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> en-US <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Articles published in the Ghana Medical Journal may not be published elsewhere without the consent of the publishers.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> (Prof David Ofori-Adjei) (The Managing Editor) Sun, 27 Jun 2021 13:41:01 +0000 OJS 60 Publication ethics in practice <p>Publication ethics ensure that publications are truthful, due credit is given to contributors, the rights of participants are protected, applicable rules and guidelines are adhered to, and the public's trust is nurtured.</p> Joseph Bonney, Peter Donkor Copyright (c) 2021 Tue, 01 Jun 2021 00:00:00 +0000 Clonidine as an adjuvant to bupivacaine in spinal anaesthesia for infra-umbilical surgeries in children: a prospective randomized, double-blind trial <p><strong>Objective</strong>: Spinal anaesthesia (SA) is a well-established technique for infra-umbilical surgeries but is underutilized in children. One important reason is the limited duration of action. Clonidine is a useful adjuvant in this regard but has not been studied in a dose of 1.5 μg/kg.<br><strong>Design</strong>: a prospective randomized study</p> <p><strong>Setting</strong>: A single centre study conducted at a Super speciality paediatric tertiary care centre.<br><strong>Participants</strong>: Sixty children (5-12yrs) scheduled for lower abdominal surgery with duration &lt;90min were included.<br><strong>Interventions</strong>: The participants were randomized into two groups to receive 0.4mg/kg of 0.5% hyperbaric bupivacaine with clonidine 1.5μg/kg (Group-I, n=30) or 0.4mg/kg of 0.5% hyperbaric bupivacaine with saline(Group-II, n=30) in the subarachnoid block.<br><strong>Main outcome measures</strong>: The sensory and motor block duration, time to two-segment regression, time to first rescue analgesic, and the number of rescue doses required were recorded.<br><strong>Results</strong>: Mean duration of sensory blockade (147.5±7.28 vs 310.33±10.17min; P&lt;0.001) and motor blockade (132.5±10.06 vs 283.33±11.77min; P &lt; 0.001) and duration of analgesia (172±9.61 vs 364.50±28.75min; P &lt; 0.001) were significantly prolonged in the clonidine group. In the control group, most patients needed three analgesic doses over 24hr while in the clonidine group, the majority needed two doses. Adverse effects were infrequent in both groups.<br><strong>Conclusions</strong>: Clonidine as an adjuvant to 0.5% hyperbaric bupivacaine significantly prolonged the duration of analgesia with improved quality of anaesthesia while maintaining safety. We recommend the routine use of clonidine 1.5 μg/kg dose as an adjuvant to 0.5% bupivacaine in paediatric SA.</p> Geeta Kamal, Raman Piplani, Anju Gupta, Nidhi Sehgal Copyright (c) 2021 Tue, 01 Jun 2021 00:00:00 +0000 Determinants of viral load non-suppression among people living with HIV on antiretroviral therapy in Kumasi, Ghana <p><strong>Objectives</strong>: To determine the rate and factors associated with viral load non-suppression among adults living with HIV/AIDS on active anti-retroviral therapy (ART).<br><strong>Design</strong>: A retrospective cross-sectional study<br><strong>Setting</strong>: Three ART clinics in Kumasi, Ghana<br><strong>Participants</strong>: All HIV-infected adults who were ≥18 years and on active ART for 12 months and whose viral loadnhad been estimated were included.<br><strong>Main outcome measure</strong>: Unsuppressed viral load among patients on ART<br><strong>Results</strong>: In all, 483 HIV patients were included in the study, with 369 (76.4%) achieving viral load suppression. Gender, educational level, comorbidity status, and duration on ART were independently associated with viral nonsuppression (p &lt; 0.05).<br><strong>Conclusions</strong>: This study has revealed that the rate of viral suppression in the study area is lower than the UNAIDS 90% target. The findings have implications on designing new and stemming up implementation of existing interventions to improve the rate of viral suppression among patients in the study area. It is also necessary that more of such studies are replicated in other parts of the country to identify risk factors for virological failure among patients on ART.