Ghana Medical Journal

The African Journal Partnership Program’s guidance on the use of AI in scholarly publishing

Mon, 25 Mar 2024 00:00:00 +0000

The rapid introduction and evolution of artificial intelligence (AI), machine learning (ML), natural language processing (NLP), and large language models (LLMs) combined with the emergence of text-generating chatbots have ushered in a transformative era in scholarly publishing.

Reviewers for 2023

Editor-in-Chief — Mon, 25 Mar 2024 00:00:00 +0000

Reviewers of manuscripts for our journal contribute immensely to the standard and quality of the papers we publish. The Ghana Medical Journal is grateful for the voluntary service provided by the following reviewers for the year 2023.

Satisfaction levels and associated influencing factors among inpatients and outpatients with breast cancer at a tertiary health facility in Ghana

Mon, 25 Mar 2024 00:00:00 +0000

Objectives: To uncover variables linked to breast cancer patient satisfaction in order to improve policy choices and actions for breast cancer care in Ghana.
Design: We employed a cross-sectional design using a quantitative approach
Setting: The Radiotherapy, Oncology and Surgery Departments of the Korle Bu Teaching Hospital, Accra
Participants: Inpatient and outpatient breast cancer patients.
Main outcome measures: The level of inpatient and outpatient satisfaction was measured using descriptive and inferential statistical analyses. The Shapiro-Wilk test was employed to assess normality, while the Heckman selection model assessed significance with outcomes of interest.
Results: A total of 636 participants, with a mean age of 52.64±14.07 years, were recruited. The measured inpatient and outpatient levels of satisfaction out of 100 were 74.06±7.41 and 49.99±1.00 respectively, while the self-reported satisfaction levels out of 5 were 4.22±0.63 and 4.11±0.85 respectively. The level of inpatient satisfaction was significantly influenced by age, marital status, income level, and number of previous facilities visited (p<0.05). Outpatient satisfaction level was significantly associated with place of residence and income level (p<0.05).
Conclusions: The study offers insight into the satisfaction levels of breast cancer patients receiving inpatient and outpatient services at the largest tertiary referral centre and teaching hospital in Ghana, as well as the factors influencing attendance and satisfaction levels. Understanding and improving breast cancer patients' levels of satisfaction is a way that providers can safeguard their emotional well-being. Improvement in patient satisfaction at our institution among outpatients is an area for future growth.

Economic cost of management of glaucoma in public and private health facilities in the Tema metropolis in Ghana

Matilda Adda, Samuel Amon, Justice Nonvignon, Moses Aikins, Genevieve C Aryeetey — Mon, 25 Mar 2024 00:00:00 +0000

Objectives: This study sought to determine the economic cost of the management of glaucoma among patients seeking care in health facilities in Ghana.
Design: A cross-sectional cost-of-illness (COI) study from the perspective of the patients was employed.
Setting: The study was conducted in public and private eye care facilities in the Tema Metropolis of Ghana.
Participants: About 180 randomly selected glaucoma patients seeking healthcare at two facilities participated in the study.
Main outcome measure: Direct cost, including medical and non-medical costs, indirect cost, and intangible burden of management of glaucoma.
Results: the cost per patient treated for glaucoma in both facilities was US$60.78 (95% CI: 18.66-107.80), with the cost in the public facilities being slightly higher (US$62.50) than the private facility (US$ 59.3). The largest cost burden in both facilities was from direct cost, which constituted about 94% of the overall cost. Medicines (42%) and laboratory and diagnostics (26%) were the major drivers of the direct cost. The overall cost within the study population was US$10,252.06. Patients paid out of pocket for the frequently used drug- Timolol, although expected to be covered under the National Health Insurance Scheme (NHIS). Patients, however, expressed moderate intangible burdens due to glaucoma.
Conclusion: The cost of the management of glaucoma is high from the perspective of patients. The direct costs were high, with the main cost drivers being medicines, laboratory and diagnostics. It is recommended that the National Health Insurance Authority (NHIA) should consider payment for commonly used medications to minimize the burden on patients.

