Burden of Neonatal Surgical Conditions in Northern Ghana.
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ABSTRACT:
SUBMITTER: Abdul-Mumin A
PROVIDER: S-EPMC6925064 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
Publications
Burden of Neonatal Surgical Conditions in Northern Ghana.
Abdul-Mumin Alhassan A Anyomih Theophilus T K TTK Owusu Sheila A SA Wright Naomi N Decker Janae J Niemeier Kelli K Benavidez Gabriel G Abantanga Francis A FA Smith Emily R ER Tabiri Stephen S
World journal of surgery 20200101 1
<h4>Background</h4>Congenital anomalies have risen to become the fifth leading cause of under-five mortality globally. The majority of deaths and disability occur in low- and middle-income countries including Ghana. This 3-year retrospective review aimed to define, for the first time, the characteristics and outcomes of neonatal surgical conditions in northern Ghana.<h4>Methods</h4>A retrospective study was conducted to include all admissions to the Tamale Teaching Hospital (TTH) neonatal intens ...[more]
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Project description:ObjectiveTo estimate the surgical burden of malignant disease in the Eastern Region of Ghana.DesignDescriptive cross-sectional study.SettingRegional hospital in the eastern region of Ghana.ParticipantsPatients treated by the surgery department at Eastern Regional Hospital in Koforidua, Ghana.InterventionsNone.Primary and secondary outcome measuresPrimary outcome was incidence of malignancy and secondary outcome descriptive differences between patients who had a benign indication for surgery compared with those with a malignant indication for surgery.ResultsA total of 1943 inpatient surgical procedures were performed from 2015 to 2017 with 13.4% (261) of all procedures ultimately performed for malignancy. Of all breast procedures performed, 95.2% of procedures resulted in a malignant diagnosis. The remaining subtypes of procedures had rates ranging from <1% to 41.2% of procedures performed for malignant disease. Additionally, this study found over 13% of patients admitted to the surgical service for breast cancer ultimately did not undergo a surgical procedure.ConclusionThis is the first study investigating the burden of malignant disease in the Eastern Region of Ghana. We found a substantial prevalence of malignant disease in the surgical population in this region. This information can be used to aid in future medical resource planning in this region.
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Project description:BackgroundMoral distress has been studied widely in nursing but not in developing economies.AimTo investigate how moral distress is experienced by nurses working in neonatal intensive care and paediatric wards in Northern Ghana and to determine support measures offered by nurse managers.MethodQualitative descriptive method. Forty nurses and fourteen nurse managers working with children in four hospitals in Northern Ghana were interviewed. Thematic data analysis was carried out.ResultsSix themes were identified: nurses experience morally distressing situations due to a variety of causes; the impact of morally distressing situations on nurses; coping mechanisms of nurses who experienced morally distressing situations; recommendations made by the nurses to reduce the incidence of moral distress; inadequate support measures available to nurse managers and nurse managers experience moral distress too.ConclusionThe causes of moral distress in developed and developing economies are similar. The frequency and intensity of moral distress is high in Northern Ghana. Consistent with other studies conducted in Africa, nurses and nurse managers relied on their religious faith as a form of resilience. No support measures are available to nurse managers to support nurses who experience moral distress.
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Project description:Dyslipidaemia is a primary risk factor for cardiometabolic disease, causing over 17 million deaths globally in 2015. However, the burden of dyslipidaemia and factors associated with lipid levels remain unknown in many rural African populations. Therefore, this study evaluated the association of socio-demographic, anthropometric and behavioural factors with lipid levels in rural Ghana. The prevalence of hypercholesterolaemia, hypertriglyceridaemia and elevated LDL-C in the total population of 1839 (846 men and 993 women) was 4.02%, 2.12%, and 5.55% respectively and did not differ between genders. The prevalence of low HDL-C levels was 60.30% and differed (p = 0.005) between men (56.86%) and women (63.24%). Subcutaneous abdominal fat was associated with TC (? = 0.067, p = 0.015) and TG (? = 0.137, p<0.001) among women and LDL-C (? = 0.139, p = 0.006) and TC (? = 0.071, p = 0.048) among men. Body mass index was associated with TC (? = 0.010, p = 0.043) among men while waist circumference was associated with LDL-C (? = 0.116, p<0.001) and TG (? = 0.094, p<0.001) among women. Hip circumference was negatively associated (? = -0.053, p = 0.043) while visceral fat was positively associated with TG (? = 0.033, p = 0.022) among women. Socioeconomic status, education, being unmarried and employment were associated with HDL-C (? = 0.081, p = 0.004), LDL-C (? = 0.095, p = 0.004) and TG (? = 0.095, p = 0.001) all among women, and TC (? = 0.070, p = 0.010) among men, respectively. Nankana women had lower TC (? = -0.069, p = 0.001), and men lower TG levels (? = -0.084, p = 0.008) than the other ethnic groups. Tobacco smoking (? = 0.066, p = 0.024) and alcohol intake (? = 0.084, p = 0.001) were associated with HDL-C levels among men and women respectively. Further studies are required to investigate whether high prevalence of low HDL-C levels in this population presents with any adverse cardiovascular disease outcomes. Associations of education, employment and adiposity with lipid levels suggest that future societal advances and increases in the prevalence of obesity may lead to associated adverse health consequences. Monitoring and interventions are required to limit these effects.
