The Prevalence of the Metabolic Syndrome in Ghanaian Psychiatric Patients on Antipsychotic (First versus Second Generation) Treatment in the Kumasi Metropolis

Metabolic syndrome (MetS), a predominant public health problem linked to cardiovascular and other morbidities, has acquired a significant precedence in clinical settings and patients with severe mental illnesses who are at higher risk for deviant components of this syndrome due to their illness and its treatment require careful and regular monitoring in this regard. Even though MetS has been established to be more prevalent among psychiatric patients than among any other population group, no data exist on its prevalence in Ghanaian psychiatric patients. This study seeks to find the prevalence of the MetS, in Ghanaian psychiatric patients on antipsychotics (first or second generation) compared to newly diagnosed psychiatric patients. This cross-sectional study of patients attending psychiatric department of the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana between February 2009 and July 2010.  A total of 200 psychiatric patients comprising 100 newly diagnosed antipsychotic naïve patients and 100 patients on antipsychotic medication were sampled for the study. Prevalence of MetS diagnosed using the World Health Organization (WHO), International Diabetes Federation (IDF) and the National Cholesterol Education Programme, Adult Treatment Panel III (NCEP ATP III) criteria for defining MetS was employed.The prevalence was significantly higher among psychiatric patients on treatment in comparison with the treatment naïve group using NCEP ATP III (21.0% vs. 2.0%; p < 0.0001) and IDF (29.0% vs. 2.0%; p < 0.0001) criteria but not WHO (13.0% vs. 14.0%; p = 0.8372). Irrespective of the criteria used, the prevalence of MetS was higher among patients on second generation versus first generation antipsychotic medication (i.e. 44.4% vs. 18.7% for NCEP ATP III; 22.2% vs. 12.1% for WHO and 56.6% vs. 27.5% for IDF), however these did not reach a significant levelPrevalence of MetS was not only highly prevalent among Ghanaian patients treated with antipsychotic drugs, it was also higher among patients on second generation versus first generation antipsychotic medication. Keywords: Diabetes, hypertension, dyslipidaemia, mental illness, antipsychotics.

Exposition of Discriminatory Variables in a Family of Hypertensive and Non hypertensive Diabetic Patients: A Case Study of Komfo Anokye Teaching Hospital – Kumasi, Ghana

This study sought to expose variable(s) capable of predicting hypertensive status of diabetic patients. To this end, data on 260 diabetic  patients at the Komfo Anokye Teaching Hospital’s Diabetic Centre in Ghana were collected using data extraction form. The majority (144) of the 260 diabetic patients representing about 55% were also hypertensive as against 116 (45%) who were not hypertensive. Frequency analysis also revealed female dominance as far as the two diagnoses (Diabetes with hypertension and diabetes without hypertension) were concerned. However, the percentage of females in diabetes with hypertension (77%) was greater than the percentage of females in diabetes without hypertension (67%). The minimum age of hypertensive diabetic patients was 30 years as against 11 years for those diagnosed as non-hypertensive diabetic. A discriminant analysis was adopted to expose the discriminatory variables as far as the two diagnoses were concerned. The study indicated a strong association between diagnosis (diabetes with hypertension and diabetes without hypertension) and body mass index (BMI), and to some extent, also between diagnosis and age. BMI and age were identified as principal discriminating variables for separating patients diagnosed with diabetes with hypertension from those with diabetes without hypertension. The index of discrimination (canonical correlation) associated with the resulting discriminant model was 0.42 (42%). This is good since it is greater than 30. The hit ratio, (or the percentage of cases correctly classified) is 0.654 or 65.4%. Also, leave-one-out cross-validation which was used instead of an independent holdout sample correctly classified 64.2% of the cases. Finally, it was concluded that ageing and extra BMI gained are risk factors for diabetic patients to develop hypertension. Therefore, the model was good for prediction. Keywords: Diabetes, Hypertension, Model, Discriminant Analysis, Ghan

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