Abdominal wound closure in the presence of sepsis: our experience with the use of subcutaneous drain

Mon, 25 Mar 2024 00:00:00 +0000

Objectives: Patients requiring surgery for secondary peritonitis demonstrate a significantly increased risk for incisional surgical site infection. This study aimed to evaluate the efficacy of subcutaneous wound drain post-laparotomy for contaminated surgical wounds.
Design: This was a prospective comparative hospital-based study.
Setting: Patients who had surgery for secondary peritonitis in Irrua Specialist Teaching Hospital were studied.
Participants: Fifty patients aged 16 years and above who presented with secondary peritonitis.
Intervention: Patients who met the inclusion criteria were randomized into two equal groups. Group A had a suction drain placed in the subcutaneous space after laparotomy while Group B did not.
Main outcome measures: Development of incisional surgical site infection, wound dehiscence, and duration of postoperative hospital stay.
Results: The incidence of incisional surgical site infection was significantly less in Group A (20%) than in Group B (68%). There was no case of wound dehiscence in Group A as against 3 (12%) in Group B. The difference was not statistically significant. The mean duration of hospital stay was significantly less with subcutaneous suction drain (8.96+2.81 Vs 14.04+8.05; p = 0.005).
Conclusion: Subcutaneous suction drainage is beneficial in abdominal wall closure in cases of peritonitis as it significantly
reduces the incidence of incisional surgical site infection and the duration of postoperative hospital stay. The
reduction in surgical wound dehiscence observed in this study was, however, not statistically significant.

Comparative assessment of birth preparedness and complication readiness among couples in rural and urban communities of Ekiti State, Southwestern Nigeria

Mon, 25 Mar 2024 00:00:00 +0000

Objectives: To assess and compare the level of Birth Preparedness and Complications Readiness (BPCR) and determine the predicting effect of socio-demographic factors on it among couples in rural and urban communities of Ekiti State.
Design: A community-based comparative cross-sectional study.
Setting: The study was conducted in twelve rural and twelve urban communities in Ekiti State.
Participants: Couples from rural and urban communities. Female partners were women of reproductive age group (15-49 years) who gave birth within twelve months before the survey.
Main outcome measures: Proportion of couples that were well prepared for birth and obstetric emergencies, and its socio-demographic determinants.
Results: The proportion of couples that were well prepared for birth and its complications was significantly higher in urban (60.5%) than rural (48.4%) communities. The study also revealed that living above poverty line (95% CI=1.01– 3.79), parity and spousal age difference less than five years (95% CI=1.09 – 2.40) were positive predictors of BPCR among respondents.
Conclusions: Urban residents were better prepared than their rural counterparts. Living above poverty line, parity, and spousal age difference less than five years were positive predictors of BPCR. There is a need to emphasize on educating couples on the importance of identifying blood donors as a vital component of BPCR.

Cervical ripening with vaginal Misoprostol plus Hyoscine-N-Butylbromide versus vaginal Misoprostol alone among pregnant women: a double-blind randomised controlled trial

Ifeakachukwu D. Agadaga, Peter N. Ebeigbe, Babatunde Oyefara — Mon, 25 Mar 2024 00:00:00 +0000

Objective: To compare cervical ripening time with the use of vaginal Misoprostol plus Hyoscine-N-Butylbromide, with vaginal Misoprostol alone.
Design: A double-blind randomized controlled trial with Pan-African Clinical Trials Registry (PACTR) approval number PACTR202112821475292
Setting: Federal Medical Centre, Asaba, Nigeria.
Participants: A total of 126 eligible antenatal patients for cervical ripening were enrolled.
Interventions: Participants in Group A had 25μg of vaginal misoprostol with 1ml of intramuscular placebo, and those in Group B had 25μg of vaginal misoprostol with 20mg of Intramuscular Hyoscine (1 ml). Oxytocin infusion was used when indicated, and the labour was supervised as per departmental protocol.
Main outcome measure: Cervical ripening time
Results: The mean cervical ripening time was statistically significantly shorter in the hyoscine group (8.48±4.36 hours) than in the placebo group (11.40±7.33 hours); p-value 0.02, 95% CI 0.80-5.05. There was no statistically significant difference in the mean induction-delivery interval in Group A (7.38±5.28 hours) compared to Group B (7.75±5.04 hours), with a value of 0.54. The mode of delivery was comparable. However, women in Group B (53, 84.1%) achieved more vaginal deliveries than women in Group A (50, 79.4%); p-value 0.49. Thirteen women in Group A (20.6%) had a caesarean section, while ten women (15.9%) in Group B had a caesarean section (p-value 0.49, RR 0.94, CI 0.80-1.11). Adverse maternal and neonatal outcomes were not statistically significant between the two groups.
Conclusion: Intramuscular hyoscine was effective in reducing cervical ripening time when used as an adjunct to vaginal Misoprostol, with no significant adverse maternal or neonatal outcome.