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Project description:ObjectivesWeight at birth is usually considered as an indicator of the health status of a given society. As a result this study was designed to investigate the association between birth weight and maternal factors such as gestational weight gain, pre-pregnancy BMI and socio-economic status in Northern Ghana.MethodsThe study was a facility-based cross-sectional survey conducted in two districts in the Northern region of Ghana. These districts were purposively sampled to represent a mix of urban, peri-urban and rural population. The current study included 419 mother-infant pairs who delivered at term (37-42 weeks). Mother's height, pre-pregnancy weight and weight changes were generated from the antenatal records. Questionnaires were administered to establish socio-economic and demographic information of respondents. Maternal factors associated with birth weight were examined using multiple and univariate regressions.ResultsThe mothers were generally well nourished before conception (Underweight 3.82%, Normal 57.76%, Overweight 25.06% and Obesity 13.37%) but approximately half of them could not gain adequate weight according to Institute of Medicine recommendations (Low weight gain 49.64%, Adequate weight gain 42.96% and Excessive weight gain 7.40%). Infants whose mothers had excess weight gain were 431g (95% CI 18-444) heavier compared to those whose mothers gained normal weight, while those whose mothers gained less were 479g (95% CI -682- (-276) lighter. Infants of mothers who were overweight and obese before conception were 246g (95% CI 87-405) and 595g (95% CI 375-815) respectively heavier than those of normal mothers, whereas those whose mothers were underweight were 305g (95% CI -565 -(-44) lighter. The mean birth weight observed was 2.98 ± 0.68 kg.ConclusionOur findings show that pre-pregnancy body mass index and weight gain during pregnancy influence birth weight. Therefore, emphasis should be placed on counseling and assisting pregnant women to stay within the recommended weight gain ranges.
| S-EPMC4539219 | biostudies-literature
Project description:BackgroundGhana did not meet the Millennium Development Goal 4 of reducing child mortality by two-thirds and may not meet SDG (2030). There is a need to direct scarce resources to mitigate the impact of the most important risk factors influencing high neonatal deaths. This study applied both spatial and non-spatial regression models to explore the differential impact of environmental, maternal, and child associated risk factors on neonatal deaths in Ghana.MethodsThe study relied on data from the Ghana Demographic and Health Surveys (GDHS) and the Ghana Maternal Health Survey (GMHS) conducted between 1998 and 2017 among 49,908 women of reproductive age and 31,367 children under five (GDHS-1998 = 3298, GDHS-2003 = 3844, GDHS-2008 = 2992, GDHS-2014 = 5884, GMHS-2017 = 15,349). Spatial Autoregressive Models that account for spatial autocorrelation in the data at the cluster-level and non-spatial statistical models with appropriate sampling weight adjustment were used to study factors associated with neonatal deaths, and a p-value less than 0.05 was considered statistically significant.ResultsPopulation density, multiple births, smaller household sizes, high parity, and low birth weight significantly increased the risk of neonatal deaths over the years. Among mothers who had multiple births, the risk of having neonatal deaths was approximately four times as high as the risk of neonatal deaths among mothers who had only single birth [aRR = 3.42, 95% CI: 1.63-7.17, p < 0.05]. Neonates who were perceived by their mothers to be small were at a higher risk of neonatal death compared to very large neonates [aRR = 2.08, 95% CI: 1.19-3.63, p < 0.05]. A unit increase in the number of children born to a woman of reproductive age was associated with a 49% increased risk in neonatal deaths [aRR = 1.49, 95% CI: 1.30-1.69, p < 0.05].ConclusionNeonatal mortality in Ghana remains relatively high, and the factors that predisposed children to neonatal death were birth size that were perceived to be small, low birth weight, higher parity, and multiple births. Improving pregnant women's nutritional patterns and providing special support to women who have multiple deliveries will reduce neonatal mortality in Ghana.
