https://www.ajol.info/index.php/gmj/issue/feed Ghana Medical Journal 2021-10-21T11:39:37+00:00 Prof David Ofori-Adjei gmj@dslghana.com Open Journal Systems <p><em>The Ghana Medical Journal</em> is a peer-reviewed, open access journal published by the Ghana Medical Association. It was established in 1962 It publishes quality manuscripts in in all aspects of health, health care and the medical sciences. The full text of published articles are available online at this website and at African Journals Online ( AJOL) and PubMed Central ( PMC).</p><p>The Ghana Medical Journal is indexed in Medline, African Journals Online (AJOL), African Index Medicus, Scopus, EBSCO</p><p>Other websites related to this journal: <a title="http://www.ghanamedj.org/" href="http://www.ghanamedj.org/" target="_blank">http://www.ghanamedj.org/</a></p> https://www.ajol.info/index.php/gmj/article/view/215483 Anxiety, depression, and stress in caregivers of children and adolescents with mental disorders in Ghana and implications for medication adherence 2021-10-04T14:33:03+00:00 Patience M.E. Ocansey ikretchy@ug.edu.gh Irene A. Kretchy ikretchy@ug.edu.gh Genevieve C. Aryeetey ikretchy@ug.edu.gh Kofi Agyabeng ikretchy@ug.edu.gh Justice Nonvignon ikretchy@ug.edu.gh <p><strong>Objective</strong>: This study assessed levels of anxiety, depression, and stress among family caregivers of children and adolescents with mental disorders in Ghana and the implication on medication adherence.<br><strong>Design</strong>: A cross-sectional study.<br><strong>Setting</strong>: The study was conducted at the outpatient departments of the three main public psychiatric hospitals in Ghana.<br><strong>Participants</strong>: Two hundred and ten non-paid family caregivers of children and adolescents with mental disorders were recruited for this study.<br><strong>Main Outcome Measure</strong>: The study assessed symptoms of anxiety, depression and stress among the caregivers and estimated caregiver-reported medication adherence.<br><strong>Results</strong>: About 56.2%, 66.2% and 78% of the caregivers experienced severe anxiety, severe depression and moderate to severe stress symptoms respectively. From the multiple logistic regression model, while anxiety was significantly affected by religion and education, depression was influenced by sex, age, marital status, proximity to facility, and employment status. Female caregivers had about four times higher odds of being depressed compared to male caregivers<br>(aOR: 3.81, 95% CI: 1.66 - 8.75). The caregiver-reported medication adherence was 11.9%. Anxiety was significantly predictive of medication adherence.<br><strong>Conclusion</strong>: Most family caregivers of children and adolescents with mental disorders experienced symptoms of anxiety, depression and stress with anxiety having implications for medication adherence. The study findings underscore the need to consider psychological characteristics of caregivers and the provision of mental health support for them, as part of the routine health care for children and adolescents with mental disorders.</p> 2021-09-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/gmj/article/view/215486 Association between serum chlamydial antibody levels and tubal infertility in tertiary health facility in South-East Nigeria: a case-control study 2021-10-04T14:54:14+00:00 Augustine D. Onyeabochukwu izuksman@yahoo.com Emmanuel O. Izuka izuksman@yahoo.com Onyema A. Onyegbule izuksman@yahoo.com Chiemeka C. Onumajuru izuksman@yahoo.com Uchenna T. Ejelonu izuksman@yahoo.com Chukwunonyerem P. Duke-Onyeabo izuksman@yahoo.com Chinelo E. Obiora-Izuka izuksman@yahoo.com Uchenna I. Nwagha izuksman@yahoo.com <p><strong>Objectives</strong>: This study evaluates the association between genital Chlamydial infection and tubal factor infertility in a tertiary health facility in South-East Nigeria.<br><strong>Design</strong>: This was a case-control analytical study.<br><strong>Setting</strong>: Gynaecology Clinic and Maternity Unit of the Department of Obstetrics and Gynaecology of the Federal Medical Centre (FMC), Owerri, Imo State, Nigeria.<br><strong>Participants</strong>: Ninety-six (96) women with confirmed tubal factor infertility served as the cases, and 96 women with normal intra-uterine pregnancy matched in age served as the control.<br><strong>Data Collection/Intervention</strong>: A structured questionnaire was used to extract information on the sociodemographic data and the sexual history of the participants. About 2mls of blood was collected, the blood was allowed to clot, and the sera were used for the test.<br><strong>Statistical analysis/Main outcome measure</strong>: Pearson Chi-square, Fisher’s exact test, likelihood ratio and multivariate logistic regression were used to determine risk associations and identify factors independently related to tubal factor infertility. P-value &lt; 0.05 was considered significant.