Journal Issues – Draft

PUBLIC HEALTH PHYSICIANS: PREVENTIVE MEDICINE SPECIALISTS PERPETUALLY CONFINED TO MANAGEMENT AND ADMINISTRATION

Key Words: Postgraduate, medicine, training, doctors, specialization, public health.

SUMMARY

A medical specialty constitutes a branch of medical practice, in furtherance of medical education focused on groups of patients, diseases, skills, or philosophy acquired after a multiple-year residency, pursued after completion of medical school education1. Specialist training in Ghana, typically state-sponsored, is aimed to ensure availability of highly skilled doctors to boost a currently sparse population of medical specialists who typically function in new professional capacities after post graduate training as specialists or consultants; this attracts higher remuneration. Public Health specialists, unlike clinical specialists, face a career, (refutably though) defined by an unclear professional job description coupled with ambiguous professional expectations. A reliable escape from this conundrum remains that of application for public health advertised jobs that are inextricably linked to management that will be competed for with other staff of varied backgrounds. This, by deduction, implies that Public Health specialists in the Ghana Health Service have no technical/professional job descriptions aside that of management which largely otherwise continues to define them. Management is inherently not entirely professional/technical as it essentially constitutes a responsibility that other cadre of varied professional backgrounds with recognized organizational and coordination skills can perform. The possible risk of inadvertent human resource underutilization should be averted through development of specific professional job descriptions for all public health practitioners of varying backgrounds in the health service.

PUBLIC HEALTH PHYSICIANS: PREVENTIVE MEDICINE SPECIALISTS PERPETUALLY CONFINED TO MANAGEMENT AND ADMINISTRATION

Key Words: Postgraduate, medicine, training, doctors, specialization, public health.

SUMMARY

A medical specialty constitutes a branch of medical practice, in furtherance of medical education focused on groups of patients, diseases, skills, or philosophy acquired after a multiple-year residency, pursued after completion of medical school education1. Specialist training in Ghana, typically state-sponsored, is aimed to ensure availability of highly skilled doctors to boost a currently sparse population of medical specialists who typically function in new professional capacities after post graduate training as specialists or consultants; this attracts higher remuneration. Public Health specialists, unlike clinical specialists, face a career, (refutably though) defined by an unclear professional job description coupled with ambiguous professional expectations. A reliable escape from this conundrum remains that of application for public health advertised jobs that are inextricably linked to management that will be competed for with other staff of varied backgrounds. This, by deduction, implies that Public Health specialists in the Ghana Health Service have no technical/professional job descriptions aside that of management which largely otherwise continues to define them. Management is inherently not entirely professional/technical as it essentially constitutes a responsibility that other cadre of varied professional backgrounds with recognized organizational and coordination skills can perform. The possible risk of inadvertent human resource underutilization should be averted through development of specific professional job descriptions for all public health practitioners of varying backgrounds in the health service.

OTOACOUSTIC EMISSION HEARING SCREENING OF NEWBORNS IN KORLE-BU TEACHING HOSPITAL, GHANA.

Key Words: Neonatal Intensive Care Unit, External Auditory canal, Otoacoustic Emissions, Caesarean Section, Ear, Nose and Throat

Objectives: The aim of the study was to determine outcomes of new-born hearing screening and identify possible causes of hearing loss in NICU Admissions.

Method: The research is a cross sectional study of new born screening conducted on all consenting consecutive new- born who are healthy and seen at the post-delivery ward, and NICU outpatient department of KBTH.
Associations or differences in variables were examined using chi-squared test. P-value ≤0.05 was considered statistically significant.

Methods: This was a cross-sectional study which was conducted on 97 consenting patients with clinical diagnosis of repaired cleft palate at the Plastic and Reconstructive surgery unit, Korle Bu Teaching Hospital. The hearing loss threshold levels in the right and left cleft palates were then compared using Chisquare test of independence.

Results: A total of 483 babies were screened during the period. The incidence of hearing loss in the new-born was 7.2%. More than half of the new-born were 4 weeks or less weeks (n=254, 52.6%) and the rest were greater than 4 weeks (n=229, 47.4%). The mean age (±SD) of the new-born are 3.94 (±2.09) and 3.80 (±2.16) weeks in the admitted and not admitted group respectively. It was revealed that 27% of the babies were admitted at
Neonatal Intensive Care Unit (NICU) because of prematurity and Macrosomia (from diabetic mothers) respectively. Among the babies that were admitted, 7 failed the OAE and 101 passed. In the not admitted
group, 28 failed OAE test and the rest passed (n=347). This study revealed that, there was no statistically significant association of hearing loss between babies admitted to NICU and Non-NICU babies (p= 0.728).