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Project description:IntroductionIdentifying high risk geographical clusters for neonatal mortality is important for guiding policy and targeted interventions. However, limited studies have been conducted in Ghana to identify such clusters.ObjectiveThis study aimed to identify high-risk clusters for all-cause and cause-specific neonatal mortality in the Kintampo Districts.Materials and methodsSecondary data, comprising of 30,132 singleton neonates between January 2005 and December 2014, from the Kintampo Health and Demographic Surveillance System (KHDSS) database were used. Verbal autopsies were used to determine probable causes of neonatal deaths. Purely spatial analysis was ran to scan for high-risk clusters using Poisson and Bernoulli models for all-cause and cause-specific neonatal mortality in the Kintampo Districts respectively with village as the unit of analysis.ResultsThe study revealed significantly high risk of village-clusters for neonatal deaths due to asphyxia (RR = 1.98, p = 0.012) and prematurity (RR = 5.47, p = 0.025) in the southern part of Kintampo Districts. Clusters (emerging clusters) which have the potential to be significant in future, for all-cause neonatal mortality was also identified in the south-western part of the Kintampo Districts.ConclusionsStudy findings showed cause-specific neonatal mortality clustering in the southern part of the Kintampo Districts. Emerging cluster was also identified for all-cause neonatal mortality. More attention is needed on prematurity and asphyxia in the identified cause-specific neonatal mortality clusters. The emerging cluster for all-cause neonatal mortality also needs more attention to forestall any formation of significant mortality cluster in the future. Further research is also required to understand the high concentration of prematurity and asphyxiated deaths in the identified clusters.
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Project description:OBJECTIVE:To examine the association between early Bacille Calmette-Guerin (BCG) vaccination and neonatal mortality in northern Ghana. METHODS:This ecological study used vaccination and mortality data from the Navrongo Health and Demographic Surveillance System. First, we assessed and compared changes in neonatal mortality rates (NMRs) and median BCG vaccination age from 1996 to 2012. Second, we compared the changes in NMR and median BCG vaccination age from 2002 to 2012 by delivery place when data on delivery place were available. RESULTS:Neonatal mortality rates declined from 46 to 12 per 1000 live births between 1996 and 2012 (trend test: p<0.001). Within the same period, median BCG vaccination age declined from 46 to 4 days (trend test: p<0.001). Among home deliveries, BCG vaccination age declined from 39 days in 2002 to 7 days in 2012 (trend test: p<0.001) and neonatal mortality declined by 24/1000 (trend test: p<0.001). Among health facility deliveries, BCG vaccination age was stable around 3 days from 2002 to 2012 (trend test: p=0.49) and neonatal mortality declined by 9/1000 (trend test: p=0.04). In a small study of children whose vaccination cards were inspected within the first 28 days of life, the HR for BCG-vaccinated compared with BCG-unvaccinated children was 0.55 (95% CI 0.12 to 2.40). CONCLUSION:The data support the hypothesis that early BCG vaccination may be associated with a decrease in neonatal mortality. However, as suggested by WHO, randomised control trials are required to address the question of whether there is indeed a causal association between early BCG vaccination and neonatal mortality.
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Project description:A comprehensive chemical quality assessment of groundwater resources in the Talensi District has been conducted using conventional graphical methods and multivariate statistical techniques. The study sought to determine the main controls of groundwater chemistry and its suitability for domestic and irrigation purposes in the district. Silicate and carbonate mineral weathering were identified as the main controls on groundwater chemistry in the district, with reverse ion exchange also playing a role. High nitrate and lead levels observed have been associated with agrochemicals and wastewater from farms and homes. Three main flow regimes have been identified with Q-mode cluster analysis, in which mixed cation water types have been revealed, where areas designated as recharge zones are dominated by Na+?+?K+-Mg2+-HCO3 - fresh water types characterised by low mineralisation and pH, which evolve into Mg2+- Na+?+?K+- HCO3 - fresh water type with corresponding increased mineralisation of the groundwater. Based on the water quality index (WQI) technique modified for the district and an interpolation technique using ordinary kriging developed from a well-fitted exponential semivariogram for the estimated WQIs, the groundwater quality has been spatially classified as generally 'good' to 'excellent' for domestic purposes. Generally, the quality of groundwater for domestic usage deteriorates as one moves towards the north of the district, whereas waters in the east and west present the best quality. Classifications based on the United States Salinity Laboratory (USSL), Wilcox, and Doneen diagrams suggest that groundwater from the unconfined aquifers of the district is of excellent quality for irrigation purposes.