Sex hormone-binding globulin is a valuable diagnostic indicator of gestational diabetes mellitus

Mon, 25 Mar 2024 00:00:00 +0000

Objective: To assess the performance of the Sex Hormone-Binding Globulin (SHBG) assay as a diagnostic indicator of Gestational Diabetes Mellitus (GDM) in the study population.
Design: Analytical cross-sectional study
Setting: Hospital-based, Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria.
Participants: Women with singleton pregnancies at 24 to 28 weeks gestational age attending Antenatal care at BSUTH, Makurdi.
Intervention: Serum SHBG levels were assayed by ELISA during a diagnostic 75-gram Oral Glucose Tolerance Test (OGTT) for assessment of GDM in the cohort of consecutively selected participants who met the inclusion criteria.
Main Outcome Measures: Serum levels of SHBG and presence of GDM in the participants.
Result: Serum SHBG was significantly negatively correlated (rpb = - 0.534, p-value < 0.001) with the presence of GDM. It had an area under the ROC curve of 0.897 (95% Confidence Interval = 0.858–0.935; p-value < 0.001). A cut-off value of 452.0 nmol/L indicative of GDM had a diagnostic odds ratio of 21.4 in the study population.
Conclusion: SHBG is a valuable diagnostic indicator for GDM in the study population.

Predictors of sexual and reproductive health knowledge and utilization of services among adolescents in Ghana’s Adaklu district

Mon, 25 Mar 2024 00:00:00 +0000

Objective: To explore factors associated with adolescents’ sexual and reproductive health (SRH) knowledge and their engagement with educational and clinical services
Design: Regression analysis of secondary data collected during a community survey
Setting: Adaklu district, Volta Region, Ghana
Participants: 221 adolescent caregiver pairs
Main outcome measures: The study employed three main outcome measures: (1) adolescents’ level of SRH knowledge (assessed via questionnaire), (2) membership in district-sponsored adolescent health clubs (AHCs), and (3) ever-utilization of clinical SRH services.
Results: Greater SRH knowledge was significantly associated with older age, AHC membership, and relying primarily on teachers or friends for SRH information. Increased odds of AHC membership were observed among females (AOR = 2.38, 95% CI 1.14-4.95); those who had communicated with one parent about sexual issues (OR 2.70, 95% CI 1.17-6.21); and those with a history of transactional sex (OR 5.53, 95% CI 1.04-29.37). Decreased odds were observed among adolescents whose caregivers were educated to the primary level (AOR = 0.24, 95% CI = 0.07-0.79). Overall, utilization of clinical SRH services was low, but higher odds were detected among individuals reporting a history of forced sex (AOR = 117.07, 95% CI 3.82-3588.52) and those who had discussed sexual issues with both of
their parents (AOR = 13.11, 95% CI 1.85-92.93).
Conclusions: Awareness of the predictors of knowledge, AHC involvement, and clinical service utilization can empower adolescent SRH initiatives—both present and future—to enhance their teaching, develop targeted outreach to underserved groups, and promote engagement with key clinical resources.

Detection of Helicobacter pylori infection in children using rapid urease and histologic methods of diagnosis

Mon, 25 Mar 2024 00:00:00 +0000

Objective: The study aimed to detect the presence of Helicobacter pylori infection in children using two investigative methods: the rapid urease test and histological methods. It also examined the relationship between socioeconomic status and Helicobacter pylori infection.
Design: This was a cross-sectional study conducted in the paediatric theatre at Korle Bu Teaching Hospital in Accra, Ghana.
Participants: Children who were scheduled for upper gastrointestinal endoscopy were recruited into the study.
Main outcome measures: The presence of Helicobacter pylori in gastric biopsies was measured using a rapid urease test and histology.
Results: Seventy-three children aged 2 years to 16 years were seen during the period. Both tests were positive at the same time in 36 (49.3%) out of the 73 children (p<0.0001). The positivity rates for the rapid urease test and histology were 57.5% and 53.4 %, respectively. Significant predictors of the histology presence of H. pylori were a large household size of at least 6 members (AOR: 4.03; p<0.013) and the presence of pets at home (AOR: 3.23; p<0.044).
Conclusions: Substantial agreement was found between the rapid urease test and histology examination of gastric biopsies for the presence of H. pylori. Children from large households and those with pets at home appear to have increased odds of having H. pylori infection of the gastric mucosa.

