome measure was the level of mHgbc with varying IPTp-SP exposure.
Results: The overall mean exposure to IPTp-SP was 2.35 (±2.35) doses. Of the women, 5.9% had ‘nil’ exposure, with a mean mHgbc of 9.71 g/dL (±1.6). Among the 75.9% who received 1-3 doses, the mean mHgbc was 10.39 g/dL (±1.3). For the 18.2% who received ≥4 doses, the mean mHgbc was 10.77 g/dL (±1.4). The mHgbc notably rose as the mean doses of IPTp-SP increased. The crude odds ratios (COR) were 1.96 (95% CI: 0.99-3.89, p = 0.06) for ‘nil’ exposure, 1.28 (95% CI: 0.92-1.78, p = 0.16) for 1-3 doses, and 0.59 (95% CI: 0.41-0.84, p = 0.002) for ≥4 doses.
Conclusion: The consistent linear increase in mean mHgbc with higher IPTp-SP doses remains clinically crucial.

An age-matched comparative study of ocular biometry parameters in cataractous and non-cataractous eyes of children in Ibadan, Nigeria.

Ezinne O. Onebunne — 2025-01-10

Objective: This study compared the preoperative ocular biometric parameters of children who had cataract with age-matched healthy children to provide an understanding of a range of typical measurements in indigenous African eyes and aid management of childhood cataract.
Design: Observational, cross-sectional, comparative study of two groups- cases and controls.
Setting: Child eye health tertiary health facility
Participants: Group A consisted of children aged 2 to 6 years with cataracts, and Group B of age-matched controls. Ocular biometry measurements including keratometry, axial length (AXL), pachymetry (central corneal thickness [CCT]) and tonometry were measured.
Results: Thirty eyes of 24 children were studied in each group. Seventeen (70.8%) children had bilateral cataracts. The mean age of the cataract group (A) was 5.97±2.93 years, while that of the control group (B) was 6.33±2.89 years. The mean preoperative values for the ocular biometric parameters were: Group A AXL= 23.4(±1.4) mm versus Group B AXL= 22.7(±0.9) mm, p= 0.028; Group A CCT= 563.6(±59.7) μm versus Group B CCT= 551.0(±36.4) μm, p= 0.33; and Group A K = 43.4(±2.3) D versus Group B K = 42.5(±1.5) D, p= 0.08. Group A IOP was 13.7(±2.8) mmHg, while Group B IOP was 13.8 (±3.1) mmHg, p =0.93.
Conclusion: There was no statistically significant difference in ocular biometric parameters between children’s eyes with and without cataracts except for the axial length.

An evaluation of pain experienced by patients during and after ultrasound-guided breast biopsy and patient coping strategies

Yaw B. Mensah — 2025-01-10

Objective: To ascertain the experience and determinants of pain by breast biopsy patients and how the pain is managed in the first week following the procedure.
Design: This was a panel longitudinal study design.
Settings: The study was conducted at the Radiology Department of Korle Bu Teaching Hospital.
Participants: The study participants comprised adult patients who presented to the Department of Radiology of Korle Bu Teaching Hospital for breast biopsy between 1 August 2022 and 31 January 2023.
Main Outcome: The severity of biopsy-related pain, its associated factors and management were evaluated and documented.
Results: The participants were between 21 and 81 years with a mean age of 48.1 years. There was no association between demographic and participant factors and the degree of pain experienced by the patient. There was a significant association between the radiologist's expertise (p<.001), blood pressure before the procedure (p=.026), quality of education given to the participant before the procedure (p<.001) and the degree of pain experienced.
Conclusion: There was significant anxiety before the procedure. Most participants experienced mild pain, which did not interfere with daily activity. There was a significant association between participant pain and pre-procedure blood pressure, the radiologist’s expertise and the quality of education participants received before the biopsy.

Occurrence of extended-spectrum beta-lactamase (ESBL) in Gram-negative bacterial isolates from high vaginal swabs in a teaching hospital in Nigeria