</p> David Ansah, Emmanuel Kumah, Vitalis Bawontuo, Peter Agyei-Baffour, Emmanuel K Afriyie Copyright (c) 2021 Tue, 01 Jun 2021 00:00:00 +0000 Challenges facing community health workers in promoting maternal and neonatal health in Bagamoyo and Mkuranga districts, Tanzania <p><strong>Objectives</strong>: Community health workers (CHWs) play significant roles in areas where professional health workforce succumb to serious human resource deficiencies. This study explored challenges the CHWs face in promoting maternal and neonatal health in two districts of Tanzania.<br><strong>Design</strong>: A cross-sectional study design was conducted in Bagamoyo and Mkuranga districts from March to May 2019.<br><strong>Methods</strong>: Qualitative data were collected using in-depth interviews from 30 CHWs, thematic analysis was carried out by identifying major key themes emerging from the data.<br><strong>Results</strong>: The study found little community support resulted from jealousy of male household heads, mistrust, socialcultural believes and lack of community appreciation on the role of CHWs. Little support from local government resulted by political grievances among local leaders due to change in political administration. Other challenges were lack of basic knowledge in maternal and neonatal health, including breastfeeding. Irregular working schedules due<br>to poor supervision, huge workload, old age and tiredness<br><strong>Conclusion</strong>: CHWs programs in Bagamoyo and Mkuranga districts were inactive and required innovative strategies to raise community and local government cooperation. Jealousy among male household’s heads and CHWs need community members to participate in establishment of selection criteria. Socio-cultural beliefs call for community sensitization on how they affect maternal and neonatal health. Lack of community appreciation on the role of CHWs, irregular working schedule implied poor supervision and defined age limit would overcome challenges related to old age.</p> Kabula Jumanne, Liliane Pasape, Irene R. Moshi, Mwifadhi Mrisho Copyright (c) 2021 Tue, 01 Jun 2021 00:00:00 +0000 Psychological comorbidities in epilepsy: a cross-sectional survey among Ghanaian epilepsy patients <p><strong>Objective</strong>: To evaluate the prevalence and patterns of psychiatric disorders in epilepsy patients at the Korle-Bu Teaching hospital, Accra, Ghana.<br><strong>Design</strong>: The study design was a cross-sectional survey<br><strong>Setting</strong>: The study was conducted at the Neurology Clinic of the Department of Medicine and Therapeutics, Korle-nBu Teaching hospital, Accra, Ghana.<br><strong>Participants</strong>: A total of one hundred and sixty-six patients diagnosed with epilepsy aged at least 18 years and accessing services at the neurology clinic participated in the study.<br><strong>Main Outcome Measure</strong>: Prevalence and patterns of psychiatric disorders among patients diagnosed with epilepsy using the Brief Symptom Inventory.<br><strong>Results</strong>: The mean age for onset of epilepsy was 20.1 ± 16.9 years, and generalized epilepsy (73.2%) was the major type of epilepsy identified. The aetiology of the epilepsy condition was unknown in most patients (71.1%). The estimated mean Brief Symptom Inventory scores in all the nine diagnostic psychiatry characteristics (Depression, Anxiety, Somatization, Hostility, Phobic Anxiety, Obsessive Compulsive Disorder, Psychoticism, Interpersonal Sensitivity, and Paranoid Ideation) were higher in the epilepsy patients compared to the normative data scores for non-patients. Global Severity Index scores for females were significantly higher (p=0.002) than the scores for males on all the psychological outcomes except hostility.<br><strong>Conclusion</strong>: Psychological disorders were prevalent among epilepsy patients, with females more likely to experience psychological problems than males. The findings call for a holistic approach in managing epilepsy to highlight and manage some exceptional psychological comorbidities.</p> Patrick Adjei, Kodwo Nkromah, Albert Akpalu, Sammy Ohene, Peter Puplampu, Elvis T. Aboagye, Vincent Ganu, Stella Nartey, Kenneth Ae-Ngibise Copyright (c) 2021 Tue, 01 Jun 2021 00:00:00 +0000 Attitudes and perceptions of final year medical students on sexual history taking from patients in Ogun state, Southwestern Nigeria <p><strong>Background</strong>: An important aspect of sexual health is the ability to take a sexual history. Previous studies have shown that most medical students believed that sexual history taking is an important skill for future practice. Still, a majority reported inadequate, inconsistent or no training in this area.<br><strong>Objectives</strong>: To assess the attitudes of final year medical students on sexual history taking and perceptions of the training they received in medical school<br><strong>Design</strong>: A cross-sectional study using an online survey<br><strong>Participants</strong>: Consented and conveniently sampled 100 final year medical students.<br><strong>Results</strong>: The overall response rate was 74.6%, and the mean age of the respondents was 24.1±2.9 years. The majority (97%) of the students believed it is important for doctors to know how to take a sexual history. Still, only 31% admitted to finding it easy, with 57% of the students admitted to being comfortable taking a sexual history from adult patients. While 70% had exposure on simulated patients, just 54% have observed doctors taking sexual history during clinical rotations, mostly in Obstetrics and Gynaecology (97%) and Urology (60%) postings.<br><strong>Conclusions</strong>: Many final year medical students are interested in and appreciated the importance of sexual history taking, but they are not well grounded in many aspects of the topic. Despite the importance of sexual health, many students did not have enough exposure and training on the topic while still in medical schools. There is thus a need for a review of the curriculum of undergraduate medical education in Nigeria.</p> Oluseun O. Adeko, Adekunle J. Ariba, Akindele E. Ladele Copyright (c) 2021 Tue, 01 Jun 2021 00:00:00 +0000 What predicts mental health literacy among school teachers? <p><strong>Objectives</strong>: The present study aimed at assessing high school teachers’ mental health literacy (MHL) and predictors related to study outcomes.<br><strong>Design</strong>: Cross-sectional study<br><strong>Methods</strong>: We employed 460 high school teachers who engaged with adolescents for at least six hours per week with a minimum of five years of teaching experience in southern India. Semi-structured questionnaires were used to assess their MHL. Descriptive analysis and backward logistic regression analysis were performed. A p-value &lt; 0.05 was set as significant.<br><strong>Results</strong>: Teachers’ MHL on depression was less than desirable; however, they identified 288 (62.6%) adolescents with mental health problems during their career, and 172(59.72%) were referred to mental health professionals. On logistic regression analysis, teachers’ educational status, their marital status, teaching a class with an average strength of 31-60 students per class, previous mental health training and having self-efficacy concerning seeking information<br>on mental health, perceived ability to spread awareness and to provide referrals were found to predict MHL among teachers.<br><strong>Conclusion</strong>: Sociodemographic factors including teachers’ educational status, average class strength and having had previous mental health training were predictors for MHL among high school teachers. Establishing training programs and referral networks may be key in early intervention among adolescents.</p> Vidya Prabhu, Lena Ashok, Veena G. Kamath, Varalakshmi C. Sekaran, Asha Kamath, Sebastian Padickaparambil, Asha P Hegde, Virupaksha Devaramane Copyright (c) 2021 Tue, 01 Jun 2021 00:00:00 +0000 Improving stroke care in Ghana: a roundtable discussion with communities, healthcare providers, policymakers and civil society organisations <p>Even though there have been advances in medical research and technology for acute stroke care treatment and management globally, stroke mortality has remained high, with a higher burden in low- and middle-income countries (LMICs) such as Ghana. In Ghana, stroke mortality and disability rates are high, and research on post-stroke survival care is scarce. The available evidence suggests that Ghanaian stroke survivors and their caregivers