Ghana Medical Journal

Reducing the risks of nuclear war—the role of health professionals

Kamran Abbasi — 2023-09-17

In January, 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90 s before midnight, reflecting the growing risk of nuclear war. In August, 2022, the UN Secretary-General António Guterres warned that the world is now in “a time of nuclear danger not seen since the height of the Cold War. The danger has been underlined by growing tensions between many nuclear armed states. As editors of health and medical journals worldwide, we call on health professionals to alert the public and our leaders to this major danger to public health and the essential life support systems of the planet and urge action to prevent it.

A three-year review of lung cancer patient characteristics in a tertiary hospital

Jane S. Afriyie-Mensah — 2023-09-17

Objective: The study sought to determine clinical characteristics and histologic subtypes of a cohort of lung cancer patients in a tertiary facility.
Design: Retrospective review of the medical records of histology-confirmed lung cancer cases at the respiratory clinic over a 3-year period.
Setting: Respiratory Clinic, Korle-Bu Teaching Hospital, Accra, Ghana
Participants: All adult patients with histologically diagnosed lung cancer were enrolled.
Main outcome measures: Lung cancer histological types
Results: The proportion of lung cancer cases was 12.4%. The majority were women (57.8%) and the mean age at diagnosis was 55.8±16.0 years. The patients were predominantly non-smokers (61%). Common symptoms were chronic cough and chest pain. More than two-thirds of the cases presented in clinical stages III and IV with the pre-dominant histological subtype being adenocarcinoma in smokers and non-smokers. Genetic testing for epidermal growth factor receptor (EGFR) and Anaplastic Lymphoma kinase (ALK) mutations were largely absent.
Conclusions: The majority of lung cancer patients presented late with advanced disease. Adenocarcinoma was the predominant histological subtype in a predominantly non-smoking population, with an increased prevalence among women less than 60 years. This should encourage testing for genetic mutations to improve patient survival.

Risk factors for chronic obstructive pulmonary disease (COPD) in a tertiary health institution in Lagos, Nigeria

Obianuju B. Ozoh — 2023-09-17

Objective: To describe the clinical characteristics and identifiable risk factors for Chronic Obstructive Pulmonary Disease (COPD) in a real-world clinical setting.
Design: Cross-sectional study among patients with COPD.
Setting: The Respiratory clinic of the Lagos University Teaching Hospital.
Participants: Consecutive patients with spirometry confirmed COPD on follow-up for ≥3 months. There were 79 participants.
Intervention: None
Main outcome measure: COPD risk factors, disease severity, comorbidities, and the severity of airflow limitation.
Results: The mean age of the participants was 63.3± 12.4 years, and 47 (59.5) were male. There was a high symptom burden (73.4% had COPD assessment test (CAT) score >10), 33 (41.8%) and 4 (5.1%) had GOLD 3 and GOLD 4 airflow limitation, respectively. Risk factors were identified for 96.2% of the participants: history of asthma in 37 (46.8%), tobacco smoking 22 (27.8%), occupational exposure 15 (19%), biomass exposure 5 (6.6%), post-tuberculosis 3 (3.8%), old age (3.8%), and prematurity 1 (1.3%). Fifty-nine (74.7%) had Asthma COPD Overlap (ACO). There were no significant associations between the risk factors and disease severity. Participants with ACO had lower lung function and a high frequency of allergic rhinitis.
Conclusion: Asthma was the most commonly identifiable risk factor for COPD, underscoring asthma risk reduction and management optimisation as priorities toward COPD burden mitigation. Future studies need to validate these findings and identify the predominant COPD phenotypes in our setting.