<br><strong>Results</strong>: The sociodemographic characteristics of both cases and control did not differ (P = 0.975). The Chlamydial antibody seropositivity was significantly higher in the cases than the control 78(81.2%) versus 13(13.5%) respectively {(P &lt; 0.001; OR (95% CI) = 27.7(12.7-60.2)}. Only lower abdominal pain {(P = 0.011); OR (95% CI) = 4.3(1.4-13.3)}; was independently associated with tubal factor infertility.<br><strong>Conclusion</strong>: Tubal factor infertility is strongly associated with chlamydial IgG antibodies, and a history of lower abdominal pain significantly predicted tubal factor infertility.</p> 2021-09-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/gmj/article/view/215490 Breast cancer treatment and outcomes at Cape Coast Teaching Hospital, Ghana 2021-10-04T15:23:26+00:00 Fejiro O. Okifo d.anamaale@uccsms.edu.gh Derek A. Tuoyire d.anamaale@uccsms.edu.gh Anthony B. Appiah d.anamaale@uccsms.edu.gh Samue Y. Debrah d.anamaale@uccsms.edu.gh Martin T. Morna d.anamaale@uccsms.edu.gh Rosemary B. Duda d.anamaale@uccsms.edu.gh <p><strong>Objectives</strong>: This study sought to determine the presentation, treatment and outcomes of breast cancer among women in Cape Coast, Ghana.<br><strong>Design</strong>: Retrospective medical record review<br><strong>Setting</strong>: Cape Coast Teaching Hospital, Cape Coast, Ghana<br><strong>Participants</strong>: Female breast cancer patients<br><strong>Interventions</strong>: None<br><strong>Main outcome measures</strong>: Proportion of female breast cancer patients presenting with advanced disease.<br><strong>Results</strong>: Approximately 84% of women had a primary presentation of breast cancer, with metastatic disease present in 34% of patients. Surgical management mainly involved partial mastectomy (21.7%) and total mastectomy (78.6%), with the most common postoperative complications being surgical site infections (3.8%). Non-surgical management involved chemotherapy, radiation therapy and anti-estrogen therapy, with Stage 3 and 4 patients twofold more likely to receive neoadjuvant chemotherapy than earlier stages (OR= 2.0 95% CI (1.4, 3.0, p&lt;0.001). Grade 1 cancers were diagnosed in 11.0%, Grade 2 in 43.8%, and Grade 3 in 45.2%. The mean cancer size was 6.5 centimetres (range 1.5 to 20.0). Lymphatic vascular invasion was present in 59/125 (47.2%), estrogen receptor status was positive in 32.6%, progesterone receptors were positive in 22.1%, and Her-2/neu was positive in 32.6%. Triple-negative breast cancer was identified in 41/89 (46.1%).<br><strong>Conclusions</strong>: Women with breast cancer typically present to the Cape Coast Teaching Hospital with advanced stage disease and experience poor outcomes.</p> 2021-09-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/gmj/article/view/215491 Community acceptance, satisfaction, and support for case management of malaria of various degrees in selected rural communities in Ibadan, Oyo-State 2021-10-04T16:04:59+00:00 IkeOluwapo O. Ajayi tayoogunwale@yahoo.com Ayodele S. Jegede tayoogunwale@yahoo.com Akintayo O. Ogunwale tayoogunwale@yahoo.com Janet Ogundairo tayoogunwale@yahoo.com Oladipupo S. Olaleye tayoogunwale@yahoo.com Frederick O. Oshiname tayoogunwale@yahoo.com Catherine O. Falade tayoogunwale@yahoo.com <p><strong>Objectives</strong>: This study aimed to assess communities’ perception and adoption of the evidenced-based malaria diagnosis and case management intervention targeted at under-five children. The effectiveness of trained Volunteer Community Health Workers (VCHWs) to diagnose malaria among under-five children using rapid diagnostic testing kit, provide treatment using Artemisinin Combination Therapy and rectal Artesunate were assessed.<br><strong>Design</strong>: A qualitative evaluation study was conducted in October 2015.<br><strong>Setting</strong>: Communities in the 6 rural wards in Ona-Ara Local Government Area, Oyo State Nigeria.<br><strong>Participants</strong>: Caregivers of under-five children, community–based frontline health workers, and community leaders selected using purposively sampling.<br><strong>Methods</strong>: Nine Focus Group Discussions and 15 Key Informant Interviews were conducted using a pre-tested guide. Data were subjected to thematic analysis.<br><strong>Results</strong>: It was disclosed that VCHWs promoted people’s access to prompt and appropriate malaria treatment. The communities accepted the VCHWs; the reasons given for this included the following: effectiveness of VCHWs in case management of malaria; good inter-personal relationship with caregivers; and the positive health outcomes associated with services provided by them. In addition, community members expressed satisfaction with the VCHWs and provided them with all the support needed to function throughout the malaria case management intervention. The VCHWs considered the support as a great source of encouragement.<br><strong>Conclusions</strong>: The use of VCHWs to treat malaria was adjudged to be effective and considered acceptable to the communities. The adoption of the intervention and its integration into the primary health system by the government is advocated for in medically underserved rural communities.