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Project description:IntroductionInguinal hernia repair is a common procedure and a priority for public health efforts in Ghana. It is essential that inguinal hernia repair be performed in a safe, efficient manner to justify its widespread use. Local anesthesia has many favorable properties and has been shown to be superior, compared to regional or general anesthesia, in terms of pain control, safety profile, cost-effectiveness, resources required, and time to discharge. Local anesthesia is recommended for open repair of reducible hernias, provided clinician experience, by multiple international guidelines. Regional anesthesia is associated with myocardial infarction and other complications, and its use is discouraged by multiple guidelines, especially in older patients. This study aims to assess the current state of anesthesia for inguinal hernia repair in the northern and transitional zone of Ghana. In addition we will assess the perceptions of different types of anesthesia along with understanding of evidence-based guidelines among clinicians participating in inguinal hernia repair.MethodsWe performed a retrospective review of all inguinal hernia repairs for male patients, 18 and older, in over 90% of hospitals in northern Ghana. All 41 hospitals were visited and caselogs and patient charts were manually reviewed to extract data. Multivariate logistic regression was used to determine predictors of local anesthesia use. We designed a survey instrument to assess the perceptions of physicians and anesthetists regarding different types of anesthesia for inguinal hernia repair. The survey was designed by a Ghanaian surgeon, reviewed by all co-authors, and tested prior to implementation using a sample (n = 8) of clinicians having similar practices to those of the survey population. Of 70 clinicians, 66 responded, yielding a response rate of 94%.Results8080 patients underwent hernia repair of which 37% were performed under local anesthesia, while the majority, 60%, were performed under regional anesthesia. Negative predictors of local anesthesia were emergent repair (OR = 0.258, p < 0.001), surgery performed at a teaching hospital (OR = 0.105, p < 0.001), and bilateral hernia repair (OR = 0.374, p < 0.001). 1,839 (22.8%) of IH repairs were done on patients age 65 or older and RA was most frequently used among the elderly population (57.8%), while local anesthesia was used 39.5% of the time. Sixty-six clinicians participated in the survey with the majority reporting that local anesthesia requires fewer staff, less equipment, has a shorter recovery, is more cost-effective, and might be safer for patients. However 66% were unfamiliar with or incorrectly perceived international guidelines.ConclusionTo our knowledge, this study is the largest assessment of anesthesia use for inguinal hernia repair in an LMIC. Although the selection of anesthetic technique should be guided by a patient's general health, the anatomy of the hernia, and clinician judgment, local anesthesia appears to be underutilized in northern Ghana. Survey responses demonstrate high rates of unfamiliarity or incorrectly perceived evidence-based guidelines. Future research should assess how education on the benefits and technique of local anesthesia administration may further increase rates for inguinal hernia repair, especially for older patients.
| S-EPMC6248905 | biostudies-literature
Project description:BackgroundBuruli ulcer disease (BUD) results in disabilities and deformities in the absence of early medical intervention. The extensive role of caregiving in BUD is widely acknowledged, however, associated caregiver burden is poorly understood. In this paper we assessed the burden which caregivers experience when supporting patients with BUD in Ghana.Method/ principal findingsThis qualitative study was conducted in 3 districts in Ghana between August and October 2019. 13 semi-structured interviews were conducted on caregivers of BUD patients in the local language of Twi. Data was translated into English, coded into broad themes, and direct content analysis approach was used to analyse results. The results show the caregivers face financial, psychological and health issues as a consequence of their caregiving role.Conclusion/ significanceThis study found significant caregiver burden on family members. It also highlighted the psychological burden caregivers experience and the limited knowledge of the disease within endemic communities. Further research is needed to quantify the caregiver burden of BUD at different economic levels in order to better understand the impact of possible caregiver interventions on patient outcomes.
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