Quality of Care: A Review Of Maternal Deaths In A Regional Hospital In Ghana

The government of Ghana and key stakeholders have put into place several interventions aimed at reducing maternal deaths. At the institutional level, the conduct of maternal deaths audit has been instituted. This also contributes to reducing maternal deaths as shortcomings that may have contributed to such deaths could be identified to inform best practice and forestall such occurrences in the future. The objective of this study was to review the quality of maternal care in a regional hospital. A review of maternal deaths using Quality of Care Evaluation Form adapted from the Komfo Anokye Teaching Hospital (KATH) Maternal Death Audit Evaluation Committee was used. About fifty-five percent, 18 (55%) of cases were deemed to have received adequate documentation, senior clinicians were involved in 26(85%) of cases. Poor documentation, non-involvement of senior clinicians in the management of cases, laboratory related issues particularly in relation to blood and blood products as well as promptness of care and adequacy of intensive care facilities and specialists in the hospital were contributory factors to maternal deaths . These are common themes contributing to maternal deaths in developing countries which need to be urgently tackled. Maternal death review with emphasis on quality of care, coupled with facility gap assessment, is a useful tool to address the adequacy of emergency obstetric care services to prevent further maternal deaths. (Afr J Reprod Health 2015; 19[3]: 68-76). Keywords: Maternal death, Review, Quality of care, Sub-saharan Africa, Ghana Le gouvernement du Ghana et les principaux intervenants ont mis en place plusieurs interventions visant à réduire la mortalité maternelle. Au niveau institutionnel, l’on a mis en place le processus de vérification des décès maternels. Ceci contribue également à réduire la mortalité maternelle puisque les lacunes qui peuvent avoir contribué à ces décès pourraient être identifiées pour influencer les meilleures pratiques et prévenir de telles occurrences dans l'avenir. L'objectif de cette étude était d'évaluer la qualité des soins de santé maternelle dans un hôpital régional. Un examen des décès maternels a été effectué à l'aide du Formulaire d'Evaluation de la Qualité des Soins adapté du Comité de vérification des décès maternels du Centre Hospitalier Universitaire de Komfo Anokye (CHUKA). Il est estimé qu’environ cinquante-cinq pour cent, 18 (55%) des cas ont reçu une documentation adéquate ; des cliniciens chevronnés ont été impliqués dans 26 (85%) des cas. La documentation insuffisante, la non-implication des cliniciens expérimentés dans la gestion des cas, les problèmes relatifs au laboratoire surtout en ce qui concerne le sang et les produits sanguins ainsi que la rapidité des soins et de l'adéquation des services du soin intensif et des spécialistes à l'hôpital, ont été des facteurs contributifs à la mortalité maternelle. Ce sont des thèmes communs qui contribuent à la mortalité maternelle dans les pays en développement qui doivent être abordés d'urgence. L’examen de décès maternel, tout en mettant l'accent sur la qualité des soins, ajouté à l'évaluation de l'écart de l'installation, est un outil utile pour faire face à la pertinence des services de soins obstétricaux d'urgence pour prévenir d'autres décès maternels. (Afr J Reprod Health 2015; 19[3]: 68-76). Mots-clés: mortalité maternelle, critique, qualité des soins, Afrique subsaharienne, Ghan

EFFECTIVENES AND SAFETY ASSESSMENT OF MIST TONICA, A HERBAL HAEMATINIC

Anaemia is a widespread public health problem, and in Ghana it is the fourth leading cause of hospital admissions and the second factor contributing to death. Mist Tonica, an herbal haematinic produced by the Centre for Scientific Research into Plant Medicine (CSRPM), Ghana, was assessed for its effectiveness and safety in humans after Ethics Committee approval. Clinically established anaemic-patients aged, 13 years and above, with haemoglobin levels less than 11.5 g/dl and 13.5g/dl for females and males respectively were treated with Mist Tonica, 8.96 g/ 40 mls three times daily for two weeks . The mean haemoglobin rise per week caused by Mist Tonica was 1.92 (0.76) g/dl, range (1.66 - 2.55) g/dl/week and over 88 % of the patients on Mist Tonica had their appetite for food improved. Haematological profile, liver and kidney functions were not adversely affected by Mist Tonica. Results of the study suggest that Mist Tonica is an effective and safe herbal haematinic

The burden of drug resistance tuberculosis in Ghana; results of the First National Survey.

