Ghana Medical Journal <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="" href="" target="_blank"></a></p> Ghana Medical Association en-US Ghana Medical Journal 0016-9560 <p>Articles published in the Ghana Medical Journal may not be published elsewhere without the consent of the publishers. Request for consent for reproduction of material published in the Ghana Medical Journal should be addressed to the Editor-in-Chief. The publisher of this Journal reserves the right of copyright of all articles published in the Journal. It should also be understood by all authors that articles approved for publication in the journal are also deemed for publication online by the publisher.</p><p><span>Ghana Medical Journal is an Open Access journal and applies the Creative Commons Attribution (CC BY) license (Creative Commons Attribution License) 4.0 International. See details on the Creative Commons website ( to articles and other content published in the Journal.</span></p> Reviewers for 2020 <p>Reviewers contribute greatly to shaping the quality of manuscripts published in our journal. Our reviewers give of their time and expertise to the service of science. We recognise those who reviewed for us in 2020. We hope that many<br>more will respond to our invitation in the coming years.</p> Editor In Chief Copyright (c) 2020-12-31 2020-12-31 54 4 204 206 10.4314/gmj.v54i4.1 Safety and efficacy of single-dose preoperative intravenous dexamethasone on postoperative nausea and vomiting following breast surgery at Korle-Bu Teaching Hospital <p>Objectives: Dexamethasone has beneficial effects on postoperative nausea and vomiting, however, many clinicians have raised legitimate concerns regarding its effect on blood glucose concentrations. This study determined the safety and efficacy of a single pre-operative dose of dexamethasone for PONV prophylaxis in patients undergoing breast surgery.</p> <p>Design: Prospective, double-blind, placebo-controlled trial</p> <p>Setting: Surgical wards of the Korle-Bu Teaching Hospital, Accra, Ghana</p> <p>Participants: The study was conducted among breast surgery patients. They were consecutively recruited and randomized into two groups: dexamethasone (n = 47) and placebo (n = 47).</p> <p>Interventions: Patients in the dexamethasone group received 8mg (2mls of 4mg/ml) dexamethasone while those in the placebo group received 2mls of saline intravenously. PONV impact scores and blood glucose levels were recorded at 4, 8 and 24 hours postoperatively.</p> <p>Main outcome measures: Incidence of PONV and blood glucose levels</p> <p>Results: The incidence of postoperative nausea (PON) was lower in the dexamethasone group compared with the placebo group (12.8% vs. 29.8%; p-value= 0.044). There was no significant difference in the incidence of postoperative vomiting (POV) and PONV between the two groups. Blood glucose levels were higher in the dexamethasone group throughout the study period and significant at 8 and 24 hours postoperatively (p &lt; 0.05). There was no difference in the incidence of clinically significant hyperglycemia between the groups (p-value = 0.169).</p> <p>Conclusion: A preoperative intravenous dexamethasone 8mg, reduces PON but not POV or PONV in breast surgery without clinically significant postoperative hyperglycemia.</p> Papa K. G. deGraft-Johnson Robert Djagbletey Henry K. Baddoo Ernest Aniteye Raymond Essuman George Aryee Pokua Sarpong Ebenezer O. Darkwa Copyright (c) 2020-12-04 2020-12-04 54 4 207 214 10.4314/gmj.v54i4.2 How mindful of their own health are healthcare professionals? perception and practice of personnel in a tertiary hospital in Nigeria <p>Objectives: To assess health professionals’ perception and determinants of their health and practice of preventive self-care</p> <p>Methods: An analytic cross-sectional design was employed, and 232 professionals were selected by stratified sampling from all health professional departments of Delta State University Teaching Hospital. Healthcare professionals who had worked in the hospital for at least six months were included in the sampling frame. Pregnant women and supernumerary professionals were excluded. A self-administered questionnaire was used, and data analysed using SPSS. The main outcome measures were the level of perception of self-health and level of practice of preventive selfcare.