Ghana Medical Journal

Emeritus Professor Francis Kwesi Nkrumah (1935 – 2024)

Kwadwo A. Koram — 2024-09-30

Emeritus Professor Francis Kwesi Nkrumah, former Director of the Noguchi Memorial Institute for Medical Research (1990 – 1998) and former Head of the Department of Child Health, University of Ghana Medical School (UGMS) from 1980 to 1983, died on June 30, 2024, at the age of 89.

Management and associated outcomes of COVID-19 infection among Ghanaian autoimmune rheumatic disease patients

Dzifa Dey — 2024-09-30

Objective: This study assessed the prevalence of infection, management strategies and associated disease outcomes of COVID-19 among Autoimmune Rheumatic Disease (AIRD) patients in a teaching hospital in Ghana.
Design: This was a retrospective cross-sectional study.
Setting: Rheumatology Unit, Korle Bu Teaching Hospital.
Participants: Autoimmune Rheumatic Disease patients.
Results: Thirty-one (31) out of approximately 1700 AIRD patients in the unit tested positive for COVID-19, registering a COVID-19 prevalence of 1.82%. The majority, 25(80.6%), were females with a mean ± SD age of 41.7 ± 12.8 years. Systemic lupus erythematosus was the most affected autoimmune rheumatic condition, reporting fever as the commonest COVID-19-related symptom. Most participants, 22(71%), were managed by the “self-isolation”/home management” strategy. In comparison, 7(22.5%) were monitored at the hospital, with both strategies having resulted in complete recovery. The remaining 2(6.5%) patients who managed under “intensive care unit” strategy resulted in mortality.
Conclusion: These findings highlight the relatively low frequency of COVID-19 infection among AIRD patients, the encouraging recovery, and the low severe disease rates observed within this cohort. Additionally, the outcome of self-isolation and home management strategies underscore the importance of personalised approaches to COVID-19 management in this population.

Comparative analysis of clinical profile, laboratory profile and outcome in COVID-19 patients with and without hypothyroidism

Sindhu Malini B — 2024-09-30

Objectives: Previous studies suggest that patients’ thyroid status might directly impact the course of Coronavirus disease 2019 (COVID-19). The objective of the study was to determine the clinical profile of COVID-19 patients with hypothyroidism and compare it with that of COVID-19 patients without hypothyroidism.
Design: Retrospective observational study
Setting: The study was conducted in a tertiary healthcare centre in Tamil Nadu between May and June 2021.
Participants: The study included 117 patients admitted with hypothyroidism and COVID-19 as well as 117 age and Gender matched COVID-19 patients without hypothyroidism.
Main outcome measures: Data regarding the demography, comorbidities, presenting symptoms, method of diagnosis of COVID-19, computed tomography (CT) severity score, Interleukin 6 (IL-6), D-dimer, oxygen requirement, number of days in hospital and outcome were collected for both groups. Data analysis was conducted, and p<0.05 was considered statistically significant.
Results: The study comprised 234 patients over two months, from May to June 2021. Distribution of presenting symptoms showed that the hypothyroidism group presented with a higher incidence of fever (66.67%), loose stool (18.80%) and myalgia (7.69%). Results show that RTPCR+, O2 Requirement, death, D-dimer, IL-6, number of days admitted as well as CT-severity did not show any statistically significant differences (p>0.05) between both groups. The outcomes also showed that both groups reported four mortalities.
Conclusions: The results of the study help conclude that the hypothyroidism status of a COVID-19 patient is not associated with higher severity of clinical symptoms, deranged laboratory values as well as mortality.

The risk perception of COVID-19 and vaccine uptake among patients with chronic illnesses at a tertiary health facility in Nigeria

Oluwatoyosi R. Aibinuomo — 2024-09-30

Objectives: This study assessed the risk perception of COVID-19 and the uptake of the COVID-19 vaccine among patients with chronic illnesses in a tertiary health facility.
Design: A hospital-based cross-sectional study.
Setting: The outpatient clinics in a tertiary health facility in Ilorin, North-Central Nigeria
Participants: Patients with chronic diseases attending outpatient clinics in UITH, Ilorin from November- December 2022, excluding patients under 18 years of age, using simple random sampling by balloting for outpatient clinics, proportional allocation for participants from each clinic, and systematic sampling method for eligible respondents.
Main outcome measure: Risk perception of COVID-19 and vaccine uptake among patients with chronic illnesses in Nigeria
Results: Respondents believed that older people were most at risk of COVID-19. Over two-thirds, 278 (69.5%) of the respondents had received the COVID-19 vaccine. Fear of the unknown (36.0%) and fear of side effects 30 (24.6%) were the most common reasons for not taking the vaccine. Those married were more likely to have received at least one dose of the vaccine (p=0.007).
Conclusion: COVID-19 risk perception and COVID-19 vaccine uptake were relatively above average. Fear of the unknown and side effects were significant reasons for not taking the vaccines.

Antibiotic use in surgical infections at a tertiary teaching hospital in Ghana

Josephine Mensah — 2024-09-30

Objective: The study aimed to assess antibiotic prescribing and use patterns at the Department of Surgery, Korle Bu Teaching Hospital.
Design: A cross-sectional study design was employed in this study.
Setting: The study was conducted at the Department of Surgery, Korle Bu Teaching Hospital.
Participants: Forty-two prescribers out of 63 (67%) at the Department of Surgery responded to questionnaires. Over the study period, prescriptions and medical records of 1715 patients from the general surgery, neurosurgery, and urology units were reviewed.
Main Outcome Measures: Percentage of prescriptions with antibiotics, percentage of prescribers using guidelines for antibiotic prescriptions, and percentage using culture and sensitivity to inform antibiotic prescriptions.
Results: Of the 1715 prescriptions assessed, 75% (1294/1715) were from inpatients, and 45% (772/1715) included an antibiotic. Ciprofloxacin and metronidazole constituted 54% of antibiotic prescriptions from general surgery. Amoxicillin/clavulanic acid and ceftriaxone constituted 64.7% of antibiotic prescriptions from neurosurgery, and ceftriaxone and ciprofloxacin made up 37.7% of antibiotic prescriptions from urology. Microbiology testing was done for only 14.5% (9/62) of inpatients who received antibiotics for treatment. The choice of antibiotics was influenced mainly by doctors’ previous experience (37/42, 88.1%).
Conclusion: Antibiotics are widely used. About half of all prescriptions had antibiotics, with ciprofloxacin and metronidazole constituting more than half of antibiotic prescriptions from general surgery. Doctors mainly based their antibiotic prescriptions on previous experience and occasionally on microbiological investigations.

Equity of access to free maternal and child health services among reproductive-age women in Delta State, Nigeria

Christie A Enuku — 2024-09-30

Objective: The study aimed to assess the equity of access to free maternal and child health services among reproductive-age women in Delta State, Nigeria
Design: the study adopted a descriptive cross-sectional survey design
Participants: The population for the study were 368 women of reproductive age (15-49 years) who had given birth between April 2015 and December 2015 in two randomly selected senatorial districts of Delta State. Data were collected using a pre-tested interviewer-administered questionnaire.
Results: 368 women were recruited for the study, consisting of 73.3% (N =270) from the urban setting and 26.7% (N=98) from the rural setting. 54.1% (N=199) had completed secondary school, while 28.8% (N=106) had completed tertiary education. Most respondents were aged 21 to 30 years 217(59.0%). 20% of respondents belonged to the poorest, poor and least poor socioeconomic status (SES) groups and 19.8% to average poor and rich SES groups. The results showed equity between different SES (0.014) and educational (0.027) backgrounds, as indicated in concentration curves. However, the concentration index between the geographical areas (-0.0200) indicates inequity in access in favour of urban dwellers.
Conclusion: Free maternal and child health services (FMCHS) were equitable across the different SES groups and educational levels. However, there was inequity in access due to distance to the hospitals among the women of childbearing age in the communities. This study is relevant to all healthcare professionals, especially those in public health, because it will encourage them to exercise their energy towards home care to reduce maternal and child mortality.

Nocturnal blood pressure dipping and left ventricular hypertrophy among hypertensive outpatients in a Ghanaian hospital

Abdul-Subulr Yakubu — 2024-09-30

Objectives: To investigate the association between the extent of nocturnal systolic blood pressure decline and left ventricular hypertrophy in patients with primary hypertension who were receiving antihypertensive drug therapy.
Design: This was a cross-sectional hospital-based study from November 2020 to March 2021.
Setting: The study was conducted at the Polyclinic of Korle Bu Teaching Hospital, Ghana.
Participants: Outpatients ≥18 years old with primary hypertension who were receiving antihypertensive drug therapy.
Interventions: Each participant underwent a 24-hour ambulatory blood pressure monitoring and a transthoracic echocardiogram.
Main outcome measures: Left ventricular hypertrophy and the extent of mean systolic blood pressure decline during sleep.
Results: 180 participants were recruited, comprising 110 (61.1%) females. The participants’ mean (±SD) age was 57.6 ± 11.0 years. 80% had a non-dipping blood pressure pattern, and 43.9% had left ventricular hypertrophy. Uncontrolled office blood pressure was an independent predictor of left ventricular hypertrophy in these patients (AOR 2.010, 95% CI 1.048-3.855, p=0.036); however, a non-dipping nocturnal systolic blood pressure status was not (AOR 1.849, 95% CI 0.850-4.022, p=0.121). 61.1% had abnormal left ventricular geometry, with concentric hypertrophy being the predominant geometric pattern.
Conclusion: Left ventricular hypertrophy and non-dipping nocturnal blood pressure were common in these hypertensive Ghanaian patients on antihypertensive therapy. Left ventricular hypertrophy was associated with uncontrolled office blood pressure but not the extent of nocturnal systolic blood pressure declines during a single 24-hour ambulatory blood pressure recording.