Resistance to Tuberculosis drugs has become a major threat to the control of tuberculosis (TB) globally. We conducted the first nation-wide drug resistance survey to investigate the level and pattern of resistance to first-line TB drugs among newly and previously treated sputum smear-positive TB cases. We also evaluated associations between potential risk factors and TB drug resistance. Using the World Health Organization (WHO) guidelines on conducting national TB surveys, we selected study participants from 33 health facilities from across the country, grouped into 29 clusters, and included them into the survey. Between April 2016 and June 2017, a total of 927 patients (859 new and 68 previously treated) were enrolled in the survey. Mycobacterium tuberculosis complex (MTBC) isolates were successfully cultured from 598 (65.5%) patient samples and underwent DST, 550 from newly diagnosed and 48 from previously treated patients. The proportion of patients who showed resistance to any of the TB drugs tested was 25.2% (95% CI; 21.8-28.9). The most frequent resistance was to Streptomycin (STR) (12.3%), followed by Isoniazid (INH) (10.4%), with Rifampicin (RIF), showing the least resistance of 2.4%. Resistance to Isoniazid and Rifampicin (multi-drug resistance) was found in 19 (3.2%; 95% CI: 1.9-4.9) isolates. Prevalence of multidrug resistance was 7 (1.3%; 95% CI: 0.5-2.6) among newly diagnosed and 12 (25.0%; 95% CI: 13.6-39.6) among previously treated patients. At both univariate and multivariate analysis, MDR-TB was positively associated with previous history of TB treatment (OR = 5.09, 95% CI: 1.75-14.75, p = 0.003); (OR = 5.41, 95% CI: 1.69-17.30, p = 0.004). The higher levels of MDR-TB and overall resistance to any TB drug among previously treated patients raises concerns about adherence to treatment. This calls for strengthening existing TB programme measures to ensure a system for adequately testing and monitoring TB drug resistance

Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

Summary Background Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. Methods In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and self-reported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). Findings We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N = 740,815). Across surveys, 15.1%–56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27–2.40) and symptomatic TB (OR 1.49, 95% CI 1.34–1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17–2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55–1.55). For alcohol drinking ≥ twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70–3.62) for subclinical TB and OR 1.43, 95% CI 0.59–3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0–85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. Interpretation Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB

Tobacco smoking clusters in households affected by tuberculosis in an individual participant data meta-analysis of national tuberculosis prevalence surveys: Time for household-wide interventions?

Tuberculosis (TB) and non-communicable diseases (NCD) share predisposing risk factors. TB-associated NCD might cluster within households affected with TB requiring shared prevention and care strategies. We conducted an individual participant data meta-analysis of national TB prevalence surveys to determine whether NCD cluster in members of households with TB. We identified eligible surveys that reported at least one NCD or NCD risk factor through the archive maintained by the World Health Organization and searching in Medline and Embase from 1 January 2000 to 10 August 2021, which was updated on 23 March 2023. We compared the prevalence of NCD and their risk factors between people who do not have TB living in households with at least one person with TB (members of households with TB), and members of households without TB. We included 16 surveys (n = 740,815) from Asia and Africa. In a multivariable model adjusted for age and gender, the odds of smoking was higher among members of households with TB (adjusted odds ratio (aOR) 1.23; 95% CI: 1.11–1.38), compared with members of households without TB. The analysis did not find a significant difference in the prevalence of alcohol drinking, diabetes, hypertension, or BMI between members of households with and without TB. Studies evaluating household-wide interventions for smoking to reduce its dual impact on TB and NCD may be warranted. Systematically screening for NCD using objective diagnostic methods is needed to understand the actual burden of NCD and inform comprehensive interventions

Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys

Background Non-communicable diseases (NCDs) and NCD risk factors, such as smoking, increase the risk for tuberculosis (TB). Data are scarce on the risk of prevalent TB associated with these factors in the context of population-wide systematic screening and on the association between NCDs and NCD risk factors with different manifestations of TB, where ∼50% being asymptomatic but bacteriologically positive (subclinical). We did an individual participant data (IPD) meta-analysis of national and sub-national TB prevalence surveys to synthesise the evidence on the risk of symptomatic and subclinical TB in people with NCDs or risk factors, which could help countries to plan screening activities. Methods In this systematic review and IPD meta-analysis, we identified eligible prevalence surveys in low-income and middle-income countries that reported at least one NCD (e.g., diabetes) or NCD risk factor (e.g., smoking, alcohol use) through the archive maintained by the World Health Organization and by searching in Medline and Embase from January 1, 2000 to August 10, 2021. The search was updated on March 23, 2023. We performed a one-stage meta-analysis using multivariable multinomial models. We estimated the proportion of and the odds ratio for subclinical and symptomatic TB compared to people without TB for current smoking, alcohol use, and self-reported diabetes, adjusted for age and gender. Subclinical TB was defined as microbiologically confirmed TB without symptoms of current cough, fever, night sweats, or weight loss and symptomatic TB with at least one of these symptoms. We assessed heterogeneity using forest plots and I2 statistic. Missing variables were imputed through multi-level multiple imputation. This study is registered with PROSPERO (CRD42021272679). Findings We obtained IPD from 16 national surveys out of 21 national and five sub-national surveys identified (five in Asia and 11 in Africa, N = 740,815). Across surveys, 15.1%–56.7% of TB were subclinical (median: 38.1%). In the multivariable model, current smoking was associated with both subclinical (OR 1.67, 95% CI 1.27–2.40) and symptomatic TB (OR 1.49, 95% CI 1.34–1.66). Self-reported diabetes was associated with symptomatic TB (OR 1.67, 95% CI 1.17–2.40) but not with subclinical TB (OR 0.92, 95% CI 0.55–1.55). For alcohol drinking ≥ twice per week vs no alcohol drinking, the estimates were imprecise (OR 1.59, 95% CI 0.70–3.62) for subclinical TB and OR 1.43, 95% CI 0.59–3.46 for symptomatic TB). For the association between current smoking and symptomatic TB, I2 was high (76.5% (95% CI 62.0–85.4), while the direction of the point estimates was consistent except for three surveys with wide CIs. Interpretation Our findings suggest that current smokers are more likely to have both symptomatic and subclinical TB. These individuals can, therefore, be prioritised for intensified screening, such as the use of chest X-ray in the context of community-based screening. People with self-reported diabetes are also more likely to have symptomatic TB, but the association is unclear for subclinical TB

