Educational status and religion influence uptake of voluntary HIV counseling and testing by Ghanaian antenatal clinic attendees.

A cross-sectional survey of 150 gravidae, randomly sampled from three antenatal clinics in Tema was conducted to investigate factors influencing their acceptance of routine “opt-out” counseling and testing. Descriptive analysis was done for participants’ demographic characteristics, as well as knowledge of vertical transmission and its implications for mother and child. Other measures of interest were rate and potential determinants of acceptance. Associations between respondents’ socio-demographic variables and acceptance behaviour were determined using odds ratios, with p-values and 95% confidence intervals. P-values were obtained from Fisher’s exact tests and significance levels set at a p-value of 0.05. Participants’ mean age was 29.7years±1.31 (95% CI 24.15-35.25). Of 150 participants, 76.7% (115/150) were married, 9.3% (14/150) had received no formal education, 25.3% (38/150) were unemployed and 78.7% (118/150) were Christians. Most (96%; 144/150) respondents knew about the disease and 89% (128/144) of this proportion identified vertical transmission as a means for its spread. Within the latter, 69% (87/128) knew of preventive interventions against vertical transmission. Acceptance rate of counseling and testing was approximately 93% (140/150). Main reasons cited for acceptance were to safeguard mother’s own health (92.1%, 129/140) and to prevent transmission to baby (87.1%, 122/140). Respondents identified fear (80%, 8/10) and stigmatization (70%, 7/10) as perceived barriers to acceptance. Age (OR=2.78; 95% CI=0.62-12.42; p=0.16), parity (OR=1.98; 95%CI=0.39-10.14; p=0.41) and marital status (OR=2.04; 95%CI=0.46-9.02; p=0.34) did not influence acceptance behaviour. Educated women were about 1.5 times [(132/136)/(9/14); OR=24.44; 95%CI=5.02-118.99; p=0.001)] more likely than their uneducated counterparts to accept counseling and testing services, while Christian women were 1.2 times [(115/118)/(26/32]); OR=13.27; 95%CI=2.53- 69.51; p=0.001)] more likely to do so than Muslims. Counseling and testing services were highly acceptable among our sample irrespective of age, parity and marital status. Educational status and religion were potential determinants of acceptance. Keywords: HIV, voluntary counseling and testing (VCT), prevention of mother-to-child transmission (PMTCT), Ghana

Antibiotic Use in a Municipal Veterinary Clinic in Ghana.

Antimicrobial resistance (AMR) is a threat to public health, impacting both human and animal health as well as the economy. This study sought to describe antibiotic prescription practices and use in the Kintampo North Municipal Veterinary Clinic in Ghana using routinely collected data. Of the 513 animals presented for care between 2013 and 2019, the most common animals were dogs (71.9%), goats (13.1%), and sheep (11.1%). Antibiotics were prescribed for 273/513 (53.2%) of the animals. Tetracycline was the most commonly prescribed class of antibiotics, (99.6%). Of the 273 animals that received antibiotics, the route of administration was not documented in 68.9%, and antibiotic doses were missing in the treatment records in 37.7%. Details of the antibiotic regimen and the medical conditions diagnosed were often not recorded (52.8%). This study recommends appropriate documentation to enable continuous audit of antibiotic prescription practice and to improve quality of use. There is also the need for a national survey on antibiotic prescribtion and use in animal health to support policy implementation and decision making in One-Health in Ghana

Investigating Ghanaian Allium species for anti-infective and resistance-reversal natural product leads to mitigate multidrug-resistance in tuberculosis

The bulbs of Allium species are a known source of antibacterial phytochemicals. Anti-infective, efflux pump and biofilm inhibitory activities of bulb extracts of selected Ghanaian shallots Allium cepa var aggregatum were evaluated using the HT-SPOTi assay and other whole-cell phenotypic screening techniques to determine their possible mechanisms of action. Ethanol and aqueous extracts of white A. cepa inhibited the growth of Mycobacterium smegmatis mc2 155 and Escherichia coli, respectively. The majority of the Allium extracts significantly (p < 0.05) exhibited efflux pump inhibitory activity against all the acid-fast, Gram-positive and Gram-negative strains used. Hexane and chloroform extract of the pink A. cepa and the aqueous extract of the white A. cepa significantly inhibited M. smegmatis biofilm formation. For Pseudomonas aeruginosa, the inhibition was observed at 250 µg/mL for the aqueous extract (~77.34%) and 125 µg/mL for the hexane extract (~76.51%). The results suggest that Ghanaian shallots could potentially be useful when further developed to tackle antimicrobial resistance, particularly in tuberculosis (TB)