</p> <p>Results: More than four-fifths of doctors and 64.8% of nurses had good perception of their health, with significant association between perception and service area (X2 = 11.828, p =0.008). Screening practice was lowest amongst doctors except for HIV/HBV screening. Whereas 63.4% of all participants adjudged their BMI to be normal, only 36.2% actually had normal BMI, the difference being significant (p &lt;0.001). Almost 20% of doctors had not had a BP check in a year or more, and the same proportion of doctors and nurses had never checked their FBS. The proportion of personnel who had never checked their serum lipid profile was high among nurses (76.1%) and doctors (58.3%).</p> <p>Conclusion: Respondents had good perception but poor preventive behaviour, beginning management after disease onset. This may be ominous for the sector. Urgent health promotion action to safeguard productivity is needed. Comprehensive data from a multi-centre study will provide a deeper understanding of the issue.</p> Irikefe P. Obiebi Nnamdi S. Moeteke Godson U. Eze Ibiyemi J. Umuago Copyright (c) 2020-12-04 2020-12-04 54 4 215 224 10.4314/gmj.v54i4.3 Systemic disorders and the prognosis of stroke in Congolese patients: a cross-sectional study <p>Objectives: Stroke is one of the leading causes of death, disability, and dementia in developing countries. Our study aimed to evaluate the systemic disorders associated with mortality in patients admitted within 72 hours of the initial stroke event.</p> <p>Setting: The study took place at a tertiary hospital in Kinshasa.</p> <p>Participants: Patients admitted within 72 hours of the initial stroke event.</p> <p>Interventions: This cross-sectional study consisted of a retrospective review of stroke patient records from January 2016 to December 2018. The Pearson-Chi square test and odds ratios were calculated with a threshold of significance of 0.05.</p> <p>Main outcome measures: Mortality</p> <p>Results: We recruited 114 cases. The mean age was 61.8 ± 2.4 years, and the sex ratio was 1.78 in favor of men. Hypertension (76.3%), dyslipidemia (71.1%), and diabetes mellitus (58.8%) were the most frequent comorbidities. Most patients had hypoxia (85.9%), hypertension (82.4%), hyperglycemia (57.8%), and fever (28.1%). We registered thirty-two deaths (28.1%): 20 (62.5%) from the ischemic strokes, and 12 (37.5%) from hemorrhagic strokes. Systemic disorders with the worst prognosis during were arterial hypotension (OR=3.87, p &gt;0.001), and fever (OR = 1.56, p = 0.047).</p> <p>Conclusion: Arterial hypotension and fever adversely affect stroke patient outcomes, and strokes are responsible for high mortality in Congo</p> Marc Tshilanda Ulrick S. Kanmounye Remy Kapongo Michel Tshiasuma Copyright (c) 2020-12-04 2020-12-04 54 4 225 230 10.4314/gmj.v54i4.4 Assessment of patients waiting and service times in the ophthalmology clinic of a public tertiary hospital in Nigeria <p>Introduction: Long waiting time in the out-patient clinic is a major cause of dissatisfaction in Eye care services. This study aimed to assess patients’ waiting and service times in the out-patient Ophthalmology clinic of UITH.</p> <p>Methods: This was a descriptive cross-sectional study conducted in March and April 2019. A multi-staged sampling technique was used. A timing chart was used to record the time in and out of each service station. An experience based exit survey form was used to assess patients’ experience at the clinic. The frequency and mean of variables were generated. Student t-test and Pearson’s correlation were used to establish the association and relationship between the total clinic, service, waiting, and clinic arrival times. Ethical approval was granted by the Ethical Review Board of the UITH.</p> <p>Result: Two hundred and twenty-six patients were sampled. The mean total waiting time was 180.3± 84.3 minutes, while the mean total service time was 63.3±52.0 minutes. Patient’s average total clinic time was 243.7±93.6 minutes. Patients’ total clinic time was determined by the patients’ clinic status and clinic arrival time. Majority of the patients (46.5%) described the time spent in the clinic as long but more than half (53.0%) expressed satisfaction at the total time spent at the clinic.