Femmes enceintes et l’usage de l’alcool dans le Disrict d’Ashanti Region, Ghana

Drinking alcohol in pregnancy is a serious public health concern worldwide. This study sought to determine the magnitude and socio-demograhic characteristics of pregnant women attending Antenatal clinic in the Bosomtwe district, Ghana who drank alcohol and to assess their general knowledge about the effects of alcohol in pregnancy. The study, a descriptive cross-sectional, was conducted in all the ten health facilities providing reproductive health care with a sample size of 397 pregnant women using structured questionnaires. The findings of the study were that 20.4% of pregnant women drank alcohol. The 25-29 year group 26 (34.0%), married 50 (61.7%) and Junior High School Educated 37 (45.7%) as well as Christians 69 (85.0%) and traders 28 (34.6%) drank most. Majority 77 (33.5%) heard about the detrimental effects of alcohol at Antenatal Clinics (ANC). The District Health Management Team (DHMT) should strengthen health education on alcohol at ANC and through the radio as well as the DHMT collaborating with the Ghana Education Service to embark on education of school pupils and students on the harmful effects of alcohol in pregnancy (Afr J Reprod Health 2012; 16[1]:55-60).La consommation de l’alcool pendant la grossesse est un gros problème de santé publique partout dans le monde. Cette étude a cherché à déterminer l’ampleur et les caractéristiques sociodémographiques des femmes enceintes qui fréquentent la clinique prénatale qui consomment l’alcool et à évaluer leur connaissance générale sur l’effet de l’alcool dans la grossesse. L’étude, qui est descriptive et transversale, a été menée auprès de dix établissements de santé qui assurent des services de santé de la reproduction à l’aide d’un échantillon de 397 femmes enceintes à travers des questionnaires structurés. Les résultats de l’étude révélaient que 24% des femmes enceintes buvaient de l’alcool. Le groupe des femmes qui ont 25 – 29 ans, 26 (34,0%) mariées, 50(61, 7%) et celles qui sont scolarisées jusqu'au niveau du collège 37 (45,7%) aussi bien que les chrétiennes 69(85,0) et les marchandes 28 (34,6%) buvaient le plus. La majorité ,77 (33,5%) a appris les effets nuisibles de l’alcool aux cliniques anténatales (CAN). Le District Health Management Team (DHMT) doit renforcer l’éducation sanitaire sur l’alcool dans les CAN et à travers la radio et le DHMT doit collaborer avec le Ghana Education Service pour commencer la sensibilisation des élèves et des étudiants concernant les effets nuisibles de l’alcool pendant la grossesse (Afr J Reprod Health 2012; 16[1]:55-60)

Pregnant women and alcohol use in the Bosomtwe district of the Ashanti region-Ghana.

Drinking alcohol in pregnancy is a serious public health concern worldwide. This study sought to determine the magnitude and socio-demograhic characteristics of pregnant women attending Antenatal clinic in the Bosomtwe district, Ghana who drank alcohol and to assess their general knowledge about the effects of alcohol in pregnancy. The study, a descriptive cross-sectional, was conducted in all the ten health facilities providing reproductive health care with a sample size of 397 pregnant women using structured questionnaires. The findings of the study were that 20.4% of pregnant women drank alcohol. The 25-29 year group 26 (34.0%), married 50 (61.7%) and Junior High School Educated 37 (45.7%) as well as Christians 69 (85.0%) and traders 28 (34.6%) drank most. Majority 77 (33.5%) heard about the detrimental effects of alcohol at Antenatal Clinics (ANC). The District Health Management Team (DHMT) should strengthen health education on alcohol at ANC and through the radio as well as the DHMT collaborating with the Ghana Education Service to embark on education of school pupils and students on the harmful effects of alcohol in pregnancy

Effectiveness And Safety Assessment Of Mist Tonica, A Herbal Haematinic

Anaemia is a widespread public health problem, and in Ghana it is the fourth leading cause of hospital admissions and the second factor contributing to death. Mist Tonica, an herbal haematinic produced by the Centre for Scientific Research into Plant Medicine (CSRPM), Ghana, was assessed for its effectiveness and safety in humans after Ethics Committee approval. Clinically established anaemic-patients aged, 13 years and above, with haemoglobin levels less than 11.5 g/dl and 13.5g/dl for females and males respectively were treated with Mist Tonica, 8.96 g/ 40 mls three times daily for two weeks . The mean haemoglobin rise per week caused by Mist Tonica was 1.92 (0.76) g/dl, range (1.66 - 2.55) g/dl/week and over 88 % of the patients on Mist Tonica had their appetite for food improved. Haematological profile, liver and kidney functions were not adversely affected by Mist Tonica. Results of the study suggest that Mist Tonica is an effective and safe herbal haematinic

Assesssing Herbal Medical Practitioners in Professional Qualifying Examination in Ghana, a Model

About 70% of Ghanaians depend on Alternative health practice for their primary health care needs. Hence, there is the need to streamline and regulate these practices. Graduates from the Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology (K.N.U.S.T), Kumasi-Ghana were assessed by the Professional Qualifying Examination Board of the Traditional Medicine Practice Council (TMPC), Ghana, after two years of internship training. A model of assessment took into consideration, the scope of the university training, internship and the primary health care needs of the society