</p> 2021-09-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/gmj/article/view/215492 Epidemiological features of brucellosis and factors affecting its treatment failure and relapse in Qom Province, Iran 2021-10-04T16:25:59+00:00 Abolfazl Mohammadbeigi abed.saghafi@yahoo.com Abedin Saghafipour abed.saghafi@yahoo.com Amir Hamta abed.saghafi@yahoo.com Salman Khazaei abed.saghafi@yahoo.com Atefeh Maghsoudi abed.saghafi@yahoo.com Saeed Shams abed.saghafi@yahoo.com <p><strong>Background</strong>: Brucellosis is one of the major health problems in many areas of the world, especially in the Mediterranean and the Middle East regions.<br><strong>Objective</strong>: To determine the epidemiological characteristics, clinical signs, and risk factors of relapse rate in patients with brucellosis, Qom Province, Iran.<br><strong>Methods</strong>: A descriptive-analytic study was conducted on 410 confirmed brucellosis cases in Qom Province, central Iran, from 2015 to 2019, based on epidemiological checklists and according to the Iran Ministry of Health and Medical Education (MOHME). Univariate and multiple logistic regression analyses were conducted using Stata software version 14.<br><strong>Results</strong>: The relapse rate of brucellosis was 6.6% until nine months after s arting the treatment, and all recurrent cases were infected by Brucella melitensis. Based on univariate logistic regression analysis, the delayed treatment and type species of Brucella were significant factors affecting the relapse of brucellosis. The relapse rates were 5.4%, 6.2%, and 20.0% in patients whose delayed treatments were &lt;50, 51-150, and &gt;151days, respectively. Based on the multiple logistic regression, it was observed that delayed treatment &gt;50 days increased the rate of relapse more than four times.<br><strong>Conclusion</strong>: The delayed initiation of treatment was a significant factor influencing the relapse of brucellosis; therefore, it is necessary to provide enough diagnostic and laboratory facilities, and people need to be educated about the signs and symptoms of the disease.</p> 2021-09-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/gmj/article/view/215616 Utility of an orthopaedic trauma registry in Ghana 2021-10-06T18:01:18+00:00 Elissa K. Butler cmock@uw.edu Dominic Konadu-Yeboah cmock@uw.edu Peter Konadu cmock@uw.edu Dominic Awariyah cmock@uw.edu Charles N. Mock cmock@uw.edu <p>In most low- and middle-income countries, trauma registries are uncommon. Although institutional registries for all trauma patients are ideal, it can be more practical to institute departmental registries for specific subsets of patients. Komfo Anokye Teaching Hospital (KATH) has started a locally developed, self-funded orthopaedic trauma registry. We describe methods and experiences for data collection and examine patient and injury characteristics, data quality, and the utility of the registry. Of 961 individuals in the registry, 67.9% were males, and the median age was 40 years. Motor vehicle collision (23.3%) was the most frequent mechanism of injury. Lower extremity fractures were the most common injury (60.6%), and 43.9% of injuries were managed operatively. Data quality was reasonable with missingness under 10% for 13 of 14 key variables, with inconsistencies of dates of injury, admission, treatment, and discharge in 9.1% of cases. However, the type of operation was missing for 73.2% of operative cases. Despite these limitations, the registry has been used for quality improvement and to successfully advocate for resources to improve trauma care. The registry has been improved by adding more detailed outcome variables, creating a standardised<br>codebook of categorical variables, and adding more fields to allow for multiple injuries. In conclusion, it is practical and sustainable to institute a locally developed, self-funded orthopaedic trauma registry in Ghana that provides data with reasonable quality. Such a registry can be used to advocate for more resources to care for injured patients adequately and for quality improvement.</p> 2021-09-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/gmj/article/view/215618 Continuous positive airway pressure in managing acute respiratory distress in children in district hospitals: evidence for scale-up 2021-10-06T18:13:22+00:00 Frank Baiden baidenf@gmail.com Patrick T Wilson baidenf@gmail.com <p>In children, acute respiratory distress (ARD) is a clinical presentation requiring emergency management, including mechanical ventilation. Mechanical ventilators are lacking in sub-Saharan Africa. Continuous Positive Airway Pressure (CPAP) is an alternative form of non-invasive respiratory support that has been used in high-income countries for over four decades. Its use in sub-Saharan Africa is, however, limited and often restricted to neonates. Controlled trials in Ghana have shown that the use of CPAP in children younger aged 1-12 months reduces 2-week all-cause mortality from ARD by 60% (RR 0·40, 0·19–0·82; p=0·01). The absolute reduction in mortality of 4% implies one infant life saved for every 25 children treated with CPAP. This paper reviews the findings of the trials in Ghana and<br>contrasts the findings with those of trials in Bangladesh and Malawi. It makes the case that implementation research (rather than more controlled trials) is now needed to support the routine, safe and effective use of CPAP in managing ARD in older infants in district hospitals in Ghana.