Legal and ethical challenges in assisted reproductive technology practice in Ghana

Theresa Barnes, Gordon Abakah-Nkrumah, Oboshie Anim-Boamah, Promise E. Sefogah — Mon, 25 Mar 2024 00:00:00 +0000

Objective: Infertility remains a global challenge, with assisted reproductive technology (ART) progressively gaining relevance in developing countries, including Ghana. However, associated ethico-legal challenges have not received the needed policy attention. This study explored the legal and ethical challenges of ART practice in Ghana.
Design: The study employed an exploratory phenomenological approach to examine ART in Ghana, focusing on ethics and law governing this practice.
Participants: Respondents were ART practitioners, managers, facility owners, representatives of surrogacy/gamete donor agencies, and regulatory body representatives.
Methods: A semi-structured interview guide was used to collect data. The in-depth interviews were audiotaped, and responses transcribed for analysis through coding, followed by generation of themes and sub-themes, supported with direct quotes.
Results: It emerged that there are no ethical and legal frameworks for ART practice in Ghana, and this adversely affects ART practice. Ethical challenges identified border on informed consent, clients’ privacy and clinical data protection, gamete donation issues, multiple gestations, single parenting, and social and religious issues. The legal challenges identified include the non-existence of a legal regime for regulating ART practice and the absence of a professional body with clear-cut guidelines on ART practice. In the absence of legal and ethical frameworks in Ghana, practitioners intimated they do comply with internationally accepted principles and general ethics in medical practice.
Conclusion: There are no regulations on ART in Ghana. Legal and ethical guidelines are essential to the provision of
safe and successful ART practices to protect providers and users. Governmental efforts to regulate Ghana need to be
prioritized.

Tracking the shift in enteric fever trends and evolving antibiotic sensitivity patterns

Mon, 25 Mar 2024 00:00:00 +0000

Objective: This study aims to examine the frequency of Salmonella Paratyphi found in blood cultures and evaluate the antibiotic susceptibility pattern of Salmonella isolates to different antibiotics. Additionally, the study aims to assess the paradigm shift in the trend of enteric fever caused by Salmonella Typhi (S. Typhi) to Salmonella Paratyphi(S. Paratyphi) .
Study Design: Retrospective study
Participant: The study enrolled patients aged 12 years and above diagnosed with enteric fever (positive blood culture) and admitted to Peelamedu Samanaidu Govindasamy Naidu (PSG) Hospital.
Interventions: The study analyzed demographic and antibiotic susceptibility profiles of Salmonella isolates collected from 106 enteric fever patients in the hospital between 2010 and 2022. The susceptibility profiles of Salmonella isolates to multiple antibiotics were assessed.
Results: There were 106 participants, and 95 (89.62%) of them had enteric fever linked to Salmonella Typhi, while only 11 (10.38%) had enteric fever linked to Salmonella Paratyphi A. From 2010 to 2022, the study discovered a general decline in the prevalence of enteric fever caused by Salmonella species. But between 2014 and 2022, the incidence of enteric fever linked to S. Typhi rapidly increased. Azithromycin (100% , n = 106) and ceftriaxone (99%, n = 105) were highly effective against the Salmonella isolates, whereas nalidixic acid was resisted by 3 isolates (4.72%, n = 3).
Conclusion: The study observed a higher incidence of Salmonella Typhi in comparison to Paratyphi A and a greater susceptibility of males to enteric fever.

