Neonatal Jaundice: awareness, perception and preventive practices in expectant mothers

Background: Neonatal jaundice (NNJ) is a preventable cause of neonatal morbidity and mortality. Improving mothers’ knowledge will help with early recognition of NNJ, prompt and appropriate intervention. This study highlights the knowledge, attitude and practice regarding neonatal jaundice among expectant mothers attending the antenatal clinics of Korle-Bu Teaching Hospital and Mamprobi Polyclinic in Accra.Methods: This was a cross-sectional study involving 175 expectant mothers. Interviewer based questionnaire was used to obtain data on knowledge, attitude and practice concerning NNJ. The study was conducted between 1st and 17th November 2013 at two antenatal clinics in Accra.Results: Out of the 175 respondents, 135 (77.1%) had heard about NNJ but only 37 (27.4%) of them heard it from the hospital. Among those who had heard about NNJ, 98 (72.6%) knew at least one symptom of NNJ; 125 (92.6%) did not know the causes of jaundice or had the wrong information and there was no significant association with theirlevel of education (X2 =6.757, p=0.15). Only 7(5.2%) knew one or more correct forms of treatment of NNJ; 67(49.6%) knew one or more danger signs and 86(63.5%) knew one or more complications.Conclusion: Majority of expectant mothers attending antenatal clinics at a Teaching Hospital and a Polyclinic in Accra, Ghana are aware of NNJ but have poor knowledge about the causes, danger signs and treatment of NNJ, irrespective of their level of education or their parity.Keywords: Jaundice, new born, mothers, knowledge, AccraFunding: None declare

Healthcare provider perspectives on HIV cure research in Ghana

INTRODUCTION: Antiretroviral therapy (ART) has reduced mortality and improved life expectancy among HIV patients but does not provide a cure. Patients must remain on lifelong medications and deal with drug resistance and side effects. This underscores the need for HIV cure research. However, participation in HIV cure research has risks without guaranteed benefits. We determined what HIV healthcare providers know about HIV cure research trials, the risks involved, and what kind of cure interventions they are likely to recommend for their patients. METHODS: We conducted in-depth qualitative interviews with 39 HIV care providers consisting of 12 physicians, 8 counsellors, 14 nurses, 2 pharmacists, 2 laboratory scientists, and 1 community advocate from three hospitals. Interviews were transcribed verbatim and coded, and thematic analysis was performed independently by two investigators. RESULTS: Participants were happy about the success of current treatments and hopeful that an HIV cure will be found in the near future, just as ART was discovered through research. They described cure as total eradication of the virus from the body and inability to test positive for HIV or transmit the virus. In terms of risk tolerance, respondents would recommend to their patients\u27 studies with mild to moderate risks like what patients on antiretroviral therapy experience. Participants were reluctant to recommend treatment interruption to patients as part of a cure study and wished trials could be performed without stopping treatment. Healthcare providers categorically rejected death or permanent disability as an acceptable risk. The possibility of finding a cure that will benefit the individual or future generations was strong motivations for providers to recommend cure trials to their patients, as was transparency and adequate information on proposed trials. Overall, the participants were not actively seeking knowledge on cure research and lacked information on the various cure modalities under investigation. CONCLUSION: While hopeful for an HIV cure, healthcare providers in Ghana expect a cure to be definitive and pose minimal risk to their patients

Comparative genomics of Mycobacterium africanum Lineage 5 and Lineage 6 from Ghana suggests distinct ecological niches.

Mycobacterium africanum (Maf) causes a substantial proportion of human tuberculosis in some countries of West Africa, but little is known on this pathogen. We compared the genomes of 253 Maf clinical isolates from Ghana, including N = 175 Lineage 5 (L5) and N = 78 Lineage 6 (L6). We found that the genomic diversity of L6 was higher than in L5 despite the smaller sample size. Regulatory proteins appeared to evolve neutrally in L5 but under purifying selection in L6. Even though over 90% of the human T cell epitopes were conserved in both lineages, L6 showed a higher ratio of non-synonymous to synonymous single nucleotide variation in these epitopes overall compared to L5. Of the 10% human T cell epitopes that were variable, most carried mutations that were lineage-specific. Our findings indicate that Maf L5 and L6 differ in some of their population genomic characteristics, possibly reflecting different selection pressures linked to distinct ecological niches