</p> 2021-09-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/gmj/article/view/215670 Marbelization of the gallbladder, a variant of acute gangrenous cholecystitis 2021-10-07T14:12:24+00:00 Ismail Burud sherreenelhariri@imu.edu.my Mahadevan D. Tata sherreenelhariri@imu.edu.my Kogaan Selvaraja sherreenelhariri@imu.edu.my Sherreen Y. El Hariri sherreenelhariri@imu.edu.my <p>Cholelithiasis can present from a milder form of biliary colic to a more severe and complicated one like empyema gallbladder and a lesser-known variant of gangrenous gallbladder called marbleization of the gallbladder. The clinical signs and symptoms are similar to acute cholecystitis. Diabetes mellitus could have a role in the process of marbleization. Diagnosing marbleization of the gall bladder is not easy preoperatively. Computerized tomography is a better diagnostic modality when compared to laboratory investigations. Urgent cholecystectomy is the only option, and there is no role of conservative treatment. We report a case of a 36-year-old man with newly diagnosed Diabetes Mellitus diagnosed initially as acute cholecystitis and managed conservatively. He did not respond to treatment and hence underwent cholecystectomy and intraoperatively was found to have marbleization of the gall bladder.</p> 2021-09-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/gmj/article/view/215673 Obstructed right Duari hernia 2021-10-07T14:22:48+00:00 Ugochukwu U Nnadozie, ugodozie@yahoo.ca Otuu Onyeyirichi ugodozie@yahoo.ca Charles C Maduba ugodozie@yahoo.ca Andrew C Ekwesianya ugodozie@yahoo.ca <p>The caecum and appendix are uncommon contents of femoral hernia (Duari hernia). Diagnosis is usually intraoperative. We report a rare case of obstructed right femoral hernia in a 65-year-old woman. She was admitted into the accident and emergency department because of sudden irreducibility of a previously reducible right groin swelling of 5 years duration. She had obstructive symptoms with an irreducible right groin mass clinically diagnosed as obstructed right femoral hernia. A combination of infra-inguinal transverse incision and a lower midline laparotomy incision was used. The intraoperative findings included the herniation of the caecum and appendix into the right femoral canal. Patient had an uneventful recovery. Duari hernia is uncommon. A high index of suspicion and an experienced<br>surgeon, who can handle uncommon findings should be involved in the management of obstructed femoral hernias.</p> 2021-09-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/gmj/article/view/215674 Primary osteosarcoma of the uterus: a report of two cases 2021-10-07T14:43:08+00:00 Kofi Effah jtanim2000@yahoo.com Edem Hiadzi jtanim2000@yahoo.com Anita Osabutey jtanim2000@yahoo.com Alex K. Boateng jtanim2000@yahoo.com Agyeman B. Akosa jtanim2000@yahoo.com Jehoram T. Anim jtanim2000@yahoo.com <p>Primary extraskeletal osteosarcoma is an uncommon disease and has been reported to affect the uterus only rarely. Less than 20 cases have so far been reported in the English literature. The common clinical presentation is heavy bleeding per vaginam, and in virtually all cases, the diagnosis has been made at an advanced stage of the disease. Various authors have recommended adjuvant chemotherapy, but outcomes have so far been uniformly poor, with survival extended by months rather than years. We present two cases of this rare condition, which were diagnosed four months apart within our histopathology laboratory andconfirmed the very late presentation of the disease in one and the poor survival of both patients.</p> 2021-09-30T00:00:00+00:00 Copyright (c) https://www.ajol.info/index.php/gmj/article/view/215677 Solitary neurofibroma of the right lateral wall of the oropharynx 2021-10-07T15:01:50+00:00 Winga Foma adrienfoma@yahoo.fr Pani Awesso adrienfoma@yahoo.fr Essobozou P. Pegbessou adrienfoma@yahoo.fr Bathokedeou Amana adrienfoma@yahoo.fr <p>Solitary neurofibroma of the oropharynx is extremely rare. Imaging explorations may be necessary, but the diagnostic certainty is pathological. We report a case of benign tumour of the oropharynx in a 25-year-old woman who was seen for a consultation with dysphagia, a change in voice and dyspnea in the supine position. The excision was performed under general anaesthesia with orotracheal intubation via the oropharyngeal route. Pathological examination of the surgical specimen revealed neurofibroma. Although rare, solitary neurofibroma of the oropharynx should be considered in any benign tumour in the area.</p> 2021-09-30T00:00:00+00:00 Copyright (c)