Conclusions: The incidence of hearing loss among the new-born was 7.2% and the main reason for NICU admission are prematurity, big baby, Birth asphyxia, neonatal jaundice, neonatal sepsis, small baby and vacuum delivery. There is no statistically significant association between these different group babies with hearing loss.

NEONATAL MORBIDITY AND MORTALITY IN BINGHAM UNIVERSITY TEACHING HOSPITAL JOS, PLATEAU, NORTH-CENTRAL NIGERIA

Key Words: morbidity, mortality, neonate, Jos, Nigeria.

Background: Neonatal mortality rate (NMR) remains high in Nigeria. There is the need to know the major causes of neonatal morbidity and mortality, so as to reduce the trend.

Aim: To determine the causes of neonatal morbidity and mortality in the neonatology unit of Bingham University teaching Hospital (BHUTH), Jos.

Method: This is a retrospective, analytical descriptive hospital-based study carried out in the special care baby unit of BHUTH from January- December 2018.

Results: A total of 324 neonates were enrolled in the study. The ratio of male (189) to female (135) neonates was 1:0.7. There were more babies in the out born (168) than inborn (156). Major causes of morbidity were
prematurity (29.3%), Neonatal jaundice (NNJ), (21.9%), Neonatal sepsis (NS), (12.3%), birth asphyxia (BA), (11.4%) and NNS+NNJ (9.9%). The three main causes of mortality were prematurity (59.1%), severe birth asphyxia (SBA) (27.3%) and NS (13.6%). The difference in mortality due to prematurity was
statistically significant between the inborn and out born, (χ2 =9.08, p=0.001), but that due to severe birth asphyxia was not statistically significant (χ2 =1.44, p=0.230). Case fatality rate for severe birth asphyxia
(SBA) was 32.4%, prematurity 27.4%, and NS 15.0%. Out of 324, 259 (80%) were discharged, 44 (14%) died, 17 (5%) were discharged against medical advice (DAMA) and 4 (1%) were referred.

Conclusion: Prematurity, NNJ and NS were the leading causes of morbidity, while SBA, prematurity and NS were the main causes of mortality in this study.

MID-GESTATIONAL SERUM LEPTIN CONCENTRATION IN OBESE AND NONOBESE GHANAIAN MOTHERS AND ITS RELATIONSHIP WITH GESTATIONAL OUTCOME.

Key Words: Body Mass Index, Leptin, Mid-gestation, Parturition

Background: Leptin is produced abundantly in adipose tissue and in human placental trophoblast so serum leptin concentration in BMI matched pregnant women is higher than non-pregnant women. The aim of the study was to compare serum leptin concentration of obese and non-obese pregnant Ghanaian women and to match it with pregnancy outcome.

Method: This was a nested case control study, for which 80 antenatal women grouped into obese (cases) and nonobese (control) based on their booking body mass index (non-obese≤29.9kg/m2<obese). the=”” participants=”” had=”” their=”” mid=”” gestation=”” (20-24=”” weeks)=”” serum=”” stored=”” until=”” delivery=”” and=”” leptin=”” concentration=”” of=”” first=”” 20=”” cases=”” controls=”” who=”” delivered=”” at=”” study=”” site=”” were=”” compared=”” to=”” examine=”” if=”” it=”” effect=”” on=”” gestational=”” outcome.=”” correlation=”” between=”” concentration,=”” age=”” birth=”” weight=”” assessed=”” using=”” spearman’s=”” coefficient.<=”” p=””></obese).>

Results: The ages, median (range) 31(20-39) of cases and controls 32 (17-40) were not significantly different. There was no significant difference between the serum leptin concentration of cases 1.9 (0.5-50) ng/ml and
controls 1.9 (1.5-50) ng/ml (P>0.05) and these had no correlation with maternal BMI or with baby’s Apgar scores. Our study subsequently, found no correlation between maternal mid-gestational leptin concentration
and gestational age at delivery, as well as with birth weight of neonates.

Conclusion: Mid-gestational leptin concentration did not correlate with BMI in pregnant Ghanaian women and our study failed to find correlation between midgestational leptin concentration and gestational age at delivery.