</p> <p>Conclusion: Patients’ clinic and waiting times were long, however, patients expressed satisfaction with the clinic times.</p> Lateefat B. Olokoba Kabir A. Durowade Feyi G. Adepoju Abdulfatai B. Olokoba Copyright (c) 2020-12-04 2020-12-04 54 4 231 237 10.4314/gmj.v54i4.5 Living environment and health of under-five children in urban slums of a coastal region in South India <p>Objective: The primary objective of the study was to determine the association between the living environment and morbidity, nutritional status, immunization status, and personal hygiene of under-five children living in urban slums in southern India.</p> <p>Methods: This study included 224 mothers of under-five children living in urban slums of Udupi Taluk, Karnataka. A total of 17 urban slums were selected randomly using random cluster sampling.</p> <p>Results: Undernutrition was high among children of illiterate mothers (63.8%), and the children of working mothers were affected by more morbidity (96.6%) as compared with housewives. Morbidity was also found to be high among children belonging to families with low incomes (66.1%) and low socio-economic backgrounds (93.1%). Safe drinking water, water supply, sanitation, hygiene, age of the child, mother’s and father’s education, mother’s occupation and age, number of children in the family, use of mosquito nets, type of household, and family income were significantly associated with child morbidity, nutritional status, immunization status, and personal hygiene of under-five children living in urban slums.</p> <p>Conclusion: Overall, in our study, family characteristics including parental education, occupation and income were significantly associated with outcomes among under-five children. The availability of safe drinking water and sanitation, and the use of mosquito nets to prevent vector-borne diseases are basic needs that need to be urgently met to improve child health.</p> Roja VR Prakash Narayanan Varalakshmi Chandra Sekaran Ajith Kumar MG Copyright (c) 2020-12-04 2020-12-04 54 4 238 244 10.4314/gmj.v54i4.6 Prevalence of positive mental health and functioning among adults with sickle cell disease in Ghana <p><strong>Objectives</strong>: With increasing survival rates of children with sickle cell disease (SCD) reaching adulthood, there has been a growing interest in the quality of life and mental health functioning of affected individuals. Positive mental health is recognised as a significant dimension of human health that plays an important role in advancing well-being. This study explored the prevalence of positive mental health and functioning among a sample of Ghanaian adults with SCD.</p> <p><strong> Methods</strong>: A quantitative cross-sectional survey design was implemented for data-gathering. A random sample of 62 adult SCD patients (21 to 56 years; mean age of 29 years) receiving treatment at the Sickle Cell Clinic of the Ghana Institute of Clinical Genetics at the Korle-Bu Teaching Hospital completed the Mental Health Continuum–Short Form (MHC-SF). Descriptive statistics and reliability indices were estimated for the MHC-SF. We implemented Keyes’s criteria for the assessment and categorisation of levels of mental health to determine the prevalence of positive mental health and functioning.</p> <p><strong>Results</strong>: We found a high level of positive mental health (66% flourishing; 26% moderately mentally healthy; 8% languishing) and functioning, with no significant difference between the genders. A total of 34% of the participants were functioning at suboptimal levels and were at risk of psychopathology.</p> <p><strong>Conclusion</strong>: This study gives the first overview of the prevalence of positive mental health and functioning in a clinical population in Ghana. Although the majority of participants were flourishing, contextually appropriate positive psychological interventions are needed to promote the mental health of SCD patients who are functioning at suboptimal levels, which would, inherently, also buffer against psychopathology.