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Postgraduate Medical Journal of Ghana
Volume 6 Number 2

Articles in Volume 6 number 2

Calcium Supplementation For The Prevention Of Pregnancy Induced Hypertension/Preeclampsia
Omonua KI, Akaba GO, Isah AY, Offiong RA, Ekele BA

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A RANDOMIZED CONTROLLED TRIAL TO DETERMINE THE EFFICACY OF CALCIUM SUPPLEMENTATION IN THE PREVENTION OF PREGNANCY INDUCED HYPERTENSION/PREECLAMPSIA AMONG PRIMIGRAVIDAE

Key words: Calcium supplementation, pregnancy induced hypertension, preeclampsia, preterm delivery, Nigeria.

ABSTRACT
Background: Pregnancy induced hypertension (PIH) and preeclampsia (PE) contribute significantly to maternal and perinatal morbidity and mortality. The role of calcium supplementation towards preventing PIH/PE however remains unclear.

Objective: To assess the efficacy of calcium supplementation in prevention of PIH and PE.
Materials and methods: An open label, randomized controlled trial conducted at the antenatal clinic of University of Abuja Teaching Hospital between July 2014 and June 2015. A total of 484 nulliparous women 16 weeks or less gestation and with normal blood pressures were randomly assigned to either receive 1200mg of calcium tablet daily (N=242) or not to receive calcium tablets (N=242) from 16weeks until delivery. Primary outcome measure was development of PIH or PE and secondary outcome measure was preterm birth.

Results: The incidence of PIH was 7.7% among the intervention group compared to 13.7% in the control, p=0.039 and calcium supplementation reduced the risk of PIH (RR=0.56 (95% CI: 0.32-0.98)), but not PE. It also prolonged the duration of pregnancy in women who developed PIH (p=0.02). Incidence of preeclampsia was not significant, RR-0.56 (95% CI: 0.21-1.52) so also was the incidence of preterm delivery between the two groups (RR-0.65 (95% CI: 0.32-1.31)). No serious maternal side effects of treatment were recorded.

Conclusion: Calcium supplementation during pregnancy reduced the risk of PIH and thus may have a role in the prevention of PIH amongst nulliparous women. Its role in the absolute prevention of PE was not demonstrated in this study.

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Disclosing Medical Errors To Patients: Overcoming The Challenge In Clinical Communication
Awindaogo FR

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Disclosing Medical Errors to Patients: Overcoming the Challenge in Clinical Communication

Key words: disclosure, medical error, communication

Summary Ethical and professional guidelines obligate doctors to disclose medical errors to patients when they occur. But very few doctors are divulging their own errors, especially in a very paternalistic doctor-patient relationship witnessed in sub-Saharan Africa where the prevalence of medical errors is unknown due to absence of error reporting and disclosing mechanisms. Doctors are not disclosing their errors because of perceived consequences when they do and the lack of disclosure skills that is not taught at all stages of the educational system including the postgraduate level. However, patients want to know and be told when things go wrong. This article looks at the barriers to disclosure of medical errors, the benefits of disclosure for both the doctor and patient, and how doctors can begin disclosing errors based on current literature.  

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Emergency Ear, Nose And Throat Admissions In Northern Ghana
Adjeso T, Damah MC, Murphy JP

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Emergency Ear, Nose And Throat Admissions In Northern Ghana

Key words: Ear, Nose, Throat, Emergency, Tamale

ABSTRACT
Background:Ear, nose and throat (ENT) emergencies are common in the north of Ghana; however, there are no published reports. We conducted a retrospective study of ENT emergencies at the ENT Unit of the Tamale Teaching Hospital (TTH).

Method: This was a four-year review of patients admitted for emergency care at the ENT Unit of the Tamale Teaching Hospital between January 2013 and December 2016. Analyzed parameters included age, sex, diagnosis and outcome of treatment.

Results: A total of 390 patients were admitted for ENT emergency treatment during this period. Thirty-eight patients were excluded on account of incomplete information with 352 patients included in the final
analysis.
The sex distributions of patients were 209 males and 143 females with a male to female ratio of 1.46:1. The age range was 6 months to 81 years with a mean age of 27.2 ± 21.2 (median age of 25.5) years. Peak age incidence was in 0-10 age group. The most common indications for ENT emergency admissions were maxillofacial injuries (22.7%), foreign body ingestion (17.9%), deep neck (multi-)space abscesses (14.5%) and upper airway obstruction (8.2%). Fifteen patients (4.7%) admitted for emergency care died.