seek treatment from pluralistic health care providers. However, no previous attempt has been made to bring them together to discuss issues around stroke care and rehabilitation. To address this challenge, researchers from the Institute of Advanced Studies, University College London, in collaboration with researchers from the African Centre of Excellence for Non-communicable diseases (ACE-NCDs), University of Ghana, organised a one-day roundtable to discuss issues around stroke care. The purpose of the roundtable was fourfold. First, to initiate discussion/collaborations among biomedical, ethnomedical and faith-based healthcare providers and stroke patients and their caregivers around stroke care. Second, to facilitate discussion on experiences with stroke care. Third, to understand the healthcare providers’, health systems’, and stroke survivors’ needs to enhance stroke care in Ghana. Finally, to define practical ways to improve stroke care in Ghana.</p> Olutobi A. Sanuade, Leonard Baatiemaa, Kafui Adjaye-Gbewonyo, Ama De-Graft Aikins Copyright (c) 2021 Tue, 01 Jun 2021 00:00:00 +0000 A case of Cushing Syndrome due to accidental intake of dexamethasone: a call for enforcement of regulatory laws <p>Cushing syndrome could be a complication of long-term steroid use, resulting in a wide range of clinical presentations. Whereas some patients take medically prescribed doses of conventional medicines, including steroids for various ailments, others inadvertently consume unspecified doses by adulterating traditional medicines with these orthodox medications to increase their therapeutic appeal. Furthermore, some individuals with access to conventional medications may sell them in unlabelled packages as traditional medicines (TMs) to unsuspecting customers. This may lead to undesirable side effects and safety concerns. The case report highlights the problem of poorly regulated access to medications and makes suggestions to protect patrons' health of traditional medicines.</p> Kofi T. Asamoah, Josephine Akpalu, Yacoba Atiase, Ernest Yorke Copyright (c) 2021 Tue, 01 Jun 2021 00:00:00 +0000 Small bowel evisceration in a perforated uterine prolapse <p>The evisceration of the bowel through the vaginal vault is an extremely rare condition and a surgical emergency with a high-reported mortality rate. Vaginal evisceration most commonly affects menopausal women with a hysterectomy or those with previous vaginal surgery. The most common risk factors include the triad of post-menopausal atrophy, previous vaginal surgery and enterocele. Estrogen deficiency in post-menopausal women leads to weaker pelvic support structures and a thin, atrophic vagina, making it more prone to rupture. Previous vaginal surgery leaves scar tissue with diminished vascularity in the vaginal wall and apex, predisposing it to dehiscence. Post hysterectomy, the axis of the vagina may be changed, making it more vertical or shortened and resulting in the vagina losing its valve-like mechanism. We present a 70-year-old female brought to the emergency department with a vaginal prolapse complicated by bowel evisceration, without any history of vaginal surgery, hysterectomy or trauma. The bowel was inspected and irrigated copiously, then reduced into the abdominal cavity as it was still viable. A total vaginal hysterectomy with an anterior and posterior colporrhaphy was done. The patient had a successful recovery with no complication. We present this case due to its rarity, the absence of previous vaginal surgery, trauma, or hysterectomy and the successful multidisciplinary surgical approach with total recovery.</p> Eric Y. Amakpa, Gertrudis A. Hernandez-Gonzalez, Edith Camejo-Rodriguez Copyright (c) 2021 Tue, 01 Jun 2021 00:00:00 +0000 Recurrent leiomyomatosis peritonealis disseminate: a case report <p>Leiomyomatosis peritonealis disseminata (LPD), a rare and unusual condition affecting mainly women of reproductive age, causes peritoneal and subperitoneal nodules formed by smooth muscle. Very few cases have been diagnosed since the disease was first described. We present a 42year old female who was managed for infertility and uterine myomata at a Municipal hospital in Ghana. Following a pelvic ultrasound diagnosis of multiple uterine myomata the patient