Ghana Medical Journal

Emeritus Professor Samuel Ofosu-Amaah (1931-2023)

David Ofori-Adjei — 2023-02-28

Emeritus Professor Samuel Ofosu-Amaah, who died on 22 January 2023, was highly regarded in academia, medical education, and public health. Trained as a pae-diatrician, he built a significant niche in Community Health early in his career at the University of Ghana Medical. A review of his career in the last half-century reveals a man best described as a visionary leader. The words of Ralph Waldo Emerson, “Do not follow where the path may lead. Go instead where there is no path and leave a trail”, are well suited to the life of Emeritus Professor Samuel Ofosu-Amaah. Dr Anarfi Asamoah-Baah (Former Deputy Director-General of the World Health Organisation and alumnus of the University of Ghana Medical School) said this about him: “Prof [Ofosu-Amaah] was a rare cocktail of brilliance, intellectual dexterity, softness, dogged determination and foresight, stammering eloquence, compassion and respect, tolerance”.

A survey of public perception, knowledge and factors influencing COVID-19 vaccine acceptability in five communities in Ghana

Ernest Yorke — 2023-02-28

Objective: The present study assessed the public’s perception and Knowledge about COVID-19 and factors that could affect vaccine acceptability in Ghana.
Design: We carried out a cross-sectional population-based study. A structured questionnaire was used to capture data on socio-demographic information, knowledge, and the public’s perception of COVID-19 infection, as well as COVID-19 vaccine acceptability from consented participants. Factors affecting vaccine acceptability in Ghana were explored. Robust ordinary least square linear regression analysis was adopted to assess factors associated with vaccine acceptability.
Setting: Five communities (Labone, Lartebiorkoshie, Old Fadama, Chorkor, and Ashiyie) in Accra in the Greater Accra district were selected.
Participants: WHO modified cluster-sampling method was applied to select households of 997 participants in the five communities.
Results: Most respondents were males (57.6%), and the median age of participants was 30 years. The study participants demonstrated a good knowledge of COVID-19 and had high perceptions of the COVID-19 pandemic. The results revealed that the highest educational level, marital status, self-rated Knowledge of COVID-19, Knowledge of COVID-19 definition, Knowledge of COVID-19 symptoms, and perception of the COVID-19 pandemic were significantly associated with vaccine acceptability. Self-reported impact of COVID-19 lockdown/movement restrictions on agriculture and job as a source of livelihood was associated with vaccine acceptability.
Conclusion: Higher subjective and objective knowledge of COVID-19 increases vaccine acceptability scores significantly thus, education on COVID-19 and the vaccination against SARS-CoV-2 infection must be intensified to improve vaccine acceptability in Ghana, especially among those with lower educational backgrounds.

Determinants of enrolment in health insurance scheme among HIV patients attending a clinic in a tertiary hospital in South-eastern Nigeria

Chihurumnanya N. Alo — 2023-02-28

Objective: The study aimed to assess the determinants of enrolment in health insurance schemes among people living with HIV.
Design: The study was a cross-sectional study. A pre-tested interviewer-administered questionnaire was used to collect information from 371 HIV clients attending the clinic. Chi-square statistic was used for bi-variate analysis, and analytical decisions were considered significant at a p-value less than 0.05. Logistic regression was done to determine predictors of enrolment in health insurance.
Setting: The study was carried out in the HIV clinic of Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria
Participants: HIV clients attending a clinic
Result: Mean age of respondents was 45.4±10.3, and 51.8% were males. Almost all the respondents were Christians. Only 47.7% were married, and most lived in the urban area. Over 70% had at least secondary education, and only 34.5% were civil servants. About 60% of the respondents were enrolled in a health insurance scheme. Being single (AOR: 0.374, CI:0.204-0.688), being self-employed (AOR: 4.088, CI: 2.315-7.217), having a smaller family size (AOR: 0.124, CI: 0.067-0.228), and having the higher income (AOR: 4.142, CI: 2.07-8.286) were predictors of enrolment in a health insurance scheme.
Conclusion: The study has shown that enrolment in a health insurance scheme is high among PLHIV, and being single, self-employed, having a smaller family size, and having a higher monthly income are predictors of enrolment in the health insurance scheme. Increasing the number of dependants that can be enrolled so that larger families can be motivated to enrol in health insurance is recommended.

