Outbreak investigation and enhanced contact tracing of novel coronavirus disease 2019 (COVID-19), Ablekuma North Municipality, Greater Accra, Ghana

Introduction: After Ghana recorded its first two cases of COVID-19, other cases were subsequently identified in other parts of the country. The Ablekuma North Municipal Health Directorate was notified of a resident who reported to Korle-Bu Teaching Hospital on March 29, 2020 with fever, shortness of breath, general weakness, cough, chest pain. We investigated the report to estimate the magnitude of cases, to determine the secondary infection rate and to institute control and preventive measures. Methods: We conducted active case search using Ghana Health Service interim guideline for COVID-19 case investigation and management in Ablekuma North Municipality from April-July 31, 2020. We interviewed and collected samples of contacts and at-risk groups in affected households using collector for ArcGis and case investigation form. We summarized information of COVID-19 cases on our line list after samples have been confirmed. We analyzed data using Microsoft Excel 2016 and Stata 15, and presented as frequency and proportions. Results: The municipality recorded 213 cases with four deaths (Case fatality Rate=1.88%). The attack rate was 111.47 per 100,000 (213/ 191,075). Males were 135 (63.38%). The median age of case-patients was 27 years (interquartile range: 19 - 36years). Majority were students; 64 (30.05%). Most of the cases 89.20% (190/213) were asymptomatic. The median time between sample collection and release of laboratory results was 15 days (range: 4 - 22days). This response was a multi-sectorial approach, involving the Ministry of Health and the Ghana Health Service, Municipal Assembly, National Security Ministry, Ministry of Communication, Ministry of Information, and other government agencies. Conclusion: All confirmed cases were investigated. The attack rate was relatively high but low case fatality rate in the municipality. Strengthening laboratory capacity to test, to early report results is recommended. Lessons in handling cases indicate the need to sustain multi-sectorial collaboration to fight the outbreak

Hysterosalpingography Findings and Jimah Ratio of the Uterine Cavity in Women with Infertility in Central Region, Ghana

Background. Infertility affects from 1.3% to 25.7% of couples worldwide and, especially, from 14.5% to 16.4% in Africa. Hysterosalpingography (HSG) is a diagnostic modality that is considered both common and efficient. It is used to investigate abnormalities of the uterine cavity and fallopian tubes. This study assessed the spectrum of findings on HSG among women with infertility in the Central Region (Ghana). Methods. We conducted a prospective cross-sectional study to examine 203 infertile women undergoing HSG work-up at the Cape Coast Teaching Hospital. The exclusion criteria were acute infection of the vagina or cervix and active vaginal bleeding or pregnancy. Data were entered with Microsoft Excel and analyzed using SPSS version 21. Results. A total of 203 women were enrolled, and eighty-five (41.87%) of the women had at least one or more abnormalities. The mean age was 32.9 years with majority of the women within 30–39 years (61.08%). More than half (50.74%) of the women presented with secondary infertility, while age of women (p=0.004) and duration of infertility (0.034) were found to be in association with the type of infertility. Uterine findings were predominantly capacious uterine cavity (45.1%) and uterine fibroids (33.3%), while fallopian tube findings included bilateral blockage (24.2%), right unilateral proximal blockage (17.7%), loculated spillage (16.1%), and left unilateral proximal blockage (16.1%). The range of normal uterine cavity size, measured as ratio (Jimah ratio) of intercornual diameter to interiliac diameter was 0.2–0.45, with a mean of 0.36. Conclusion. Secondary infertility was the commonest indication for HSG in the study, and a significant proportion of infertile women had abnormalities. Abnormalities were higher in the fallopian tubes than the uterus, while capacious uterine cavity, uterine fibroid, and bilaterally blocked tubes were the top three abnormalities found

Competency in Chest Radiography Interpretation by Junior Doctors and Final Year Medical Students at a Teaching Hospital