Conclusion: The most common indications for ENT emergency admissions from our study were throat related conditions and maxillofacial injuries that were treated successfully in 89.4% cases.

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Factors Associated With Antenatal Steroid Uptake In Mothers At Risk Of Preterm Birth At A Teaching Hospital In Ghana
Sackey AH, Tagoe LG, Oppong SA

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Factors Associated With Antenatal Steroid Uptake In Mothers At Risk Of Preterm Birth 

Key words: Antenatal, steroids, preterm, birth

ABSTRACT
Background: This study was performed to determine the factors associated with antenatal corticosteroid (ACS) use in pregnant women at risk of preterm birth at the Korle-Bu Teaching hospital (KBTH) in Accra.

Method: A descriptive cross-sectional study. Subjects and outcome measures – Mothers who should have received antenatal steroids were identified by the admission of their preterm infants to the neonatal unit at KBTH. Maternal ACS status was determined, and the characteristics of women who received ACS were compared with those who did not.

Results: There were 284 eligible admissions during the study period of 6 months, of which 43% (121 mothers) were studied due to administrative and logistical constraints. Out of these 121 mothers, 92 (76%) had received antenatal corticosteroids. Mothers with primary and secondary education were less likely to receive antenatal corticosteroid (OR 0.240, 95% CI 0.058-0.984), (OR 0.211, 95% CI 0.050-0.897) respectively, compared to those with tertiary level education. Mothers who delivered at other hospitals outside KBTH were also less likely to receive ACS (OR 0.195, 95% CI 0.070-0.545). Women who had caesarean delivery were more likely to receive antenatal corticosteroid compared to those with vaginal delivery (OR 4.378 95% CI 1.690-11.346). In this cohort, there was no association between antenatal corticosteroid use and maternal age, maternal medical condition, fetal gender or previous preterm delivery

Conclusion: TACS use in KBTH is low but similar to other low-income countries. Low educational attainment and delivery outside the tertiary facility are factors associated with low use of ACS.

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Pattern Of Seminal Fluid Parameters And Their Clinical Correlates Amongst Infertile Men In The Niger-Delta Region Of Nigeria
Ngwu M, Omo-Aghoja LO, Adeyinka AT

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Pattern Of Seminal Fluid Parameters And Their Clinical Correlates Amongst Infertile Men In The Niger-Delta Region Of Nigeria

Key words: Pattern, Seminal Fluid, Parameters, Clinical Correlates, Infertile Men

ABSTRACT
Background: Infertility is a foremost reproductive health problem globally, with sub-Saharan Africa nations most affected. The male contributions to this burden have not been properly documented in this environment

Method: This was a cross-sectional study conducted in Central Hospital Benin City, involving 355 male partners of women with infertility. Specific clinical information was extracted and two semen analyses were conducted two weeks apart.

Results:The mean duration of infertility was 4.5 years (SD 2.17), and secondary infertility was the commonest (82.3%). Over half (59.7%) were of low socioeconomic status. Over two-thirds (66.5%) had seminal fluid abnormality; and Oligospermia was the commonest (22.8%). About two-fifth took alcohol regularly (43.9%), had previous history of urethral discharge (39.4%), or of testicular pain (42.8%). About One-fifth had a past history of mumps-orchitis
(20.3%), or smoked cigarette (22.3%). Less than a tenth had varicocele (8.8%), or undescended testes (8.5%); while more than one-tenth reported use of Cimetidine (12.4%), herniorrhaphy (14.7%), scrotal surgery (15.8%), or sexual dysfunction (14.6%). There were significantly more participants with sexual dysfunction, herniorrhaphy, scrotal surgery, undescended testes; mumps orchitis; testicular pains; varicocele; history of purulent urethral discharge; tobacco smoking; alcohol consumption; and use of Cimetidine who have abnormal seminal fluid parameters. However on multivariate logistic regression analysis, history of urethral discharge, undescended testes, and Cimetidine use had negative correlation with abnormal semen parameters.