was booked for myomectomy. At surgery to remove her myomata, the patient was found to have several peritoneal nodules some of which were attached to peritoneum, omentum and the surface of bowel loops in addition to a uterine myoma. The disease has since recurred twice after two laparotomies. The diagnosis was made by histopathology of ultrasound-guided biopsy of the nodules, and she has since been on GnRH analogue treatment. LPD simulates peritoneal carcinomatosis; thus, a good history, clinical evaluation, radiological imaging, and histopathologic analysis must be accurately diagnosed. Surgeons’ and Radiologists’ knowledge of the condition is fundamental to ensuring correct diagnosis and appropriate treatment and to minimising the probability of malignant transformation.</p> Yaw B. Mensah, Lawrence Buadi, Afua Abrahams, Andrea A. Y. Appau, Kwadwo Mensah Copyright (c) 2021 Tue, 01 Jun 2021 00:00:00 +0000 Ultrasound diagnosis of acrania with major low–lying placenta and polyhydramnios; case report <p>Acrania is a rare foetal anomaly in which the calvaria is absent, and the meninges come into direct contact with the amniotic fluid. Acrania is the most common anomaly in the acrania – exencephaly – anencephaly spectrum, with anincidence of 3.68 to 5.4 per 10,000 live births. We present a case of a primigravida who presented for an ultrasound on account of vaginal bleeding in early cyesis. Transabdominal ultrasound showed a viable foetus at 13 weeks without a calvaria, with the brain in direct contact with amniotic fluid. There was a low-lying placenta extending from the posterior to anterior part of the lower uterine segment, completely covering the internal cervical os (major low–lying placenta), a placental cyst and polyhydramnios (amniotic fluid index, AFI of 17 cm). A diagnosis of acrania with major low–lying placenta and polyhydramnios was made. Detailed ultrasound is required to detect acrania at 13 weeks. The diagnosis of acrania is required to help direct patient counselling and maternal expectation. When acrania and major low–lying placenta occur in the same patient, both diagnoses must be promptly made concurrently, regardless of gestational age and without waiting for placental trophotropism and migration to occur first.</p> Jared N. Oblitey, William K. Antwi, Benard O. Botwe, Mary K. Oblitey Copyright (c) 2021 Tue, 01 Jun 2021 00:00:00 +0000 Dapsone-induced drug reaction with eosinophilia and systemic symptoms (DRESS): the role of the primary care physician <p>Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but severe adverse drug reaction with debilitating morbidity and high mortality. The interest of this presentation is to report a case of dress and the role of the healthcare coordinator (family physician) in early diagnosis, prompt treatment and coordination of care. We report a case of a 32-year-old male who was wrongly commenced on Dapsone for seizure disorder from a primary health centre. He presented two months later with a month history of severe dry cough, pleurisy, intermittent breathlessness and high-grade fever. He had a generalized pruritic rash with erythema and desquamation. There was marked oedema of the face and feet with generalized lymphadenopathy. He was jaundiced with tender hepatomegaly. He had dark coloured urine and a trace of proteinuria but normal renal function. There was marked leukocytosis (35*109/l) with eosinophilia (36%). His chest X-ray and viral screen for HBV, HCV and HIV were all negative. The multiple systemic presentations warranted a multidisciplinary review, and a final diagnosis of DRESS was made. His symptoms began to resolve within two days of withdrawal of the offending drug and commencement of oral corticosteroid with supportive care for his symptoms. At six weeks, there was a complete resolution of clinical features, and his laboratory parameters had returned to the baseline. Diagnosis of DRESS can be challenging, and a high index of suspicion is required. The multidisciplinary coordination of care by the first line physicians can also not be overemphasized for good outcomes.</p> Blessing O Akor, Bob Ukuonu, Alexander A. Akor, Ojonugua A Ameh, Theresa Otu, Thairu Yunusa, Onyinye Onyeadi, Grace Lakai Copyright (c) 2021 Sat, 01 May 2021 00:00:00 +0000