Integration of tuberculosis (TB) and HIV services in Ghana

Integration of health services involves managing services to enhance quality for patient needs that cut across multiple services, providers and settings. The rapid growth of human immunodeficiency virus (HIV) has increased tuberculosis (TB) cases, and TB/HIV integration offers a unified strategy for control. This study evaluated TB/HIV integration in Ghana. The three sites evaluated applied varying degrees of integration. A mixed methods approach comprised an uncontrolled before-and-after study involving 1330 TB cases, and qualitative interviews with 29 providers and patients. TB treatment success was 51% before and 69% after integration [p<0.01; OR(95% CI)=2.17 (1.72 to 2.74)]. Treatment success increased in all sites after integration: 43% to 53% at the one-stop shop (OSS), 69% to 78% at the partially integrated site (PIS), and 46% to 78% at the referral site (RS). The change was significant only at the RS [(Χ2=64.54; p<0.01; OR(95% CI)=4.28 (2.97 to 6.18)]. HIV screening was highest (99%) at the OSS (Χ2=68.26; p<0.01), HIV-positive cases on CPT were highest (93.8%) at the RS (Χ2=9.29; p<0.01), and the PIS had the highest number (59.5%) on ART (Χ2=95.00; p<0.01). TB/HIV integration may improve TB treatment outcomes but effectiveness is difficult to ascertain due to study design limitations. TB treatment success and TB mortality might be more informative indicators for TB/HIV activities. TB/HIV outputs seemed unrelated to greater integration when compared across sites. This was probably due to existing barriers to integration including missed opportunities, provider fear of loss of influence, financial burden of illness, and stigma. Patient-provider interactions offered privacy and counselling but patients’ illness experiences were not explored, and there was lack of decision-sharing. Patients were also unaware of their right to dignity and respect, or their role in disease management. Facilitators of integration included direct supervision, mutual adjustment and standardisation. Recommendations include conducting more rigorous evaluation studies, including TB mortality in TB/HIV monitoring, prioritising health system strengthening instead of increasing degrees of integration, and improving patient-centred care through provider communication and patient empowerment

Causes of death at the University of Ghana Hospital in Accra-a 37-year review (1979-2015).

Background: An analysis of the causes of death in developing countries is needed to improve healthcare delivery. The aim of this study was to conduct a descriptive analysis of the causes of death at the University of Ghana Hospital from 1979 to 2015. Methods: Data were extracted from the electronic database of the University of Ghana Hospital. Diseases were grouped into three broad groups of causes of death as per the Global Burden of Disease cause list, with some diseases of epidemiological importance outlined and analysed by age, gender and time in years. Results: Of 3263 deaths, almost 60% were caused by non-communicable diseases (NCDs) that consisted of cancers, diabetes mellitus, cardiovascular diseases and other systemic conditions. Deaths by malaria, tuberculosis, diarrhoeal diseases and immunizable childhood diseases declined over the years while deaths from NCDs increased. The majority of cases of NCDs were due to cardiovascular disorders. Conclusions: The study suggests that Ghana has a double burden of disease with predominantly NCDs from cardiovascular diseases, metabolic disorders and cancers. Although malaria and other childhood-related illnesses have declined significantly, human immunodeficiency virus is fuelling the communicable disease mortalities. There is an urgent need to scale up NCD control interventions while strengthening communicable disease control

How can we achieve person-centred care for people living with HIV/AIDS? A qualitative interview study with healthcare professionals and patients in Ghana

Although person-centred care (PCC) has been identified as a means to achieve the 90-90-90 targets, limited research has considered PCC in low- or middle-income settings. We aimed to explore what constitutes PCC from the perspectives of PLWHA and healthcare professionals (HCP) in Ghana. We conducted 39 semi-structured qualitative interviews with PLWHA and HCP in two community clinics in Ghana, West Africa. Interviews were analysed deductively using thematic analysis, and sampling continued until thematic saturation was achieved. Twenty-four PLWHA (median age 42.5, 50% female) and 15 HCP (median age 34, 53% female) were interviewed. Three interconnected themes emerged across PLWHA and HCP: (1) care structures not built around the person, (2) priority outcomes and components of PCC and (3) re-engineering HIV care to be more person-centred. A conceptual model showing the overlap between PLWHA and HCP’s perspectives of PCC and a framework to inform PCC delivery have been developed from these findings. Our data revealed that PLWHA want PCC to improve care outcomes, well-being and quality of life. Further testing of this model is required to inform PCC delivery for PLWHA in low- and middle-income countries

Phase II mixed methods’ feasibility cluster randomised controlled trial of a novel community-based enhanced care intervention to improve person-centred outcomes for people living with HIV in Ghana

Person-centred care (PCC) for people living with HIV (PLWH) is a global goal for WHO and the UNAIDS strategy. We aimed to develop a novel person-centred intervention for community providers, test the feasibility of participant recruitment and retention, intervention delivery and to establish acceptability. Findings from qualitative interviews with PLWH and healthcare professionals were mapped onto a PCC theory in an expert intervention development workshop. A parallel feasibility cluster randomised controlled trial (cRCT) was conducted. We randomly assigned clusters (1:1) either to intervention or to standard care. The primary outcome was trial recruitment and retention. We screened 83 PLWH, enrolled 60 with 30 allocated to each arm. Recruitment and retention rates were 87% and 97%, respectively. Potential effect size achieved at final timepoint: a measure of person-centred outcomes [0.7 (95% CI 0.17–1.23) p < 0.001]; MOSHIV [0.7 (95% CI 0.17–1.23) p < 0.001]; Patient Experience Questionnaire [0.8 (95% CI 0.27–1.31) p < 0.001]; CARE Measure [1.0 (95% CI 0.45–1.55) p < 0.001], POSITIVE OUTCOMES [0.7 (95% CI 0.17–1.23) p < 0.001]. Post-trial interviews revealed general acceptability of the intervention. The results confirm the feasibility and justify a definitive cRCT of the enhanced care intervention to improve person-centred outcomes for PLWH.Trial registration number ISRCTN13630241