Conclusion: The prevalence of male factor infertility in our setting was high with significant association between male infertility and wide range of clinical and psychosocial problems.

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Personal And Behavioural Characteristics And Risk Of HIV Transmission Among Men And Women In An Urban Fishing Setting In Ghana
Yawson AE, Yeboah OA, Yawson AO, Yamson P, Yorke E, Boima V, Ayisi AS, Dornoo BT, Lartey M

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Personal And Behavioural Characteristics And Risk Of HIV Transmission Among Men And Women In An Urban Fishing Setting In Ghana

Key words: Behavioural Surveillance Survey, Sexual Risk Behaviour, Urban Community, Ghana

ABSTRACT
Background: HIV surveillance surveys are designed to track trends in HIV and AIDS related knowledge, attitudes and behaviours in sub-populations at particular risk of infection and link the behaviour to biological surveillance. This survey determined personal characteristics, high risk sexual behaviours and HIV perception and testing experience among men and women in an urban fishing community in Ghana.

Method: A cross-sectional community survey was conducted in 2013 among men and women in two fishing communities (Chorkor and James Town) in Accra. In all, 554 subjects (≥18 years) were involved, 264 in Chorkor and 290 in James Town. Data on personal and behavioural characteristics, high risk sexual behaviours, HIV perception and testing experience among men and women were collected with a structured questionnaire. Descriptive statistics and Chi square test were used for the analysis at 95% significant level, using SPSS version 21.

Results: Of 554 subjects, 329 (59.4%) were females, and median age was 32 years. A higher proportion of women had no formal education, relatively more men were employed and earned statistically significant
higher monthly income than women (72.2% vs. 65.9%, p ≶ 0.001). More working men were involved in itinerant occupations compared to women (46.1% vs. 22%; p ≶ 0.001). Half of all respondents have had sexual intercourse less than a month prior to survey, however, only less than a third 153 (28.5%) used condom during the last intercourse. High risk HIV sexual behaviour was more common in younger age groups (> 30 years), those living with partners, those with low education, those currently employed, and those without health insurance. It was also higher in those who did not perceive themselves as being at risk of HIV, have never tested for HIV and who were not members of any social groups or clubs.

Conclusion: The survey indicated important personnel and behavioural characteristics that are very important for programme planning and control. Targeted health promotion messages, behaviour change communication, and increased engagement with communities and groups are necessary to capture vulnerable men and women in high risk settings. Behavioural surveillance surveys should be considered essential component of national control efforts.

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Phlebotomy By House Officers
Adzamli I, Tettey M, Sagoe J, Amoako J, Dzefi-Tettey k, Mohammed S


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Phlebotomy By House Officers

Key words: Phlebotomy, Training, Certification, House Officer, Medical School

ABSTRACT
Background: Phlebotomy is a highly complex technique, requiring knowledge and skill to perform. In advanced societies, all phlebotomists undergo a well-structured training with certification.

OBJECTIVE
This study examines the practice of phlebotomy by house-officers (HO) in Korle-Bu Teaching Hospital, as part of expediency in health service delivery.

Method: Self-administered questionnaires were obtained from 54 Ghanaian trained HOs (out of a total of 85 HOs) from four main departments of the Korle-Bu Teaching Hospital in December 2010. Data obtained were analysed statistically using SPSS (Version 12; SPSS Inc, Chicago, IL, USA) programme.

Results: There were 54 HOs who had worked for a minimum of six months. Thirty-five (64.5%) of them felt that venesection was not their job description. Forty-nine (90.2%) received no formal training and 40 (74.1%) received informal training in phlebotomy during Medical School. Thirty 32 (59.3%) used the dorsum of the hand as the main site for venesection and 25 (46.5%) did not know avoidable sites during venesection. Fifty-three (98.1%) did not check for allergies to antiseptics and adhesives before performing venesection. Thirty-seven (68.5%) did not know the names of all the additives in the various sample bottles and 29 (53.7%) did not understand the colour coding of the sample bottles. In addition, 34 (63.0%) did not know the blood volume required for all the various tests. Twenty-nine (53.7%) did not know that laboratory results of analytes were affected by patient’s posture.

Conclusion: The most common indications for ENT emergency admissions from our study were throat related conditions and maxillofacial injuries that were treated successfully in 89.4% cases.