Patterns of acute chest pain at two tertiary centres in Accra, Ghana

Alfred Doku — 2024-09-30

Objective: To assess the clinical presentation and evaluation of acute life-threatening chest pain in Accra, Ghana.
Design: This was a cross-sectional study at the emergency departments of two leading tertiary hospitals in Accra.
Settings: The study was conducted at the Korle-Bu Teaching Hospital and the 37 Military Hospital in Accra
Participants: The study participants comprised adult patients aged 18 years and above who presented with acute chest pain at the emergency departments between April and June 2018.
Main Outcome: Acute coronary syndrome is the leading life-threatening cause of chest pain with poor pre- and inhospital care.
Results: 232 patients with chest pain were enrolled as respondents aged 18 to 94 years. The prevalence of life-threatening conditions causing chest pain was 31.9% of those who presented with acute chest pain. These included acute coronary syndrome (82.4%), pulmonary embolism (14.9%), and acute chest syndrome (2.7%). A few (6.6%) with life-threatening conditions such as acute coronary syndrome were transported by ambulances, and 44.3% reported to the facility within 2 to 9 days after the onset of chest pain. None of the patients with pulmonary embolism and acute chest syndrome had computer tomography pulmonary angiogram (CTPA) and echocardiogram done, respectively.
Conclusion: Our study found that life-threatening conditions amongst patients presenting with acute chest pains are common; however, there is a need to improve pre-hospital care and in-hospital assessment of these cases.

Addressing the roadblocks to hypertension management in Ghana: proceedings of a roundtable discussion

Alfred Doku — 2024-09-30

Hypertension is the top cause of preventable deaths in the African region. The burden of hypertension is increasing in Ghana, along with other countries in the African continent. Many people with hypertension in Ghana are unfortunately unaware of their diagnosis, and those who are aware often have poorly controlled blood pressure. The current situation is a signal of critical gaps in hypertension care in Ghana that need to be urgently addressed to curb this epidemic. The World Heart Federation (WHF), sponsored by Resolve to Save Lives, responded to this need by organising advocacy roundtables on hypertension in selected countries in sub-Saharan Africa to scale up hypertension management efforts in these countries. The roundtable on hypertension in Ghana was organised in collaboration with the Ghanaian Society of Cardiology (GSC) and the Stroke Association Support Network (SASNET) Ghana. A country mapping detailing the current situation and evolution of hypertension in Ghana over the years formed the basis of the roundtable discussions. The roundtable convened diverse stakeholders in hypertension care in Ghana to discuss the roadblocks to hypertension management in Ghana, proffer solutions to address them and chart a course with timelines for action. Major roadblocks to the management of hypertension in Ghana identified included inadequate financing for cardiovascular disease (CVD) care, inadequate capacity for CVD care across all levels of the healthcare system and insufficient education to empower people with hypertension for optimal self-care.

Multiple gouty tophi in a six-year-old

Imri G. Adefokun — 2024-09-30

Introduction: Gouty tophus in a child is an extremely rare presentation. Only very few cases have been documented in literature in contemporary times.
Case presentation: We present this index case of a 6-year-old child who was brought to the clinic by her parents on account of multiple subcutaneous swelling of two years’ duration on her lower limbs before she presented at our outpatient clinic. The swellings started from the knee joints and were associated with difficulty in walking. A provisional diagnosis of multiple soft tissue swelling was made before some of the swellings were excised. An excisional biopsy of some of the masses on the lower extremities was done, and histological examination revealed gouty tophus. She was then placed on oral febuxostat. Her clinical condition has improved significantly; she is on continuous follow-up at our facility's paediatric orthopaedic outpatient clinic. Hitherto, gouty tophus has been recorded in juveniles and young adults, but it may present in any child below the age of five years.
Conclusion: A high index of suspicion is needed in managing subcutaneous swellings in the paediatric age group (particularly pre-school) to identify and manage gouty tophus early enough to minimise its complications.