Hypertension and associated factors among patients attending HIV clinic at Korle-Bu Teaching Hospital

Edmund T. Nartey — 2023-02-28

Objectives: This study determined the prevalence of hypertension and its associated factors among patients attending the HIV clinic at the Korle-Bu Teaching Hospital (KBTH).
Design: A hospital-based cross-sectional study was conducted at KBTH. The prevalence of hypertension was estimated among study participants, and socio-demographic, lifestyle, anthropometric, metabolic and HIV/ART-related factors associated with hypertension were determined by logistic regression modelling.
Setting: Study participants were recruited from the HIV clinic at the KBTH.
Participants: A total of 311 Persons Living with HIV were recruited as study participants
Interventions: Simple random sampling technique was used to recruit study participants. A questionnaire adapted from the WHO STEPwise approach to chronic disease risk-factor surveillance was used to collect study participants' data.
Results: The prevalence of hypertension was 36.7%, and the factors associated with hypertension were increasing age, positive family history of hypertension, minimal exercising, current BMI ≥25.0 kg/m2, total cholesterol level ≥5.17 mmol/L, exposure to anti-retroviral therapy (ART) and increasing duration of ART exposure.
Conclusions: This study shows a high prevalence of hypertension among patients attending the HIV clinic at KBTH, associated with exposure to ART and increasing duration of this exposure. Blood pressure monitoring should move from routine to a more purposeful screening of patients for hypertension. Patients with the identified risk factors should be encouraged to have regular blood pressure measurements at home and not only when they visit the HIV clinic.

Determinants of visit-to-visit systolic blood pressure variability among Ghanaians with hypertension and diabetes mellitus

Fred S. Sarfo — 2023-02-28

Objective: To identify the determinants of systolic blood pressure variability (SBPV) among Ghanaians.
Design: We undertook a secondary analysis of data collected in a prospective study
Setting: The study involved patients with hypertension and or diabetes receiving care in five hospitals in Ghana
Main outcome measures: We assessed determinants of SBPV among 2,785 Ghanaian patients. We calculated the standard deviation (SD) of systolic BP recordings of 3 to 10 visits per patient over 18 months as a measure of SBPV. A multivariate linear regression analysis was fitted to identify factors independently associated with risk visit-to-visit SBP standard deviation.
Results: The mean SD of individual patient visit-to-visit SBP overall was 14.8± 6.3 mm Hg. Those with hypertension and diabetes had the highest SD of 15.4 ±6.2 mm Hg followed by 15.2 ±6.5 mm Hg among those with hypertension only and then 12.0 ± 5.2 mm Hg among those with diabetes only, p<0.0001. Factors independently associated with SBPV with adjusted ß coefficients (95% CI) included age: 0.06 (0.03 – 0.08) for each year rise in age, eGFR -0.03 (-0.05 - -0.02) for each ml/min rise, low monthly income of <210 Ghana cedis 1.45 (0.43-2.46), and secondary level of education -1.10 (-1.69, -0.50). Antihypertensive classes were associated with SBPV, the strongest associations being hydralazine 2.35 (0.03 – 4.68) and Methyldopa 3.08 (2.39 – 3.77).
Conclusion: Several socio-demographic and clinical factors are associated with SBPV. Future studies should assess the contribution of SBPV to CVD outcomes among indigenous Africans and identify actionable targets.

Short-term outcomes among patients with subclinical hypothyroidism undergoing primary percutaneous coronary intervention