Blood pressure and electrocardiographic profile of children with sickle cell anaemia in steady-state and vaso-occlusive crisis

Adewuyi T. Adeniyi — 2023-09-17

Objective: To compare the cardiovascular features of patients with sickle cell anaemia (SCA) in steady-state with those in vaso-occlusive crisis (VOC) at the Wesley Guild Hospital (WGH).
Design: A descriptive cross-sectional, matched, case-control study among children with SCA at the WGH, a tertiary health facility in southwest Nigeria.
Setting: The participants were recruited from the children’s emergency unit and paediatric haematology clinic of the WGH.
Participants: Consisted of 93 children with VOC (cases) and 93 age and sex-matched in steady state (controls), aged 5 – 15 years.
Main outcome measures: Cardiovascular parameters, including pulse rate, blood pressure, and electrocardiographic profile, were assessed and compared using the appropriate statistical tests.
Results: The mean (SD) age of the cases and controls were 8.8 (3.2) years and 9.0 (3.1) years, respectively (p= 0.106). There was no significant difference in the mean height of the groups. The mean pulse rate, diastolic, systolic, and mean arterial pressures were significantly higher in the cases than in the controls. A significantly higher proportion of the cases than the controls also had a higher frequency of heart blocks, prolonged QTc interval, ST elevation or depression, and T wave abnormality (p = 0.018, 0.039, 0.041, 0.009, respectively). The prevalence of chamber enlargements was not significantly different between the two groups.
Conclusion: Cardiovascular dysfunction is worse during VOC when compared with steady state. Physicians should look for these dysfunctions in SCA children with VOC to reduce mortality from the disease.

An audit of prescribing pattern of anti-epileptic drugs with its effect on therapeutic drug levels and seizure control at a tertiary care public hospital

Renuka Munshi — 2023-09-17

Objective: The study objective was to evaluate the prescription pattern and use of anti-seizure medications (ASMs) in patients with a seizure disorder and to evaluate if a change in the ASM dose had a beneficial effect on seizure control, observed through Therapeutic Drug Monitoring [TDM] level of ASMs.
Methods: Details of anti-seizure medications with their therapeutic levels in the blood of patients with seizure disorder were analysed.
Design: Hospital-based retrospective analysis of patient case records
Settings: Therapeutic Drug Monitoring OPD of a tertiary care public teaching hospital
Participants: Case records of 918 patients with seizure disorder from 2016-2021
Results: Data of men (53%) and women (47%) aged between 18-75 years was assessed About 62% (566/918) of patients were on levetiracetam, the most frequently prescribed anti-seizure medication. Whenever the ASMs dose was increased or decreased based on TDM levels, it was associated with a significant increase in the frequency of breakthrough seizures [OR- 5 (95% CI: 1.28-19.46)]. However, significant seizure control was observed when the patients were on the same maintenance dose of the anti-seizure medication [OR- 0.2 (95% CI: 0.06-0.63)]. Whenever an additional new anti-epileptic drug was prescribed or removed from the pre-existing anti-epileptic medications, it did not significantly impact seizure control.
Conclusion: Individualising drug therapy and therapeutic drug monitoring for each patient, along with patient factors such as medication compliance, concomitant drug and disease history, and pharmacogenetic assessment, should be the ideal practice in patients with seizures for better seizure control.

Plasma concentration of fucosyltransferase 7 is not associated with the number of clinically overt vaso-occlusive events in sickle cell disease

Iheanyi E. Okpala — 2023-09-17

Objective: To determine if the number of vaso-occlusive events in SCD relates to plasma concentration of fucosyl-transferase 7 (FUT7), which catalyses the synthesis of selectin ligands.
Design: A prospective, analytical study.
Setting: Haematology and Chemical Pathology Departments of tertiary healthcare centers
Participants: Steady state HbSS individuals aged 13-45 years, 20 had 3 or more vaso-occlusive crises that required hospital admission in the previous year (with or without complications of SCD); 17 other HbSS persons had 0-1 vaso-occlusive crisis that required hospital admission in the previous year and no disease complications.
Intervention: Steady-state plasma concentrations of FUT7 measured by ELISA were compared between SCD patients who had one vaso-occlusive crisis requiring hospital treatment in the previous year but no disease complications and those who had >3 crises with or without complications.
Main Outcome Measures: Plasma level of FUT7and the number of vaso-occlusive events in each HbSS patient
Results: Mean + standard deviation plasma concentration of FUT7 was 8.6 + 2.7 ng/ml in patients with >3 vaso-occlusive crises in the previous year and 7.3 + 1.7 ng/ml in those with 0-1 crisis and no complications; independent sample t-test, p > 0.05, not significantly different.
Conclusion: Plasma concentration of fucosyltransferase7 is not associated with the number of vaso-occlusive events in sickle cell disease.