</p> Richard Appiah Bempah O. Tutu Mavis E. Oman Peter Ndaa Copyright (c) 2020-12-04 2020-12-04 54 4 245 252 10.4314/gmj.v54i4.7 Chest CT features of patients under investigation for Covid-19 pneumonia in a Ghanaian tertiary hospital: a descriptive study <p><strong>Background</strong>: Coronavirus disease 2019 (COVID-19) has since December 2019 become a problem of global concern. Due to the virus’ novelty and high infectivity, early diagnosis is key to curtailing spread. The knowledge and identification of chest Computerized Tomography (CT) features in Patients Under Investigation (PUI) for the disease would help in its management and containment.</p> <p><strong>Objectives</strong>: To describe the chest CT findings of PUI for COVID-19 pneumonia referred to the Department of Radiology of the Korle Bu Teaching Hospital; as well as to determine the relationship between symptom onset and severity of the chest CT findings.</p> <p><strong>Methods</strong>: The study was retrospective and included 63 PUI for COVID-19 referred to the Department between 11th April, 2020 and 10th June, 2020, for non-enhanced chest CT imaging. Clinical data were obtained from patients’ records and Reverse Transcriptase–Polymerase Chain Reaction (RT-PCR) results were acquired after the CT evaluation.</p> <p><strong>Results</strong>: The mean age in years was 51.1±19.9 SD. More males (52.8%) than females (47.2%) tested positive for COVID-19 and the age range for positive cases was 7 months to 86 years, with a mean of 53.2±21 SD years. Common features of COVID-19 pneumonia were bilateral posterior basal consolidations, Ground Glass Opacities (GGO) and air bronchograms. Findings were worse in patients scanned 5–9 days after onset of symptoms.</p> <p><strong>Conclusion</strong>: Adequate knowledge of chest CT features of COVID-19 pneumonia, proves a valuable resource in triaging of symptomatic patients and consequent containment of the disease in the hospital setting.</p> Klenam Dzefi-Tettey Patience S. Saaka Isaac Acquah Emmanuel K. M. Edzie Philip N. Gorleku Patrick Adjei Jonathan K. Semetey Edward K. D. Ayem Arwen J. Insaidoo Ali Samba Copyright (c) 2020-12-04 2020-12-04 54 4 253 263 10.4314/gmj.v54i4.8 Chest radiography patterns of COVID-19 pneumonia in Kumasi, Ghana <p><strong>Objectives</strong>: To document the pattern of chest radiographic findings in coronavirus disease 2019 (COVID-19) patients with moderate to severe disease.</p> <p><strong>Design</strong>: Retrospective cross-sectional study.</p> <p><strong>Setting</strong>: The study site was Komfo Anokye Teaching Hospital (KATH) located at Bantama in Kumasi, the capital town of the Ashanti Region. It is the second largest hospital in the country and the major referral site for Ashanti region and the northern part of the country. The hospital hosts a highly infectious isolation unit (HIIU) for COVID19 patients with moderate to severe infections and receives referred cases from the region and within the hospital.</p> <p><strong>Participants</strong>: The study involved 27 patients admitted to the HIIU at KATH with COVID-19 infection who underwent chest X-ray as part of their investigations.</p> <p><strong>Results</strong>: The study enrolled 12 males and 15 females. The common comorbidities were hypertension and diabetes. Chest x-ray findings in most of the patients (81.5%) revealed ground-glass opacities while a few of them (18.5%) had lung consolidations without ground-glass opacities. For those with ground-glass opacities, eight (29.6%) had superimposed consolidation. All the participants had positive chest x-ray findings.</p> <p><strong>Conclusion</strong>: The chest x-ray findings in the 27 COVID-19 positive patients with moderate to severe disease on admission at the KATH HIIU enrolled in this study showed significant pulmonary abnormalities. The predominant pulmonary abnormalities were bilateral peripheral ground-glass opacities with the lower lung zones being mostly affected.</p> Augustina Badu-Peprah Ijeoma Anyitey-Kokor Allswell Ackon Obed K. Otoo Nana A. K. Asamoah Theophilus K. Adu-Bredu Copyright (c) 2020-12-04 2020-12-04 54 4 264 268 10.4314/gmj.v54i4.9 Warfarin-induced skin necrosis: a rare condition <p>Warfarin induced skin necrosis is a rare debilitating and, in some cases, life-threatening complication. A 47-year-old male on life-long anticoagulation omits his medication and develops extensive skin necrosis of the left leg complicated by acute renal failure three days after restarting warfarin. Investigations reveal possible Protein S deficiency which is known to be a predisposing condition. Various mechanisms have been proposed as the underlying cause. He was managed on heparin, wound debridement and skin grafting. Warfarin was restarted concurrently with heparin. Knowledge of this complication will enable timely diagnosis and treatment.