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An Observational Review Of Determinants Of Perinatal Deaths In Kwahu East, West And South Districts
Asare BA

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An Observational Review Of Determinants Of Perinatal Deaths In Kwahu East, West And South Districts

Key words: Perinatal death, stillbirth, early neonatal death, classification, case control

ABSTRACT
Background: Perinatal deaths, largely occurring in full-term pregnancy1, are usually of unknown causes even with statutory routine autopsy performance2. Autopsies reveal causes in only 40%4. Data paucity remains a major challenge in developing countries7.

OBJECTIVE
The study aimed to identify determinants of perinatal deaths in three Kwahu Districts and assess their preventability.

Method: An observational study with an unmatched case control design using Health Facility-based data.

Results: Most perinatal deaths occurred at term. Mean gestational age at delivery was 37 and 38.8 weeks for cases and controls respectively. Cases were mainly rural residents with informal occupations and comparatively higher gravidity and parity. Controls had higher educational backgrounds. Factors associated with perinatal deaths were Rural residence, OR – 2.7 (95% CI = 2.02 – 3.6), grandmultiparity OR – 2.0 (95% CI = 1.3 – 3.2), mal presentation OR – 2.5 (95% CI = 1.4 – 4.4), Low Birth Weight OR – 2.3 (95% CI = 1.4 – 3.8), delayed second stage OR – 8.4 (95% CI = 2 – 27), Hypertensive disease OR – 3.0 (95% CI = 1.8 – 3.6), uterine rupture OR – 2.0 (95% CI = 1.8 – 2.1) and prematurity OR – 3.8 (95% CI = 2.7 – 5.3). Formal occupations OR – 0.4 (95% CI = 0.3 – 0.7), referrals OR – 0.6 (95% CI = 0.4 – 0.7), tertiary education OR – 0.3 (95% CI = 0.2 – 0.5) and adequate ANC OR – 0.5 (0.3 – 0.6) significantly reduced odds of deaths.

Conclusion: Perinatal deaths remain preventable with accessible quality ANC, delivery and postnatal services supported by comprehensive, sustainably funded surveillance. The Human Rights Based Approach to programming must be prioritized.

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Non-Communicable Disease In Children In Ghana: Health And Social Burden Of Care On Households
Yawson A, Badasu DM, Atobra D, Anarfi J, Abuosi AA, Adzei FA

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Non-Communicable Disease In Children In Ghana: Health And Social Burden Of Care On Households

Key words: Cnon-communicable diseases, children, financial burden, Ghana

ABSTRACT
Background: Non-communicable diseases (NCDs) are on the increase among children. This paper determines the health and social burden of care imposed on households by NCDs among children in Ghana.

Method: This was a cross-sectional study in three hospitals in Ghana, Ashanti, Greater Accra and Volta Regions. Interviewer administered structured questionnaire was used for data collection. Data was analyzed by proportions, ratios and chi square for association between categorical outcome measures (at 95% confidence level) using SPSS version 21.

Results: Burden of caregiving for children with NCDs rested heavily on women (169; 75.1%) and immediate family (176; 78.3%). Managing child’s condition was expensive and created financial difficulties for households. In all 87.4% of households depended on the national health insurance scheme (NHIS) and 45.8% indicated NCDs in children was a burden. In addition, 47% of the caregivers said life was much better before they found out about child’s ailment. Families had no financial support from extended families or communities/employers. Despite enormous challenges faced by households, there was no indication families suffered isolation or discrimination.

Conclusion: National Health Insurance coverage of NCDs especially childhood cancers will reduce the burden of care on households. Improving access to care at regional/district levels for children with NCDs is imperative.

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Community Involvement In Child Birth: The Case Of West Gonja District In The Northern Region Of Ghana
Der EM, Azure SE, Kumassey AM, Yakong V

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Community Involvement In Child Birth: The Case Of West Gonja District In The Northern Region Of Ghana 

Key words: Birth preparedness, complications readiness, Decision maker, pregnancy, labour, obstetrics emergencies, West Gonja, District, Ghana

ABSTRACT
Background: Most obstetric complications are preventable if adequate preparations are made to avoid delays during obstetrics emergencies. The aim of this study was to assess the level of community involvement in preventing complications to mother and new born during pregnancy and labour.