Abdulameer J. al-Gburi — 2023-02-28

Objectives: This study aimed to examine possible associations between previously undiagnosed subclinical hypothyroidism and short-term outcomes and mortality in a sample of Iraqi patients undergoing primary percutaneous coro-nary intervention for ST-segment elevation myocardial infarction.
Design: This is a prospective observational cohort study.
Setting: The study was conducted in a single tertiary referral centre in Baghdad, Iraq.
Participants: Thyroid-stimulating hormone and free T4 levels were measured in 257 patients hospitalised with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention between January 2020 and March 2022.
Main outcome measures: Adverse cardiovascular and renal events during hospitalisation and 30-day mortality were observed.
Results: Previously undiagnosed subclinical hypothyroidism was detected in 36/257 (14%) ST-elevation myocardial infarction patients and observed more commonly in females than males. Patients with subclinical hypothyroidism had significantly worse short-term outcomes, including higher rates of suboptimal TIMI Flow (< III) (p =0.014), left ventricular ejection fraction ≤ 40% (p=0.035), Killip class >I (p=0.042), cardiogenic shock (p =0.016), cardiac arrest in the hospital (p= 0.01), and acute kidney injury (p= 0.044). Additionally, 30-day mortality was significantly higher in patients with subclinical hypothyroidism (p= 0.029).
Conclusion: Subclinical hypothyroidism previously undiagnosed and untreated had a significant association with adverse short-term outcomes and higher short-term mortality within 30 days compared to euthyroid patients undergoing primary percutaneous coronary intervention. Routine thyroid function testing during these patients' hospitalisation may be warranted.

Association of erectile dysfunction with coronary artery disease in Type 2 Diabetes mellitus

Sydney C. Dsouza — 2023-02-28

Objectives: Association of severity of Erectile Dysfunction (ED) and coronary artery disease (CAD) in type 2 diabetics based on the number of vessels involved
Design: an observational, cross-sectional study
Setting: tertiary level health care centre Participants: 104 diabetics, as defined by ADA(American Diabetes Association) criteria, who fulfilled the inclusion criteria of positive coronary angiogram (in the last six months), were selected to participate in the study after obtaining informed consent. Details regarding ED were obtained using the IIEF-5 questionnaire, and based on their scores, participants were divided into four categories ranging from mild to severe.
Interventions: use of questionnaire International Index of Erectile Function-5
Main outcome measures: Karl Pearson association was done between the number of major coronary vessels involved and the severity of ED. The receiver operating characteristic curve was plotted between ED status and coronary vessels involved to predict the cut-off limit of ED score to predict CAD.
Results: Out of 104 diabetics with CAD, 85.5% gave a history of ED. Most participants had mild to moderate degrees of ED, which was reported as occurring 4-6 years before the diagnosis of CAD. Cross tabulation between the severity of ED and association with the number of coronary vessels involved found no statistically significant association (p>0.05). However, ROC analysis showed sufficient accuracy in predicting the severity of CAD.
Conclusion: The presence of ED in diabetic patients warrants screening for cardiovascular disease. A clear association between the severity of ED and the number of coronary vessels involved is still questionable.

Psychological correlates of COVID safety protocol adherence among university students

Frances E. Owusu-Ansah — 2023-02-28

Background: The COVID-19 pandemic continues to be a global concern. Reports of insidious asymptomatic variants of the virus raise concerns about the safety of huge numbers of students on university campuses.
Objective: The study aimed to delineate psychological correlates for students’ adherence to safety protocols for appropriate context-specific coping intervention designs.
Setting & Design: 751 students from the various colleges of the KNUST were conveniently sampled for this cross-sectional survey.
Measures: Psychological instruments with good psychometric properties (DASS-21; Rosenberg Self-Esteem Scale and Perceived Control Scales) were used in addition to demographics and questions on COVID safety protocol adherence.
Results: Self-esteem positively correlated with perceived control (r = 0.40, p<0.001) and COVID adherence (r = 0.16, p<0.001); but negatively correlated with psychological distress (r = -0.44 p<0.001). Greater perceived control was associated with lower psychological distress (r = -0.20 p<0.001) and greater adherence to safety protocols (r = 0.24 p<0.001). Protocol adherence was regressed on psychological distress, self-esteem, and perceived control to determine any significant prediction. All the variables accounted for 7% of the variance in COVID protocol adherence (R2 = 0.07, F (3, 661) =17.29, p<0.001) with perceived control significantly predicting adherence to COVID safety protocol (B = 0.11, β=0.23, t=5.54 p<0.001).
Conclusion: Results indicated that perceived control over important life events and healthy self-esteem would likely facilitate adherence to COVID safety protocols and attenuate psychological distress. Implications for further research and design of appropriate COVID coping response interventions are discussed.