Clinical presentation, radiographic findings, and treatment outcomes in children with adenoid hypertrophy in a paediatric outpatient clinic in Enugu, Nigeria

Ijeoma O. Ohuche — 2023-09-17

Objectives: To determine the clinical presentation, imaging features and outcomes of children with adenoid hyper-trophy in our setting.
Design: A retrospective study.
Setting: The paediatric clinic of a private hospital in Enugu.
Participants: 51 children, aged 2 to 108 months, with suggestive clinical features and radiographic report of adenoid hypertrophy who presented over 3 years
Interventions: Clinical information was obtained from the patient’s medical records. Data was analysed for the clinical characteristics of the patients, the relationship between the degree of airway narrowing on a postnasal space (PNS) radiograph and treatment outcomes.
Main outcome measures: Degree of airway narrowing as measured on a PNS radiograph, the type of and outcomes of treatment
Results: There was an almost equal male (54.7%): female (45.1%) ratio in the occurrence of adenoid hypertrophy, with a mean age of occurrence of 31.50 ± 3.64 months. Noisy breathing was the commonest symptom (94.1%); history of atopic rhinitis in 64.7% of cases and hyperactive airway disease in 45.1% more than 50% of cases with airway narrowing resolved with medical management only.
Conclusion: Adenoid hypertrophy should be considered in evaluating the upper airway in children under five. Paediatricians should be conversant with diagnosing and managing this common cause of upper airway obstruction.

Lack of consensus in inter-laboratory haematology results in selected laboratories in the southern and northern zones of Ghana

Ibrahim B. Halidu — 2023-09-17

Objective: To assess the inter-laboratory comparability and intra-assay reproducibility of full blood count (FBC) results.
Design: Exploratory cross-sectional study.
Setting: Three and two selected medical laboratories in the northern and southern zones, respectively.
Participants: Forty-nine individuals per zone; 16 type 2 diabetes mellitus, 16 with HbAS haemoglobin type and 17 normal samples
Intervention: Each sample was run eleven times through the analysers in the participating laboratories to evaluate intra-laboratory reproducibility and comparability of FBC results.
Main Outcome Measure: Intra-laboratory reproducibility was evaluated using %coefficient variation (%CV). Inter-laboratory comparisons were assessed through t-test or One-Way ANOVA for two-sample and three-sample tests. All statistical testing was undertaken using the two-tailed assumption.
Result: Statistically significantly different haemoglobin levels were estimated in both northern and southern zones (mean difference 0.00 g/dL to 3.75 g/dL vs 0.18 g/dL to 1.92 g/dL respectively). Also, total WBC counts significantly differed across laboratories in both northern and southern zones (mean difference 0.15 x109/L - 3.86 x109/L vs 0.02 x109/L to 1.39 x109/L respectively). Furthermore, platelet counts significantly differed across the participating laboratories in the northern and southern zones (mean difference 0.40 x109/L to 299.76 x109/L vs 5.7 x109/L to 76.9 x109/L respectively). Moreover, there was evidence of non-reproducibility of results within the respective laboratories in each zone as the respective %CV were outside the acceptable limits.
Conclusion: The intra-laboratory non-reproducibility and inter-laboratory non-comparability of FBC results highlight the need to establish a national quality assessment scheme to harmonise laboratory practices nationwide.