Oluwatoyin B. Famojuro — 2025-01-10

Objective: This study aims to determine the antibiotic susceptibility pattern and incidence of extended-spectrum betalactamase (ESBL) genes in isolates from vaginal discharge of symptomatic female patients.
Study design: Cross-sectional study
Participant: Pregnant and non-pregnant women between 18 and 50 years who presented with genital tract infection and had not received antimicrobial therapy in the two weeks prior
Interventions: The study determines the prevalence of bacteria in the vaginal discharge of female patients of reproductive age, the antibiotic susceptibility pattern of the isolates and the incidence of ESBL genes in Gram-negative isolates from the sample.
Results: Bacteria were found in 74 (80.4%) and 88 (81.5%) samples from pregnant and non-pregnant women, respectively. Escherichia coli (n=48; 27.6%) occurred mostly in the samples, followed by Staphylococcus aureus (n=38; 21.8%). Among the Gram-positive, all Streptococcus. pneumoniae and Staphylococcus. epidermidis were sensitive to imipenem and meropenem (100%). S. aureus was the most resistant to cephalexin (71.4%), cefoxitin (60.5%) carbenicillin (60.5%) and ceftazidime (57.9%). Escherichia coli was highly resistant to carbenicillin (85.4%), cephalexin (64.6%) and cefotaxime (56.3%). Klebsiella pneumoniae showed the highest level of imipenem resistance (31.6%), followed by E. coli (29.2%). The prevalence of ESBL genes in Gram-negative isolates from pregnant women was 25.6% (11/43), compared to 30.3% (23/76) in non-pregnant women. Both blaTEM and blaSHV had the highest occurrence of 14.3% (17/119) of the isolates.
Conclusion: This study found Gram-negative pathogens isolated from the vaginal tract of both pregnant and non-pregnant women to be resistant to multiple antibiotics and have ESBL genes.

Foetal weight estimation, at term, using a multivariate algorithm of maternal characteristics, has an accuracy similar to that of ultrasonography.

Akeem A. Iyiola — 2025-01-10

Objective: To compare the accuracy of foetal weight estimation using a multivariate algorithm based on maternal characteristics and pregnancy-specific factors to that of ultrasound.
Design: A cross-sectional hospital-based study.
Setting: Antenatal Clinics and Antenatal Labour wards of the Department of Obstetrics & Gynaecology, Federal Medical Centre, Asaba, Nigeria.
Participants: A total of 92 pregnant women were admitted for labour, elective caesarean section or elective induction of labour at 37 weeks to 41 weeks and 3 days.
Main outcome measures: Mean of absolute error, mean of absolute percentage error and proportion of estimated weight within 10% of actual birth weight.
Results: Between April and August 2021, 92 participants were included. An equation based on maternal characteristics was derived. Ultrasound weight estimation was done using Hadlock’s 4 formula. Both methods positively correlated with actual birth weight, and their accuracy did not differ significantly. Overall accuracy within 10% of actual birth weight was higher for ultrasonography than multivariate algorithm 71.7% and 65.2%, respectively (χ2=0.286, p=0.60). The mean absolute percentage error was smaller for ultrasound (7.98±4.74%) than clinical formula (9.11±6.76%) p=0.11. The mean absolute error was 265.57±145.67g for ultrasonography and 304.32±203.29g for the multivariate model, with no statistical difference (p=0.09).
Conclusion: The multivariate algorithm based on maternal characteristics and pregnancy-specific factors was equally accurate as ultrasonography for foetal weight estimation at term.

Analysis of Human Papillomavirus-HPV-18 and HPV-45 Type-specific variants in a contemporary cohort of individuals with cervical disease in Ghana

Gladys Kaba — 2025-01-10

Objectives: E6 and E7 DNA sequence profile of HPV-18 and HPV-45 lineage/sublineage variants in Ghana.
Design: A cross-sectional study.
Setting: Obstetrics/Gynaecology Directorate, Komfo Anokye Teaching Hospital, Kumasi and Department of Radio-therapy/Nuclear Medicine and the Family Planning Unit, Korle-Bu Teaching Hospital, Accra.
Participants: 207 individuals referred with clinical suspicion of cervical cancer (CxCa) or confirmed CxCa/precancer cases.
Methods: Cervical swabs were collected (from October 2018 to November 2020) from individuals, with L1 DNA positivity for HPV-18(40 samples) and/or HPV-45(28 samples), out of 207 samples tested for 24-HPV-genotypes. DNA was extracted from a convenience sample and HPV-E6/E7-PCR (33/40-HPV-18-+ve- or 20/28-HPV-45-+ve samples), sequencing, and BLAST analysis was carried out.
Results: After PCR amplification, the E6/E7 gene regions of 26 out of 33(HPV-18+ve) samples and ten (10) out of 20 (HPV-45+ve) samples were eligible for sequencing. For HPV-18 variants, 24 out of 26 samples (92.31%) were of lineage-B/C, including samples of lineage-C and 22 samples of lineage-B (out of which ten (10) samples were with E7-SNP-C665T). Nine out of ten HPV-45 variants were sublineage-A1, of which two (2) samples harboured both E6-SNPs-C134T and C4I7T including one sample with E6-SNPs-C134T, G415C, C4I7T detected together.
Conclusions: Our study confirms a dominance of HPV-45-sublineage-A1 and HPV-18-lineage-B (with rare occurrence of Africa-specific HPV-18-lineage-C) variants in Ghana. Our study provides preliminary data on E6/E7 SNPs of HPV-18 and HPV-45 lineages and sublineages among CxCa cases in Ghana. We hope our data will inform future studies on pattern and distribution of HPV type-specific nucleotide changes that can be useful for therapeutic intervention.