Ophthalmic services utilisation and associated factors in the Ashanti region, Ghana

Abdul-Kabir Mohammed — 2023-02-28

Objective: This survey determined the utilisation of eye care services and associated factors among adults in the Ashanti region of Ghana.
Design: A population-based cross-sectional descriptive study
Method: Data for this study was collected from 1615 randomly selected individuals in the Ashanti region of Ghana, using a structured, pretested interviewer-guided questionnaire. Information regarding the accessibility and determinants of, and barriers to, eye care services was based on self-reports, using the WHO Eye Care Services Assessment Questionnaire. Inferential analyses were performed using the chi-square test for statistical significance, set at p=0.05.
Setting: Ashanti Region, Ghana
Participants: One thousand six hundred and fifteen randomly selected adults
Results: Public eye care facilities were used by 58.2% of the participants for their last eye exam. Of the participants, 47.0% had travelled less than five kilometres for their last eye exam. Waiting time and service cost were participants’ most frequently cited challenges in seeking care. No need felt (40.1%), self-medication (37.7%) and cost (22.2%) were the most frequently mentioned barriers to seeking ophthalmic services.
Conclusion: The major challenges encountered in seeking eye care services were waiting time and cost of service. Major barriers to ophthalmic services utilisation were no need felt, self-medication and cost. Factors such as cost, lack of felt need and self-medication, which serve as barriers to utilising eye care services, should be addressed by stakeholders through eye health education and promotion.

Safe duration of silicon catheter replacement in urological patients

Mawuenyo A. Oyortey — 2023-02-28

Objectives: This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks, six weeks, and eight weeks).
Design: A cross-sectional study with stratified simple random sampling
Setting: Urology Unit, Korle Bu Teaching Hospital
Participants: One hundred and thirty-seven male patients with long-term urinary catheters
Interventions: Participants were grouped into 3 weeks, 6 weeks, and 8 weeks duration of catheter replacements
Primary outcomes measures: Symptoms due to the urinary catheters, urinalysis, urine and catheter tip cultures, sensitivity, and catheter encrustations were assessed.
Results: Eighty-six patients had a primary diagnosis of benign prostatic hyperplasia (BPH), 35 had urethral strictures,13 had prostate cancer, two had BPH and urethral strictures, and one participant had bladder cancer. There was no difference in the symptoms the participants in the different groups experienced due to the urinary catheters (p > 0.05). The frequency of occurrence of complications (pyuria, p = 0.784; blocked catheter, p=0.097; urethral bleeding, p=0.148; epididymo-orchitis, p=0.769 and bladder spasms, p=1.000) showed no differences in the three groups. There was no statistical difference in the urinalysis for the three groups (p>0.05) and the degree of encrustations (3 weeks: 0.03 ± 0.06, 6 weeks: 0.11±0.27 and eight weeks: 0.12 ±0.27) with p=0.065.
Conclusions: In this study, the duration of urinary catheterisation using silicone Foley’s catheters did not influence the complication and symptom rates; hence silicon catheters can be placed in situ for up to 8 weeks before replacement instead of the traditional three-weekly change.

Leadership in health and medical education: lessons from a symposium on health sector development in Ghana

Cephas K. Avoka — 2023-02-28

The Ghana College of Physicians and Surgeons (GCPS) has established an annual leadership symposium celebrating innovative leadership in the health sector. The 2022 symposium under the theme “Health Sector Development in Ghana; The Power of Good Leadership” was held in honour of Professor Samuel Ofosu-Amaah (the laureate), an Emeritus Professor of Public Health at the University of Ghana, about his leadership legacy. This article reflects on the leadership challenges in the health sector, the lessons learnt from the symposium, and the way forward.
Leadership challenges identified in the health sector included the need for mentorship and coaching, the importance of teamwork and networking for delivering high-quality healthcare, and the role of leadership and governance in the health system. Key lessons from the symposium focused on skills in leading an event organisation, effective collaboration and teamwork, and learning from recognising prominent leaders’ contributions to the health sector while these leaders are still alive. Key lessons from the personal and professional life of the laureate included a focus on giving back to the community, building mentorship of health leaders, being a catalyst of change, leadership and governance in public health institutions and publication of research findings.
Suggestions were made to name the School of Public Health of the University of Ghana after Professor Ofosu-Amaah, to include a leadership and management module in all training modules at the GCPS and to establish a health leadership “Observatory” to focus on research on how leadership influences relevant health sector policy issues.