PREFERENCE AND REASONS FOR PEOPLE CHOOSING A PLACE OF FRACTURE CARE: A CASE STUDY IN SIX COMMUNITIES OF ASSIN NORTH DISTRICT, GHANA

Key Words: Preference, traditional bone setting, Orthodox, place of fracture care, Assin North District

Background: Studies in the African Sub-region have highlighted injuries and its associated morbidity and mortality as an emerging public health problem, making it necessary to develop a holistic approach to handle
injury outcomes in Ghana. The study purposed to assess the preference and reasons for people choosing a place of fracture care among the general population in the Assin North District of the Central region of Ghana.

Method: A prospective cross-sectional study was employed in which 237 participants were randomly selected from six communities in the Assin North District of the Central Region. Structured questionnaires after verbal informed-consent were used to collect data. The data collected was analyzed using descriptive statistics and chi-square test.

Results: A total of 237 participants were interviewed, 14.8% of them had a history of fracture for which 60% sought treatment with Traditional Bone Setters (TBS). About 27.8% of respondents preferred TBS treatment over orthodox fracture care. Most of them (69.6%) were females with more than half (56.1%) being young adults. Only gender (p=0.029) and religion (p=0.043) were associated with the study group’s preference of fracture care. Common reasons for choosing a particular place of fracture care included “perceived” healing methods (77.6%), past experience (20.7%), time to fracture healing (11.8%), and cost of treatment (9.3%). Generally, fear of complications such as mal-union (60.8%), stiff knee (62.1%), delayed union (69.6%), amputation (63.3%), and infection (76%) were some of
the reasons why participants chose hospital care over TBS.

Conclusion: People make decisions about where to seek fracture treatment (either at a hospital or with a traditional bonesetter) influenced by cost of treatment and knowledge of complications that may result from poorly handled fracture-care. The study showed the need to improve knowledge about the potential benefits of orthodox fracture-care using scientifically tested and reproducible methods which have been shown to consistently improve outcomes.

EPIDEMIOLOGY AND PATTERN OF ORTHOPAEDIC TRAUMA IN PATIENTS ADMITTED TO THE SURGICAL WARD OF A REGIONAL HOSPITAL

Key Words: Epidemiology, Pattern, Trauma, Admission

Background: Orthopaedic trauma related injuries have not been extensively studied in Sub-Saharan Africa. Increase in industrialization and motorization in these countries have seen a corresponding increase in injuries. The causes of these injuries may vary slightly from one
geographic region to another. Knowing the circumstances under which these injuries occur affords policy makers the opportunity to put in place the necessary preventive measures

Objectives: To describe the epidemiological characteristics and cause of orthopaedic related trauma injuries in patients admitted to the surgical ward of Greater Accra Regional Hospital

Methods: Patients admitted to the surgical ward with orthopaedic trauma related injuries between May 2016 and October 2017 were retrospectively reviewed

Results: A total of 253 trauma related injuries were admitted to the surgical ward with an average age of 45.2 years and a male to female ratio of 2.3:1. Road Traffic Accidents (RTA) accounted for 49.2% of all trauma related admissions, with motorcycle related accidents accounting for 52.8% of all RTAs. The second most frequent cause of trauma related admission was
falls, representing 29.9 %. Two hundred and thirteen patients (84.2%) were admitted with fractures. Seventyeight percent of the patients with fractures were managed operatively. The overall in-ward crude mortality was 1.98%

Conclusions: The findings from this study points to the fact that RTAs, (especially motorcycle related injuries) and falls, account for the majority of trauma related admissions. Fractures account for the majority of injuries sustained, with a significant proportion being managed operatively.

REVIEW OF ONE YEAR MORTALITY PATTERNS AT THE ACCIDENT AND EMERGENCY OF A TEACHING HOSPITAL IN NORTHERN GHANA

Key Words: Mortality, Death, Cerebrovascular accident (CVA)

Background: The burden of disease in every geographical area is reflected by the diseases patients present to hospital with and die from. Many deaths in hospitals occur in the emergency department. We sought to describe the mortality rate, patterns, and causes of death in the Accident and Emergency (A&E) Department of Tamale Teaching Hospital.

Methods: This was a retrospective review of deaths that occurred in the Accident and Emergency Department from January to December 2016. Information was gathered from death registers, folders, nurses’ notes, and
admission and discharge books.

Results: In 2016, 7,369 patients visited the A&E and 215 died, with a mortality rate of 2.9%. The age range of patients who died was 3-93 years. Most deaths (121,50.2%) occurred in patients aged 50 years and above.
Over 60% of the deaths occurred in the first 24 hours. Most (69%) deaths were due to a medical cause. The leading individual causes were: sepsis (17%), trauma (16%), cerebrovascular accident (12%), and pneumonia
(9%). The peak age group of medical deaths was 70-79 (eighth decade) years and peak age of surgical deaths was 30-39 years. Most patients (77%) died in the absence of an emergency physician.