</p> Josephine Nsaful Yaw Ofori Adjei Florence Dedey Nelson Agboadoh Edem Anyigba Warigbani Pieterson Copyright (c) 2020-12-04 2020-12-04 54 4 269 273 10.4314/gmj.v54i4.10 Diagnosis and management of extrahepatic oesophageal variceal bleed in children in a low resourced setting <p>Extrahepatic portal vein obstruction (EHPVO) is a major cause of portal hypertension (PH) in children. Portal vein thrombosis (PVT) is the most common cause accounting for up to 75% of cases in developing countries. Upper gastrointestinal bleeding is the most dreaded and commonest presentation of portal hypertension. Successful treatment of paediatric PH, though challenging is performed in resource constraint countries.</p> <p><strong>Cases</strong>: Five children presented over three years to a tertiary hospital in Ghana, with massive upper gastrointestinal bleeding. They had anaemia, thrombocytopaenia and four had splenomegaly. Liver function tests, INR, haemoglobin electrophoresis as well as HIV serology, hepatitis B and C screening were all normal. Abdominal doppler ultrasound scan confirmed portal vein thromboses. They were resuscitated and managed with octreotide, propranolol, antibiotics and sclerotherapy or oesophageal variceal banding in the acute setting and long term secondary prophylaxis with propranolol. Subsequently, an algorithm was developed to assist with the management of bleeding from oesophageal varices and the diagnosis of EHPVO.</p> <p><strong>Conclusion</strong>: Portal hypertension due to EHPVO is an important cause of upper gastrointestinal (GI) bleeding in children. This can be successfully managed even in a resource constraint setting once the appropriate measures are taken.</p> Taiba J. Afaa Kokou H. Amegan-Aho Elikem Richardson Bamenla Goka Copyright (c) 2020-12-04 2020-12-04 54 4 274 278 10.4314/gmj.v54i4.11 Bleomycin-induced pneumonitis in a young Ghanaian male with Hodgkin’s Lymphoma <p>We report a case of a young Ghanaian male who developed Bleomycin Induced Pneumonitis (BIP) after being treated for Hodgkin’s Lymphoma. Pulmonary toxicity is the most feared complication of bleomycin therapy despite its effectiveness in achieving cure in patients with Hodgkin’s lymphoma and germ cell tumors. BIP has a significant mortality rate if detected late and a high index of suspicion is required in all patients on bleomycin-based therapies with sudden onset of respiratory symptoms.</p> Yvonne A. Dei-Adomakoh Jane S. Afriyie-Mensah Hafisatu Gbadamosi Copyright (c) 2020-12-04 2020-12-04 54 4 279 283 10.4314/gmj.v54i4.12 Vascularised fibular graft in the management of non-union of fracture shaft of radius: a less ventured entity <p><strong>Introduction</strong>: Non-union of the radius and ulna is a major complication of forearm fractures, accounting upto 10% of all forearm fractures. Multiple modalities are available for the treatment of non-union. Vascular grafts are a less sought-after surgical choice owing to the need of expertise and skills of surgeons. We discuss a case of gap non-union of fracture shaft radius treated with vascular fibula graft.</p> <p><strong>Case Report</strong>: We describe a case of 45yr old lady with closed fracture of both bones of left forearm. She underwent open reduction and internal fixation with 3.5 small DCP (6 hole) two days following trauma. On subsequent follow up in 6 months the radius fracture showed signs of infected non-union with osteolysis at screw sites while the ulnar side showed signs of satisfactory union. The patient underwent debridement with implant removal and osteosynthesis with vascularised fibula for gap non-union as second stage. 3 and 6 months follow up showed improvement in DASH score as well as VAS score and fair return of regular activity.</p> <p><strong>Conclusion</strong>: In management of gap non-union of Shaft radius with gap (&gt;6cm) vascularised fibular graft provides excellent functional outcome with far less donor site complications.</p> Tapas K. Panigrahi Ramesh C. Maharaj Debi P. Nanda Copyright (c) 2020-12-04 2020-12-04 54 4 284 286 10.4314/gmj.v54i4.13