Knowledge, attitude and utilisation of evidence-based therapeutic exercises in knee osteoarthritis management in Nigeria

Adesola C. Odole, Anita Okafor, Olufemi O. Oyewole, Ezinne Ekediegwu — Mon, 25 Mar 2024 00:00:00 +0000

Background: In Nigeria, there is a disparity among physiotherapists regarding therapeutic exercise as a core treatment for patients with knee osteoarthritis (OA). The attitudes and beliefs of physiotherapists could influence this.
Objective: To investigate Nigerian physiotherapists’ knowledge, attitude, and utilisation of evidence-based therapeutic exercises
Design: A mixed-method of cross-sectional survey and focus group discussion.
Setting: Secondary and tertiary health institutions in Nigeria
Participants: Physiotherapists consecutively sampled from the selected institutions.
Main outcome measures: Participants’ knowledge, attitude and utilisation of evidence-based therapeutic exercises for the management of knee OA
Results: This study revealed that 81% of physiotherapists in Nigeria had a fair knowledge of evidence-based practice and the efficacy of therapeutic exercises in managing knee OA. Despite this fair knowledge, 95.3% had a poor attitude. The important emerging categories/themes are treatment preference, clinical experience, and strength of evidence.
Conclusion: Physiotherapists in Nigeria have a fair knowledge of evidence-based therapeutic exercises in managing patients with knee OA, although there is a poor attitude and disparity between the use and current recommendations.

Adverse drug reactions, adherence, and virologic outcomes in adult patients on dolutegravir- based antiretroviral therapy at a tertiary hospital, southeast Nigeria

Mon, 25 Mar 2024 00:00:00 +0000

Objective: To assess the adherence, adverse drug reactions (ADR), and virologic outcomes of dolutegravir-based antiretroviral therapy.
Design: This was a retrospective chart review.
Setting: A tertiary health facility-based study in Abakaliki, Nigeria.
Participants: Five hundred and fifteen (515) adult patients on dolutegravir were selected using a Random Number Generator. Demographic and clinical data were extracted from patients’ case notes and analysed with IBM-SPSS version-25.
Main outcome measures: Adherence to dolutegravir, ADRs, virologic outcome, and change in Body Mass Index (BMI) were estimated.
Results: The mean age of the patients was 45.5±10.8 years; 68.2% of them were females; 97.1% of them had good self-reported adherence. The majority (82.9%) of them reported no ADRs and among those (17.1%) that did, headache (9.7%), body-itching (3.1%), and skin rash (2.7%) dominated. Most achieved viral suppression (94.4%) and did not have detectable viral particles (57.4%). There was a significant increase in the BMI of the patients with a mean weight increase of 0.9kg, a mean BMI increase of 0.3 kg/m2, and a 2.6% increase in the prevalence of overweight and obesity.
Conclusions: Patients on dolutegravir reported low ADRs, good self-reported adherence, and a high viral suppression rate. However, dolutegravir is associated with weight gain. We recommend widespread use and more population-wide studies to elucidate the dolutegravir-associated weight gain.

Mucocoele of the appendix

Mon, 25 Mar 2024 00:00:00 +0000

Introduction: Mucocoele of the appendix occurs in 0.2-0.7% of people in the world without any well-defined clinical symptoms. It occurs when there is an accumulation of mucous in the lumen of the appendix.
Case Presentation: We present three cases: a 48-year-old male admitted to the emergency room with a one-day history of right iliac fossa pain. Abdominal examination was suggestive of acute appendicitis. The initial abdominal computerised tomography scan was reported as being unremarkable. At surgery, a firm tumour of the appendix was found, and a limited right hemicolectomy was done. Histopathology confirmed a mucocoele of the appendix with borderline mucinous histology.
The second case is a 63-year-old man who presented with a one-year history of abdominal distension and weight loss. Previous abdominal ultrasound was suggestive of liver cirrhosis with significant ascitic fluid. Abdominal magnetic resonance imaging found an appendix mucocoele with infiltration of the omentum and scalloping of the liver surface suggestive of pseudomyxoma peritonei. A percutaneous biopsy of the omental mass confirmed metastatic mucinous adenocarcinoma of the appendix.
The third case is a 68-year-old man who, during an annual medical check-up, had an incidental finding of a cystic right iliac fossa mass on ultrasound, confirmed on abdominopelvic computerised tomography scan to be an appendix mucocele. He had laparoscopic appendicectomy. The histopathological diagnosis confirmed a mucinous cystadenoma of the appendix.
Conclusion: Preoperative diagnosis of appendiceal mucocoele is difficult and commonly discovered intraoperatively. The prognosis is good for the histologically benign type, but it is poor when malignant or peritoneal lesions are present.