Background. Chest radiography (CXR) is a widely used imaging technique for assessing various chest conditions; however, little is known on the medical doctors’ and medical students’ level of skills to interpret the CXRs. This study assessed the residents, medical officers, house officers, and final year medical students’ competency in CXRs interpretation and how the patient’s clinical history influences the interpretation. Methods. We conducted a cross-sectional study in the Cape Coast Teaching Hospital in the Central Region of Ghana among 99 nonradiologists, comprising 10 doctors in residency programmes, 18 medical officers, 33 house officers, and 38 final year medical students. The data collection was done with a semistructured questionnaire in two phases. In phase 1, ten CXRs were presented without patient’s clinical history. Phase 2 involved the same ten CXRs presented in the same order alongside the patient’s clinical history. Participants were given 3 minutes to interpret each image. Median and interquartile ranges were used to describe continuous variables, while frequencies and percentages were used to describe categorical variables. Test of significant difference and association was conducted using a Wilcoxon rank-sum test/Kruskal–Wallis test and chi-square (X2) test, respectively. Results. The average score for interpreting CXRs was 7.0 (IQR = 5–8) and 4.0 (IQR = 3-4), when CXRs were, respectively, presented with and without clinical history. No significant difference was seen in average scores regarding the levels of formal training. Without clinical history, only 40.0% of residents, 22.2% of medical officers, 24.2% of house officers, and 13.2% of medical students correctly interpreted CXRs, while more than 75% each of all categories correctly interpreted CXRs when presented with clinical history. However, all participants had difficulties in identifying CXR with pneumothorax (27.3% vs. 30.3%), pneumomediastinum or left rib fracture (8.1% vs. 33.3%), and lung collapse (37.4% vs. 37.4%) in both situations, with and without patient clinical history. Conclusion. The patient’s clinical history was found to greatly influence doctors’ competence in interpreting CXRs. We found a gap in doctors’ and medical students’ ability to interpret CXRs; hence, the development of this skill should be improved at all levels of medical training

Ketamine Use in Hysterosalpingography (the Jimah Procedure): A Follow-Up of Bilateral Tubal Evaluation of 27 Infertile Women at a Teaching Hospital, Ghana

Background. Pain, anxiety, and distress are common in radiological investigations including hysterosalpingogram (HSG). Studies suggest that sedation allows patients to better tolerate diagnostic imaging and image-guided procedures by relieving anxiety, discomfort, and pain. This study aimed at assessing the safety and effectiveness of ketamine use in HSG and the proportion of true positive bilateral tubal blockage during HSG using the Jimah Procedure. Methods. We performed repeated HSG workup under IV ketamine (20–40 mg/mL) sedation for 27 infertile women at the Cape Coast Teaching Hospital. The exclusion criteria included unilateral tubular blockage, acute infection of the vagina or cervix, active vaginal bleeding, glaucoma, and high blood pressure at the time of the study. Data were entered with Microsoft Excel and analyzed using SPSS version 21. Results. A total of 27 patients (age range: 25–48 years) previously diagnosed of bilateral tubal blockage or spasm were enrolled for the repeat HSG procedure. The median age was 34 years (IQR: 32–37), while secondary infertility (20) (74.1%) was the commonest indication. None of the patients reported of pain or distress during or after the procedure. Two (7.4%) women vomited after HSG. Twelve patients (44.4%) had bilateral tubal blockage (true positive), while tubal patency was seen in 15 (55.6%) patients on HSG under ketamine sedation. Conclusion. This study found IV ketamine sedation produces profound anesthesia and analgesia and eliminates tubal spasm. We recommend that radiologists in developing countries should consider sedating patients during HSG and documenting observations and patients’ feedback to help assess safety and effectiveness in local settings

Decolonising vaccine production: Unpacking Ghanaians’ support for made-in-Africa vaccines

Localisation of vaccine production is essential worldwide, but it is particularly crucial for Africa. This continent is more vulnerable to disease burdens and also lags behind other continents regarding access to vaccines. Moreover, many people in Africa have a long-standing apathy towards locally made products and services. This mindset raises the question of whether Africans will support African-made vaccines and what the associated reasons are. Guided by the theories of nationalism and import substitution industrialisation, we formulated and tested eight hypotheses. To answer these, we analysed survey data from 6,731 residents backed by key informant interviews in Ghana. Our findings identified three types of local vaccine consumers: Afrocentric-ethnocentrics, Apathetic-Afrocentrics and Afrocentric-Fence Sitters. Four out of the eight hypothesised factors explain why some individuals have a positive attitude towards locally made vaccines, compared to those who are unsure of their stance. The proposed typology of local vaccine consumers and their defining characteristics can help design public health campaigns to mobilize support for locally produced vaccines. These campaigns must consider tourism-dependent and non-dependent communities since the impact of these factors varies among them

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways