Thyroid dysfunction and glycaemic control among Type 2 diabetes mellitus patients in Ghana: A comparative cross-sectional study

Introduction: Thyroid disorders and diabetes mellitus coexist and are prevalent endocrinopathies among adult population. Thyroid dysfunction contributes to metabolic imbalances, increase beta-cell apoptosis and glucose intolerance. There is paucity of data and contradicting findings on how thyroid dysfunction influence glycaemic control. Therefore, we evaluated thyroid dysfunction and glycaemic control among Type 2 diabetes mellitus (T2DM) patients in Ghana. Methods: A comparative cross-sectional study was conducted among 192 T2DM patients from Effia Nkwanta Regional Hospital. Three consecutive monthly fasting plasma glucose (FBG) and glycated haemoglobin (HbA1c) were analysed and the results were classified as, moderate hyperglycaemia (MH) (FBG = 6.1–12.0 mmol/L, HbA1c \u3c 7%), severe hyperglycaemia (SH) (FBG ≥ 12.1 mmol/L, HbA1c \u3e 7%) and good glycaemic controls (GC) (FBG = 4.1–6.0 mmol/L, HbA1c \u3c 7%). Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4), body mass index (BMI) and other clinical parameters were measured. Data analysis was done using R language version 4.0.2 and p \u3c.05 was considered statistically significant. Results: There were no significant differences in age (years) between patients in the various glycaemic groups (p =.9053). The overall prevalence of thyroid disorders was 7.8% among T2DM patients. The prevalence of thyroid disorders was higher in patients with SH (11.7%) followed by those with MH (7.5%) and then those with GC (5.4%). Serum levels of TSH and FT3/FT4 ratio were significantly lower in T2DM patients with SH compared to those with MH and the GC (p \u3c.0001). However, FT4 was significantly higher in SH patients compared to the good glycaemic controls (p \u3c .01). The first tertiles of TSH [aOR = 10.51, 95% CI (4.04–17.36), p \u3c .0001] and FT3 [aOR = 2.77, 95% CI (1.11–6.92), p =.0290] were significantly and independently associated with increased odds of hyperglycaemia. Conclusion: The prevalence of thyroid dysfunction is high in T2DM and increases with hyperglycaemia. Reduced TSH and T3 may worsen glycaemic control. Periodic monitoring of thyroid function should be incorporated into management guidelines among T2DM patients in Ghana

Prevalence, knowledge, and lifestyle-associated risk factors of dyslipidemia among Ghanaian type-2 diabetes mellitus patients in rural and urban areas: A multicenter cross-sectional study

Background and Aims: Dyslipidemia in diabetes mellitus has been linked to unhealthy lifestyle and bad eating habits. However, this association has not been well studied among rural and urban Ghanaian populations. In this study, we determined the prevalence, knowledge, and lifestyle-associated risk factors of dyslipidemia among Ghanaian type-2 diabetes mellitus (T2DM) patients in rural and urban areas. Methods: This comparative multicentre-cross-sectional study recruited 228 T2DM outpatients attending the St. Michael Hospital, Pramso (rural) and Kumasi South Regional Hospital (urban), Ghana for routine check-ups. Self-structured questionnaire was used to collect sociodemographic, knowledge, and lifestyle characteristics. Fasting blood samples were taken to measure lipid profiles. Dyslipidemia was defined per the American Diabetes Association criteria. All p \u3c 0.05 were considered statistically significant. Results: The overall prevalence of dyslipidemia was 79/228 (34.7%). Dyslipidemia was more prevalent among urban participants 43 (18.9%) than rural participants 36 (15.8%). Twenty-seven (11.7%) had adequate knowledge about the risk factors, complications, and management of diabetes. Eating supper after 7 p.m. [adjusted odds ratio = 3.77, 95% confidence interval (1.70–8.37), p = 0.001] significantly increased one\u27s risk of having dyslipidemia by 3.8-fold compared to eating supper earlier (before 5 p.m.). Conclusion: Dyslipidemia is increasing among T2DM patients in both urban and rural areas and it\u27s independently influenced by eating supper after 7 p.m. Most participants were ignorant of the risk factors, complications, and management of diabetes. Adjusting eating habits and increasing diabetes awareness programs to sensitize the general public can mitigate the increasing prevalence of dyslipidemia in both urban and rural areas

Coagulation factors and natural anticoagulants as surrogate markers of preeclampsia and its subtypes: A case-control study in a Ghanaian population

Preeclampsia (PE) is associated with endothelial injury and hemostatic abnormalities. However, the diagnostic role of coagulation parameters and natural anticoagulants in predicting PE has not been explored in Ghana. This study assessed plasma levels of these factors as surrogate markers of PE and its subtypes. This case-control study included 90 women with PE (cases) and 90 normotensive pregnant women (controls). Blood samples were drawn for the estimation of complete blood count and coagulation tests. The prothrombin time (PT), activated partial thromboplastin time (APTT), and the calculation of the international normalized ratio (INR) were determined by an ACL elite coagulometer while the levels of protein C (PC), protein S (PS), antithrombin III (ATIII), and D-dimers were also measured using the solid-phase sandwich enzyme-linked immunosorbent assay (ELISA) method. All statistical analyses were performed using the R Language for Statistical Computing. Results showed significantly (p \u3c .05) shortened APTT (28.25 s) and higher D-dimer levels (1219.00 ng/mL) among PE women, as well as low levels of PC (1.02 g/mL), PS (6.58 g/mL), and ATIII (3.99 ng/mL). No significant difference was found in terms of PT and INR. From the receiver operating characteristic analysis, PC, PS, and ATIII could significantly predict PE and its subtypes at certain cutoffs with high accuracies (area under the curve [AUC] ≥ 0.70). Most women with PE are in a hypercoagulable state with lower natural anticoagulants. PC, PS, and ATIII are good predictive and diagnostic markers of PE and its subtypes (early-onset PE [EO-PE] and late-onset PE [LO-PE]) and should be explored in future studies

Proportion and factors influencing client satisfaction with delivery services in health facilities in the Sissala East Municipality, Ghana: A cross‐sectional study

Abstract Background and Aims Client satisfaction is the difference between the healthcare services delivered and the needs of the client. Anecdotal evidence suggests the quality of maternal health and delivery services in Ghana especially in the Upper West Region is appalling. Moreover, there is a paucity of data on clients' satisfaction with maternal and delivery services rendered by healthcare. This study, therefore, assessed clients' satisfaction with delivery services and their associated factors. Methods This analytical cross‐sectional study included 431 women who had delivered in the last 7 days from four health facilities within Sissala East Municipality using a multistage and simple random sampling technique. A well‐structured questionnaire was used to collect sociodemographic and client satisfaction data. All statistical analyses were done using Statistical Package for Social Sciences Version 26.0 and GraphPad Prism Version 8.0. A p < 0.05 was considered statistically significant. Results Clients’ satisfaction with general delivery services was rated as 80.3% and was significantly associated with process‐related factors (p < 0.0001) and structural‐related factors (p < 0.0001) of the health facilities. This study found that health facilities' delivery services differed significantly and were associated with clients’ satisfaction (p < 0.0001). Moreover, age group (p = 0.0200), occupation (p = 0.0090), kind of delivery (p = 0.0050), and delivery outcome (p < 0.0001) were significantly associated with client satisfaction with delivery services. Conclusion More than two‐thirds of women are satisfied with delivery services within selected health facilities in the Sissala East municipality, although satisfaction within health facilities differs. Furthermore, age group, occupation, kind of delivery, delivery outcome, process, and structural‐related factors significantly contribute to client satisfaction with delivery services. To provide more comprehensive coverage of customers' satisfaction with delivery services in the municipality, strategies such as free maternal health initiatives and health education on the significance of facility delivery should be reinforced

Association between endothelial nitric oxide synthase (eNOS) gene variants and nitric oxide production in preeclampsia: a case–control study in Ghana

Abstract Evidence suggests that a major cause of PE is endothelial dysfunction emanating from the reduced bioavailability of Nitric oxide (NO). Variants of endothelial nitric oxide synthase (eNOS) gene may lead to decreased NO levels. We explored the association between eNOS gene variants and nitric oxide levels among preeclamptic women in the Ghanaian population. This case–control study included 75 preeclamptic women and 75 healthy normotensive pregnant women attending antenatal care at the Nkawie-Toase Government Hospital, Ghana. A well-structured questionnaire was used to collect socio-demographic, obstetric and clinical data. Blood was obtained for DNA extraction; the gene variants were determined using PCR and RFLP. Preeclamptic women had significantly lower NO concentration compared to the normotensives (p < 0.0001) and was significantly different between VNTR variants (p < 0.0001). A significant difference in VNTR intron 4 distribution was also observed between the preeclamptic and normotensive women with 4c4c” (12.0%) and “4a4c” (1.3%) genotypes found predominantly in preeclamptic women (p < 0.0001). There was significantly higher distribution of “TC” genotype in preeclamptic women (44.0%) compared to normotensives (22.7%) (p = 0.019). However, possessing “4a4b” (cOR: 0.17, 95% CI 0.04–0.64) and “4b4b” (cOR: 0.09, 95% CI 0.02–0.38) significantly decreased the likelihood of experiencing preeclampsia by 83% and 91% respectively. Nitric oxide is reduced in preeclamptic women. NO levels in preeclampsia are altered by VNTR intron 4 variants but not T786C variants. Possessing VNTR intron 4 “4b” allele decreases the risk of PE while the “4c” allele increases the risk of PE. There is the need for eNOS variant screening and nitric oxide estimation among pregnant women for early prediction of women at risk of preeclampsia

Assessment of vitamin D levels and adipokines mediated obesity among psychiatric patients on treatment and treatment naïve: A comparative cross‐sectional study

Abstract Background and aims Antipsychotic treatment may contribute to low vitamin D levels and have impact on direct anti‐inflammatory activity such as adiponectin activity and indirect proinflammatory activity such as leptin and resistin activity. However, vitamin D levels and adipokines mediated effect on weight gain and increased adiposity are not well evaluated. This study, therefore, assessed vitamin D and adipokines‐mediated obesity among Ghanaian psychiatric patients. Methods This comparative cross‐sectional study was conducted at psychiatric unit of Komfo Anokye Teaching Hospital, Kumasi, Ghana. Anthropometric measurements, sociodemographic and previous medical history were taken from 300 antipsychotics treatment naïve and active patients. Obesity was classified using World Health Organization (WHO) body mass index (BMI)‐specific cut‐offs. Blood samples were collected for serum vitamin D and adipokines (adiponectin, leptin, and resistin) analysis using enzyme‐linked immunosorbent assay. Statistical analyses were done using SPSS version 26.0 and GraphPad Prism version 8.0. Results We observed higher prevalence of obesity among treatment active psychiatric patients (40.7%) compared to treatment naïve group (16.8%). Vitamin D insufficiency and deficiency prevalence were significantly higher among the treatment active group (25.3%; 39.5%; p < 0.001) and associated with increased odds of obesity (91.8%; cOR = 91.84, 95% confidence interval [CI]: 24.94–338.13). Moreover, adiponectin (84.2%: cOR = 14.15, 95% CI: 5.52–36.27), leptin (55.6% cOR = 2.20, 95% CI: 1.04–4.67), and resistin (79.4%: cOR = −8.34, 95% CI: 3.39–20.55) were significantly associated with increased odds of obesity among treatment active psychiatric. Furthermore, treatment active psychiatric patients exhibited inverse correlation for adiponectin and leptin with BMI (r = −0.62; −0.24), and WHtR (r = −0.53; −0.24); however, a moderate positive correlation for resistin with BMI (r = 0.80), HC (r = 0.67), and WHtR (r = 0.65). Conclusion Obesity is more prevalent in psychiatric patients on antipsychotics such as Olanzapine and Clozapine. Obesity among treatment active psychiatric patients is associated with vitamin D insufficiency and deficiency, low adiponectin and leptin levels but higher resistin level

Receptors expressions on peripheral lymphocytes and CD4+CD183+ as a diagnostics biomarker for rheumatoid arthritis: A case–control study in Ghana

Abstract Background T cell receptors play important roles in the development and progression of rheumatoid arthritis (RA). Their involvement has been reported in inflammatory autoimmune diseases. However, their role in predicting RA is still under exploration. This study evaluated the expression of CD183 (CXCR3) receptors on T‐cells and other relevant biomarkers for detecting RA and determine their relationship with disease activity. Methods This unmatched case–control study included 48 newly diagnosed RA patients and 30 apparent healthy controls from the orthopedic units of Komfo Anokye Teaching Hospital (KATH), Kumasi and Korle‐Bu Teaching Hospital (KBTH), Accra, Ghana. Sociodemographic data was obtained, and blood samples were also collected and processed for flow cytometric analysis. Statistical analyses were done using SPSS version 26.0 and R programming language. p < .05 was considered statistically significant. Results This study found a significant difference in age group (p < .0001), marital status (p = .0210), occupation (p = .0140), educational level (p = .0210) and religion (p = .0100) between RA patients and healthy controls. Moreover, hemoglobin level (p = .0010), waist circumference (p < .0001) and hip circumference (p = .0040) were significantly different between RA patients and controls. RA patients had significantly lower levels of CD4+CD183+ compared with the control group (p < .001), and was positively correlated with DAS score (r = .0397, p = .789). In Receiver Operator Characteristics analysis, CD4+CD183+ could significantly detect RA with a high area under the curve (AUC = 0.687, p = .018). At a cut‐off of 0.082, CD4+CD183+ was the best receptor biomarker for detecting RA with a sensitivity of 90.0%, specificity of 25.9%, a positive predictive value of 69.2%, and a negative predictive value of 58.3%. Conclusion CD4+CD183+ best predict RA and is positively correlated with disease activity. CD4+CD183+ could serve as diagnostics and disease‐monitoring biomarker for RA; however, it demonstrates low specificity. Future studies should be directed on CD4+CD183+ and other biomarkers to augment their diagnostics performances and routine management in RA

Demographic, Clinical Profile of Rheumatoid Arthritis Patients and Their Association with Disease Severity in Ghana

Background. Rheumatoid arthritis (RA) is one of the frequent chronic, systemic, inflammatory autoimmune disorders with an estimated global prevalence of 1%. RA leads to joint destruction and disability if left untreated. Ghana has seen very few studies on RA, and little is known about the disease’s severity and related variables. This study sought to characterize the clinical presentation and determine disease severity and associated risk factors with disease severity among RA patients in a tertiary hospital in Ghana. Methods. This cross-sectional study was conducted between September 2020 and August 2021. This study included 56 consecutively consenting RA patients from the Komfo Anokye Teaching Hospital orthopaedic unit. Diagnosis of RA was based on the updated American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2022 rheumatoid arthritis classification criteria by a rheumatologist. A study questionnaire was used to gather participant demographics and clinical features, and results from the laboratory were taken from the patients’ charts and medical records. The patients’ disease severity was evaluated based on the rheumatoid arthritis disease activity score, which is based on a 28-joint count (DAS28), and their functioning was evaluated using the modified health assessment questionnaire. Results. The participants’ mean age was 51.25±13.22 years. Out of the total participants, 46 were females, and 10 were males (female-to-male ratio 4.6 : 1). Moreover, 37.50% had arthritis of the hand; 5.30% had severe disease, and 94.60% were not severe. A majority (76.80%) were on methotrexate medication. The most frequently involved joints were the knee (42.90%), wrist (32.10%), and elbow (12.50%). There was no statistically significant association with disease severity and a functional status score of >0.5 (cOR: 10.60, 95% CI (0.52-217.30); p=0.124). In addition, marital status (p=0.04), disease duration (p=0.04), family complaints (p=0.02), and ESR (p=0.03) were significantly associated with disease severity. Conclusion. RA is predominant among elder populations and females. Disease duration, family complaints, and ESR are associated with disease severity. The findings of this study call for interventions towards ensuring early diagnosis of RA among high-risk populations to enhance good management practices

Association of body iron stores and anemia in a Ghanaian type‐2 diabetes mellitus population: A multicentered cross‐sectional study

Abstract Background and Aims Anemia has been a common comorbidity in most chronic diseases, but has not been well monitored in type 2 diabetes mellitus (T2DM) patients. In this study, we investigated the prevalence of anemia and its nexus with iron stores among T2DM patients in health facilities in the Ashanti Region of Ghana. Methods This multicenter cross‐sectional study recruited 213 T2DM out‐patients attending the diabetic clinics at the Kumasi South Hospital and St. Michaels Hospital, Jachie Pramso, Ghana, for routine check‐ups. Self‐reported questionnaires were used to collect sociodemographic, lifestyle, and clinical data from study participants. Blood samples were collected to estimate hematological parameters and iron stores. Mann–Whitney U test was used to assess the difference in hematological parameters and iron stores between anemic and nonanemic patients. All p < 0.05 were considered statistically significant. Results Of the 213 T2DM participants, the prevalence of anemia was 31.9%. More females 145 (68.1%) were registered than males 68 (31.9%). Anemic patients had significantly lower levels of mean cell volume [79.30/fL vs. 82.60/fL, p = 0.001], mean cell hemoglobin [26.60/pg vs. 27.90/pg, p < 0.0001], and mean cell hemoglobin concentration [33.10/g/dL) vs. 33.80/g/dL, p < 0.0001] than those without anemia. Serum levels of ferritin (p = 0.1140), transferrin (p = 0.5070), iron (p = 0.7950), and total iron binding capacity (p = 0.4610) did not differ significantly between T2DM patients with or without anemia. Conclusion Despite the high prevalence of anemia among the T2DM patients in our cohort, patients present with apparently normal iron stores. This unrecognized mild anemia must be frequently monitored among T2DM patients

Knowledge, attitude and acceptability of COVID-19 vaccine among residents in rural communities in Ghana: a multi-regional study

Abstract Background The Coronavirus Infectious Disease 2019 (COVID-19) pandemic has continuously affected human life with several devastating effects. Currently, there are effective vaccines to protect people from COVID‐19 and the World Health Organization (WHO) has highlighted strategies to influence COVID-19 vaccine uptake in hard-to-reach communities in Ghana. However, prior studies on COVID-19 vaccine acceptability in Ghana are online surveys targeting the literates and those in urban areas, leaving residents in far-flung communities. We assessed knowledge, attitude and acceptability of COVID-19 vaccine among residents in rural communities in Ghana. Methods This study was a community-based cross-sectional study and was conducted at three selected regions in Ghana (Northern, Ashanti and Western North) from May to November, 2021. This study included residents 15–81 years, living in the selected rural communities for more than 1 year. Study participants were recruited and questionnaires administered to collect data on knowledge, attitude and acceptance of the COVID-19 vaccine. Statistical analyses were performed using Statistical Package for Social Science (SPSS) version 26.0 and GraphPad Prism Version 8.0 software. Results Of the 764 participants included in this study, more than half had inadequate knowledge (55.0%), poor attitudes (59.4%) and bad perception about COVID-19 vaccine (55.4%). The acceptability of COVID-19 vaccine in this study was 41.9%. The acceptability of COVID-19 vaccine in Ashanti, Northern and Western North regions were 32.5%, 26.2% and 29.6% respectively. In a multivariate logistic regression analysis, receiving recent or previous vaccine such as HBV vaccine [aOR = 1.57, 95% CI (1.23–3.29), p = 0.002], having good attitude towards COVID-19 vaccine [aOR = 61.47, 95% CI (29.55–127.86), p < 0.0001] and having good perception about the COVID-19 vaccine [aOR = 3.87, 95% CI (1.40–10.72), p < 0.0001] were independently associated with higher odds of accepting COVID-19 vaccine. Conclusion More than half of residents in Ghanaian rural communities have inadequate knowledge, poor attitudes and bad perception about COVID-19 vaccine. The acceptability of COVID-19 vaccine is generally low among rural residents in Ashanti, Northern and Western North regions of Ghana. Residents living in hard-to-reach communities must be educated about the benefits of COVID-19 vaccine to achieve effective vaccination program