Clinical characteristics and prognosis of patients admitted for heart failure: A 5-year retrospective study of African patients

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Item is not available in this repository.Background Mortality associated with heart failure (HF) remains high. There are limited clinical data on mortality among HF patients from African populations. We examined the clinical characteristics, long-term outcomes, and prognostic factors of African HF patients with preserved, mid-range or reduced left ventricular ejection fraction (LVEF). Methods and results We conducted a retrospective longitudinal cohort study of individuals aged ≥ 18 years discharged from first HF admission between January 1, 2009 and December 31, 2013 from the Cardiac Clinic, Directorate of Medicine of the Komfo Anokye Teaching Hospital, Ghana. A total of 1488 patients diagnosed of HF were included in the analysis. Of these, 345 patients (23.2%) had reduced LVEF (LVEF < 40%) [HFrEF], 265(17.8%) with mid-range LVEF (40% ≥ LVEF < 50%) [HFmEF] and 878 (59.0%) had preserved LVEF (LVEF ≥ 50%) [HFpEF]. Kaplan–Meier curves and log-rank test demonstrated better prognosis for HFpEF compared to HFrEF and HFmEF patients. An adjusted Cox analysis showed a significantly lower risk of mortality for HFpEF (hazard ratio (HR); 0.74; 95% confidence interval (CI) 0.57–0.94) p = 0.015). Multivariate analyses showed that age, higher New York Heart Association (NYHA) functional class, lower LVEF, chronic kidney disease, atrial fibrillation, anemia, diabetes mellitus and absence of statin and aldosterone antagonist treatment were independent predictors of mortality in HF. Although, prognostic factors varied across the three groups, age was a common predictor of mortality in HFpEF and HFmEF. Conclusions This study identified the clinical characteristics, long-term mortality and prognostic factors of African HF patients with reduced, mid-range and preserved ejection fractions in a clinical setting.https://doi.org/10.1016/j.ijcard.2017.03.014238pubpu

Malaria rapid diagnostic test evaluation at private retail pharmacies in Kumasi, Ghana

Objective: Malaria rapid diagnostic test (MRDT) provides a good alternative to malaria microscopy diagnosis, particularly in resource-constrained settings. This study therefore evaluated MRDT in private retail pharmacies (PRPs) as a critical step in community case malaria management. Methods: In a prospective, cross-over, validation survey at six PRPs in the Ashanti Region of Ghana, 1200 patients presenting with fever in the preceding 48 h were sampled. Fingerstick blood samples were collected for preparation of thick and thin blood films for malaria microscopy. Categorized patients (600 each) went through the processes of MRDT or presumptive diagnosis (PD) of malaria. The malaria disease prevalence of the study area was established. Selectivity (Se), specificity (Sp), positive predictive value (PPV) along with false discovery rate (FDR), and negative predictive value (NPV) along with the false omission rate (FOR), and diagnostic odds ratio (DOR) of MRDT were then calculated. Findings: While 43.0% tested positive using the MRDT, 57.0% tested negative. However, 62.0% MRDT-negative patients in addition to all the MRDT positives were given artemether-lumefantrine. Of those diagnosed by PD, 98.2% were prescribed with an antimalarial (microscopy however confirmed only 70.3% as positive). Se and Sp of the MRDT were 90.68 ± 11.18% and 98.68 ± 1.19%, respectively. Malaria prevalence was estimated to be 43.3%. PPV was 98.0%, FDR was 2.0%, NPV was 98.0%, FOR was 2.0%, and DOR was 2366.43. Conclusion: Results highlighted good performance of MRDTs at PRPs which could inform decision toward its implementation

Review of novel therapeutic targets for improving heart failure treatment based on experimental and clinical studies