Coping with the economic burden of non-communicable diseases among hypertensive and diabetic patients in private and public health facilities in Ado-Ekiti, Nigeria

Tope M. Ipinnimo — 2023-09-17

Objective: To assess and compare how private and public health facilities patients cope with the economic burden of non-communicable diseases.
Design: Comparative cross-sectional study.
Setting: Thirty-nine private and eleven public health facilities in Ado-Ekiti, Nigeria
Participants: Three hundred and forty-eight (Private:173; Public:175) patients with hypertension or diabetes, or both were recruited.
Main Outcome Measures: Specific coping methods and numbers of coping strategies used by participants, as well as the perceived ability of participants to cope with the economic burden of non-communicable diseases.
Results: Majority of participants paid through out-of-pocket (OOP) than through health insurance(HI) (Pri-vate:OOP:90.2% HI:9.8%; Public:OOP:94.3% HI:5.7%; p=0.152). More participants in private used instalment payments(p<0.001). However, other coping strategies showed no significant difference in both groups(p>0.05). Delayed treatment (Private:102; Public:95) was the most used strategy in both arms, and the number of strategies used by the participants showed no significant difference(p=0.061). Lower levels of education, out-of-pocket payment, increasing number of clinic visits, and hospital admission were associated with the use of higher numbers of coping strategies in both groups while being female and retired/unemployed were associated with the private arm.
Conclusion: Although most patients in both groups pay out-of-pocket and use detrimental coping strategies, more patients in private arm use installment payment, a non-detrimental method. Healthcare providers, especially public providers, should adopt policies encouraging patients to use non-detrimental coping strategies to meet their healthcare expenditures.

Exploring prostate cancer screening among men in Accra using the health belief model

Isaac M. Boafo — 2023-09-17

Objective: To explore the prevalence of prostate cancer screening among Ghanaian men and interrogate why some individuals screen for the disease and others do not.
Design: A cross-sectional questionnaire survey based on the Health Belief Model was used to collect data from 356 men aged 40 years and above. Data were collected between February and March 2021.
Setting: The study was conducted in the Accra metropolitan area of the Greater Accra region of Ghana.
Participants: Convenience sampling was used to recruit participants for the study.
Results: Although 86% of the respondents had heard about prostate cancer, only 23% had ever screened for it. Logistic regression analysis suggested that knowledge of the disease (OR = 1.19, CI 95% = 1.03 -1.38) and barriers to screening (OR = .87, CI 95% = .83 -.91) were statistically significant predictors of screening behaviour.
Conclusion: HBM has limited predictive power as far as our study is concerned. We suggest increasing public education on prostate cancer and its screening methods. The cost of screening should also be made more affordable so as not to become a barrier.

Postnatal foot length in the estimation of gestational age in relation to intrauterine growth pattern among Nigerian neonates

Opeyemi T Kuponiyi — 2023-09-17

Objectives: To determine the relationship between postnatal foot lengths and estimated gestational age (EGA) in relation to intrauterine growth patterns determined at birth among Nigerian neonates.
Design: Hospital-based, cross-sectional.
Setting: Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.
Participants: 260 neonates with EGA 30- 42 weeks within 48 hours of life.
Interventions: Postnatal foot lengths (FL) were measured with Vernier digital calliper in millimetres. The intra-uterine growth pattern was determined using the Lubchenco chart. Pearson correlation and regression analysis tests were performed.
Main outcome measures: Postnatal foot length in relation to Intra-Uterine Growth Pattern
Results: The mean postnatal FL had a strong positive correlation with the EGA from 30 through 42 weeks (r = 0.855, p < 0.001). The overall mean foot length for preterm neonates was 65.44 (6.92) mm, while that of term neonates was 77.92 (4.24) mm. The linear regression equation was generated as: EGA = 9.43 + (0.37 × FL), p < 0.001. The EGA as measured by FL had the highest positive correlation with Small for Gestational Age (SGA) intra-uterine-growth pattern, followed by Appropriate for Gestational Age (AGA) and least by Large for Gestational Age (LGA) respectively (r = 0.936> 0.861 > 0.666).
Conclusion: The postnatal foot length correlated well with estimated gestational age, and the correlation was best among SGA infants.

Socio-demographic characteristics and dietary pattern of community-dwelling adults in Abia State, Nigeria

Patricia O. Ukegbu — 2023-09-17

Objective: Identification of dietary patterns and their association with socio-demographic factors.
Design: Community-based cross-sectional study design
Setting: Urban and rural communities in Abia State, Nigeria
Participants: Eight hundred and sixty-eight (868) male and female adults aged 20 to 59 years
Methods: Identification of Dietary patterns (DP) by Principal Component Analysis (PCA) based on the consumption of 10 food groups, assessed using a 7-day qualitative food frequency questionnaire. Bivariate and multivariate logistic regression analyses evaluated the association between identified patterns and socio-economic factors.
Results: Two dietary patterns ‘traditional and convenience DPs were identified, explaining 52% of the total variance. The traditional DP was loaded with starchy staples, vegetable soups/sauces, and animal proteins. The convenience DP was characterised by high factor loading of processed cereals, carbonated drinks and alcoholic beverages. Larger households (>3) had lower odds of adhering to high traditional DP [AOR =0.633; 95% CI (0.429-0.934); p = 0.021]. Females [AOR =1.586; 95% CI (1.104-2.279); p = 0.013] and middle-aged adults (AOR = 1.750; 95% CI (1.075-2.848);p = 0.024] were more likely to adhere to the convenience DP, whereas, the odds of adhering to the convenience pattern was lower among adults residing in rural areas [AOR =0.3161.586; 95% CI (0.219-0.456); p = 0.001].
Conclusion: Socio-economic variables (age, gender, household size and place of residence) were associated with dietary patterns among community dwellers in Nigeria.

Intracranial aneurysms in Ghanaian adults

Benjamin D. Sarkodie — 2023-09-17

Objective: To document the location, size, and multiplicity of intracranial aneurysms in Ghanaians who have undergone digital subtraction angiography (DSA) at a single centre in Accra, Ghana.
Design: We conducted a retrospective observational review of the medical records of all patients diagnosed with intracranial aneurysms on DSA
Setting: Patients’ medical records at Euracare Advanced Diagnostic and Heart Centre were reviewed between March 2018 and March 2020.
Participants: Thirty-one patients were identified with various intracranial aneurysms (IAs) within the study period. Patients’ ages, sex, and types of IAs were extracted using a checklist and analysed using Microsoft Excel for Windows 2016.
Interventions: None
Main outcome measures: The prevalence of types and distribution of intracranial aneurysms.
Results: The age range of the patients was 26-76 years, with a mean age of 45.5±14.3 years. The mean age of men and women with IA was 45.5 ±15.9 years and 46.7 51.3±12.9 years, respectively. The most common IAs were located in the posterior communicating artery (PCOM) at 54.8% (95%CI: 36.0, 72.7), followed by the anterior communicating (ACOM), which constituted 32.3% (95%CI: 16.7, 51.4). The majority, 89.2% (33/37) of these aneurysms were less than 7mm in diameter. Single aneurysms were present in 25 (80.6%).
Conclusion: The most common IAs were found in the PCOM and ACOM, and IAs tend to rupture at a younger age and smaller size among the Ghanaian adults examined. Early detection and treatment of IAs less than 7mm in diameter is recommended.

Public perception, knowledge and factors influencing COVID-19 vaccine acceptability

Amnuay Kleebayoon — 2023-09-17

survey of public perception, knowledge and factors influencing COVID-19 vaccine acceptability in five communities in Ghana”.1 The study selected families in five Accra areas using a modified cluster-sampling method. This sampling strategy may create selection bias and limit the findings’ generalizability to the Ghanaian population. The chosen localities may not be typical of the country, potentially impacting the study’s external validity. The survey has 997 participants, which may not be enough to provide an in-depth view of the public’s perspective and knowledge of COVID-19 in Ghana.

Retraction of published article

William Kudzi — 2023-09-17

We would like to retract a published article titled “Hypertension and associated factors among patients attending HIV clinic at Korle-Bu Teaching Hospital” by Edmund T. Nartey, Raymond A. Tetteh, Francis Anto, Bismark Sarfo, William Kudzi and Richard M. Adanu in the March 2023 issue of the Ghana Medical Journal