Conclusion: The mortality of 2.9% can be reduced. The first 24 hours in the emergency is crucial since most of our patients died in this period and in the absence of an emergency physician on duty. In addition to increasing
the equipment and supplies in the emergency department, increasing the number and availability of emergency physicians and improvement in records keeping will have an important role.

LIVE UNILATERAL MONOCHORIONIC DIAMNIOTIC TWIN ECTOPIC GESTATIONS AT THE LEKMA HOSPITAL, TESHIE. ACCRA, GHANA – A CASE REPORT

Key Words: Live, Monochorionic Diamniotic, Transabdominal Ultrasound, Twin Ectopic, Ghana.

Live unilateral twin ectopic gestations are a rare ultrasound finding with only 12 previous cases documented, none in Africa. This 13th case highlights a 30 year old primigravida who presented with abdominal
pain. Transabdominal ultrasound found live right adnexal monochorionic diamniotic twin ectopic gestations and 200 mls of free fluid in the pouch of
Douglas. Laparotomy showed two gestational sacs within the right fimbria and a right Salpingectomy was performed with good maternal outcome.
This case is different from most previous cases in having previous appendectomy as a risk factor and also for its use of transabdominal ultrasound. During transabdominal ultrasound, Sonologists must carefully
evaluate any surgical scars and other risk factors, as these may raise the index of suspicion and lead to a prompt diagnosis of live unilateral monochorionic diamniotic twin ectopic gestations.

MULTIDISCIPLINARY TEAMWORK IN THE MANAGEMENT OF ADVANCED ABDOMINAL PREGNANCY- A CASE REPORT

Key Words: Advanced Abdominal Pregnancy, Placenta, Multidisciplinary management.

Introduction: Abdominal pregnancies are rare; often being misdiagnosed or completely missed till surgery is done. This presents a challenge in the diagnosis and management of the condition, especially in a resource constrained setting. A high index of suspicion is therefore required for prompt diagnosis. The objective in this report is to increase the awareness of the need for early diagnosis of abdominal pregnancy and the need for
multidisciplinary planning and care for optimum management.

Case Report and Interventions: A 34-year-old gravida 4 parity 2+1, presented at 41 weeks with a two-month history of abdominal pain.
Thorough examination and ultrasound revealed an advanced abdominal pregnancy. At laparotomy an abdominal pregnancy with placenta
attached to the omentum was noted. A live male infant was delivered with a birthweight of 3.4 kg with an APGAR score of 4 and 6 at 1 and 5 minutes respectively. The baby had a respiratory arrest a few hours after the
delivery. Attempted resuscitation in the SCBU unit was unsuccessful. Mother was discharged three days later with no post-op complications.

Conclusion: The occurrence of abdominal pregnancy seems to be a gradually increasing phenomenon. It is therefore imperative for clinicians to have a high index of suspicion to reduce maternal as well as perinatal
morbidity and mortality associated with the condition.

CAESAREAN SCAR PREGNANCY: A MATERNAL NEAR- MISS IN THE SANDEMA DISTRICT HOSPITAL, GHANA.

Key Words: Caesarean scar, ectopic pregnancy, ruptured ectopic, threatened abortion, near-miss

Introduction: An ectopic pregnancy located in a caesarean scar could have more catastrophic sequelae due to abnormal placentation and early invasion of the myometrium. It has a high possibility of Placenta previa
and antenatal uterine rupture as the pregnancy progresses with gestational age. It is very high risk for severe maternal morbidity and associated high maternal mortality.

The case: We presented a case reporting a few weeks after missing her period to the Sandema District Hospital with bleeding per vaginum and a positive urine pregnancy test. The initial diagnosis was a threatened
miscarriage with a differential of possible cervicoisthmic pregnancy after ultrasound scan was done. She was managed conservatively as a case of
threatened miscarriage to be reviewed weekly but she defaulted to review and presented four months later with hemodynamic instability after she collapsed at home at 18 weeks gestation. Laparotomy with wedge resection
and reconstruction of the previous caesarean section scar was done on account of ruptured uterus and placenta percreta at 18 weeks.

Conclusion: In patients with previous caesarean scar, caesarean ectopic pregnancy should also be suspected when managing them for threatened abortions even in primary care facilities of low income countries.