Method: A cross-sectional descriptive study was conducted in 6 health facilities selected through purposive sampling. A sample size of 210 women was obtained through convenience sampling using structured questionnaires. The data was analysed using SPSS software (version 23).

Results:The mean age of the respondents was 28.3 (SD=5.7). The great majority of the women have heard of danger signs of pregnancy (91.9%) and labour (76.2%). The common danger signs of pregnancy were Vomiting (26.0%), bleeding per vaginam (24.0%) and severe waist pain (21.1%). The common danger signs of labour were bleeding per vaginam (32.9%), big baby (23.8%) and retained placenta (11.0%). The major source of information on obstetrics danger signs was health care providers (91.0%) during antenatal visits. The first and second decisions makers during obstetrics emergencies were husbands (85.1%) and mother-in-laws (57.2%), only 2.5% of the respondents can act as the first decision makers. The common support systems available for obstetrics emergencies in descending order were; preparation of items for labour (28.6%), care taker at the hospital (19.4%), transportation to place of labour (14.4%) and choice of the place of labour (13.5%). Blood was commonly organized for women from the community with obstetric complications.

Conclusion: The study found that the respondents had very good knowledge of the danger signs of obstetrics emergencies. They have good community support systems for women in labour, but only very few of them can take their own decision during obstetrics emergencies.

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Emergency Laparoscopic Appendectomy In Ghana: The 37 Military Hospital Method
Asumanu E, Yeboah R, Boadi B, Opae – Tetteh I, Teteyfio – Koney C; Antwi AA; Adiali B, Ayebge VA, Idan P

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Emergency Laparoscopic Appendectomy In Ghana: The 37 Military Hospital Method

Key words: Appendicitis, Laparoscopy, Appendectomy

SUMMARY
Emergency laparoscopic appendectomy is evolving as the method of preference for the management of acute appendicitis. Appendicitis is one of the common causes of acute abdomen diagnosed in the emergency unit in Ghana and open appendectomy has been the preferred method for most surgeons. Increasing patient preference for laparoscopy in Ghana will soon require an increase in the practice of emergency laparoscopic appendectomy in many centres. The number and sizes of ports as well as the site of placement, together with the technique of appendectomy, determines the uniqueness of the method of laparoscopic appendectomy. A simplified easy to apply method of laparoscopic appendectomy is needed to encourage its use in emergency centres.

Method: The paper describes a 3-port method of laparoscopic appendectomy which combines the principles of open appendectomy and basic laparoscopy. Patient positioning and the operative removal of the appendix is similar to what as is done in open appendectomy. Pneumoperitoneum is achieved by open access through the umbilicus. Two additional ports are placed below the iliac crest for a good cosmetic effect. The amount of consumable used usage is comparable to that of open appendectomy.

Results: The question of a gold standard procedure for laparoscopic appendix still persists. The key criteria in the choice of any method should be the success rate, affordability, resource availability and suitability. The method described meets the above criteria in a low resource environment. It offers opportunity for the practice of laparoscopic appendectomy in institutions that practice open appendectomy. The sites of port placement makes the method especially suitable for population that are keloid prone. The use of the same principle for mesappendix and appendix excision as in open appendectomy helps improve the learning curve. Modifying the 10mm port into a retrieval bag at the end of the procedure presents gives the same effect as a conventional retrieval bag without an additional risk of infection.

Conclusion: The method has an inherent easy learning curve and is expected to help scale up the conversion from open to laparoscopic appendectomy

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Interventional Radiology Practice In Ghana: The Current And The Future
Sakodie DB, Awuku YA

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Interventional Radiology Practice In Ghana: The Current And The Future

Key words: Interventional radiology, Ghana, current and future.

SUMMARY
The interventional radiologist (IR) uses radiological image guidance to target therapy. Despite the ranges of services that IR offers to patients, it is still a mirage to many of our patients. This is as a result of lack of trained personnel, the high cost of procedures and consumables and low knowledge among health professionals on the benefit of IR services. For many developing countries like Ghana IR is in the infantile stage and now taking off.
The aim of this paper is to highlight the scope of IR services and discuss the future of this subspecialty in Ghana. This paper will sensitize health professionals on the scope of interventional radiology practice in Ghana now and the future.

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