Heart failure (HF) is a major public health priority due to its epidemiological transition and the world’s aging population. HF is typified by continuous loss of contractile function with reduced, normal, or preserved ejection fraction, elevated vascular resistance, fluid and autonomic imbalance, and ventricular dilatation. Despite considerable advances in the treatment of HF over the past few decades, mortality remains substantial. Pharmacological treatments including β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone antagonists have been proven to prolong the survival of patients with HF. However, there are still instances where patients remain symptomatic, despite optimal use of existing therapeutic agents. This understanding that patients with chronic HF progress into advanced stages despite receiving optimal treatment has increased the quest for alternatives, exploring the roles of additional pathways that contribute to the development and progression of HF. Several pharmacological targets associated with pathogenesis of HF have been identified and novel therapies have emerged. In this work, we review recent evidence from proposed mechanisms to the outcomes of experimental and clinical studies of the novel pharmacological agents that have emerged for the treatment of HF

Situational analysis of antibiotic use and resistance in Ghana: policy and regulation

Abstract Background Antibiotics have played an essential role in decreasing morbidity and mortality from infectious diseases. However, indiscriminate use and unrestricted access is contributing to the emergence of bacterial resistance. This paper reports on a situational analysis of antimicrobial use and resistance in Ghana, with focus on policy and regulation. Methods Relevant policy documents, reports, regulations and enactments were reviewed. PubMed and Google search engines were used to extract relevant published papers. Websites of stakeholders such as Ministry of Health (MOH) and its agencies were also reviewed. An interview guide was used to elicit responses from selected officials from these sectors. Results Laws and guidelines to control the use of antimicrobials in humans were available but not for animals. There was no National Antimicrobial Policy (NAP). A health practice regulatory law mandates Physicians, Physician Assistants, Midwives and trained Nurses to prescribe antimicrobials. However, antibiotics are widely prescribed and dispensed by unauthorised persons, suggesting weak enforcement of the laws. Antibiotics were also supplied to and from unapproved medicine outlets. The Standard Treatment Guidelines (STG), Essential Medicines List (EML) and the National Health Insurance Scheme Medicines List (NHISML) provide restrictions regarding levels of prescribing of antimicrobials. However, existing guidelines on antibiotic use are mostly not adhered to. The use of Automatic Stop Orders to avoid wastage in the hospitals is also not practiced. Data on use of antibiotics for individuals are not readily available in most facilities. Again, there are no standards or guidelines on veterinary use of antibiotics. Surveillance systems for consumption of antibiotics and resistance monitoring were not in place in most health facilities. However, there is an ongoing national action to create awareness on bacteria resistance, strengthening knowledge through research and surveillance and development of NAP in line with global action plan on antimicrobial resistance. Conclusion Absence of national antimicrobial policy, weak regulatory environment and non-adherence to practice standards may have contributed to increased and unregulated access to antimicrobials in Ghana, a catalyst for development and spread of antimicrobial resistance

Evaluation of the Knowledge, Attitude and Perception of Healthcare Students on Antibiotics and Antibiotic Resistance: A Study in Central University, Ghana

Students undergoing programmes in healthcare will play an important role in the management of antibiotic resistance which is still a global problem. Their knowledge and attitude should be adequately documented. This study is carried out to evaluate the knowledge, attitudes and perceptions of antibiotic use and antibiotic resistance among healthcare students in Central University, Ghana. In this study, 1027 students offering courses in pharmacy, nursing and physician assistantship participated in a survey to evaluate their knowledge, attitudes and perception on antibiotic use and antibiotic resistance. Data obtained was analyzed using STATA statistics DATA analysis software version 12.0. Descriptive statistics and chi-squared test was employed. Students displayed very good knowledge of antibiotic use and antibiotic resistance with students studying physician assistantship and nursing showing greater knowledge. The attitude of the respondents on the use of antibiotics was slightly above average. There was a significant difference (p = 0.029) between students’ programme of study and how they obtained their last course of antibiotics. Students displayed average knowledge on antibiotic use and antibiotic resistance but there is a need for more education to improve their perception and attitudes in order to contribute towards curbing the global problem of antibiotic resistance