Factors influencing the choice of anaesthesia as a field of specialty in University of Ghana School of Medicine and Dentistry, Korle-Bu Teaching Hospital

Background: Specialisation is perceived as essential for success, and affects the availability and distribution of medical personnel and the quality of service the health system is able to deliver. In Ghana, some areas of medical specialties have a relatively good number of practitioners and are constantly attracting prospective doctors into these fields. Anaesthesia, which is an essential and integral part of the health care system, is one field with an inadequate workforce and has been attracting few doctors into the specialty.Method: A cross-sectional study was conducted among 183 undergraduate final-year students of the University of Ghana School of Medicine and Dentistry. A total of 183 self-reporting questionnaires were distributed among the students during tutorials for their final exams. Of these, 146 questionnaires were completed and returned.Results: General surgery was the most desirable specialty 26 (17.8%), paediatrics was the second most desirable specialty 24 (16.4%), whilst anaesthesia 2 (1.4%) ranked seventh.Conclusions: The results of this survey suggest that duration of exposure during clinical clerkship influences career decision among undergraduate medical students. Most of the students prioritise their choice of specialty based on interest and exposure during rotation through the specialty.Keywords: anaesthesia, medical students, specialtie

Patients’ knowledge and perception of anaesthesia and the anaesthetist at a tertiary health care facility in Ghana

Background: Anaesthesia has always been misconstrued as a ‘behind the scenes’ specialty. Despite advancements in anaesthesia, there is inadequate public knowledge regarding the specialty, the scope of the functions of anaesthetists, and the pivotal role anaesthetists play in the healthcare delivery system. This study therefore assessed the knowledge and perception of anaesthesia and the role of anaesthetists among patients in a tertiary healthcare facility.Methods: A cross-sectional study was conducted over 3 months in 2015 among 279 patients accessing services at the preanaesthetic clinic of the Korle-Bu Teaching Hospital. Patients were interviewed using a structured questionnaire assessing sociodemographic characteristics, their knowledge and perceptions about anaesthesia, and the role of anaesthetists.Results: The majority of patients (62.4%) had heard about anaesthesia. Most (85%) knew that specially trained doctors or nurses were responsible for the delivery of anaesthesia. Nearly half the patients indicated anaesthesia was all about ‘putting people to sleep and waking them up’. Less than 15% of patients had knowledge of the role of anaesthetists outside the confines of the operating theatre suites.Conclusion: A considerable number of patients had heard about anaesthesia and knew the people responsible for the delivery of anaesthesia. The perception of most patients is that anaesthesia is all about ‘putting patients to sleep and waking them up’. There was poor knowledge of patients regarding the role of anaesthetists beyond the confines of the operating theatre.Keywords: anaesthesia, anaesthetist, knowledge, misconceptions, patients, perception

Safety and efficacy of single-dose preoperative intravenous dexamethasone on postoperative nausea and vomiting following breast surgery at Korle-Bu Teaching Hospital

Objectives: Dexamethasone has beneficial effects on postoperative nausea and vomiting, however, many clinicians have raised legitimate concerns regarding its effect on blood glucose concentrations. This study determined the safety and efficacy of a single pre-operative dose of dexamethasone for PONV prophylaxis in patients undergoing breast surgery. Design: Prospective, double-blind, placebo-controlled trial Setting: Surgical wards of the Korle-Bu Teaching Hospital, Accra, Ghana Participants: The study was conducted among breast surgery patients. They were consecutively recruited and randomized into two groups: dexamethasone (n = 47) and placebo (n = 47). Interventions: Patients in the dexamethasone group received 8mg (2mls of 4mg/ml) dexamethasone while those in the placebo group received 2mls of saline intravenously. PONV impact scores and blood glucose levels were recorded at 4, 8 and 24 hours postoperatively. Main outcome measures: Incidence of PONV and blood glucose levels Results: The incidence of postoperative nausea (PON) was lower in the dexamethasone group compared with the placebo group (12.8% vs. 29.8%; p-value= 0.044). There was no significant difference in the incidence of postoperative vomiting (POV) and PONV between the two groups. Blood glucose levels were higher in the dexamethasone group throughout the study period and significant at 8 and 24 hours postoperatively (p < 0.05). There was no difference in the incidence of clinically significant hyperglycemia between the groups (p-value = 0.169). Conclusion: A preoperative intravenous dexamethasone 8mg, reduces PON but not POV or PONV in breast surgery without clinically significant postoperative hyperglycemia

Nitric Oxide and Pre-Eclampsia: A Comparative Study in Ghana

BACKGROUND: Preeclampsia is one of the commonest aetiologies of foetal and maternal mortality and morbidity. Though common, the aetiology of preeclampsia has remained unknown with several inconclusive theories surrounding the disease. Recent studies have implicated vascular endothelial dysfunction and possibly nitric oxide in preeclampsia.AIM: To compare plasma nitric oxide levels in pre-eclampsia and healthy pregnant women in a large tertiary hospital in Ghana.METHODS: This was a case-control study conducted among pre-eclampsia and healthy pregnant women in Korle-Bu Teaching Hospital over a four-month period. Thirty (30) pre-eclamptic and 30 healthy pregnant women aged 18-35 years with over 30 weeks’ gestation were consecutively recruited into the study after obtaining informed consent. Plasma nitric oxide levels were determined using the Griess Reagent system.  Data were analysed using Statistical Package for the Social Sciences (SPSS) software version 20.0 and results were compared using the independent t-test. A P-value of ≤ 0.05 was considered statistically significant.RESULTS: The parity and body mass index (BMI) of the participants were similar. There was a significant difference in the blood pressure of the pre-eclamptic compared to healthy pregnant women. There was no statistically significant difference (P-value = 0.160) in the plasma levels of nitric oxide in pre-eclamptic (Mean = 1178.78; SD = 89.70 nM) compared to healthy pregnant women (Mean = 1365.43; SD = 95.46 nM).CONCLUSION: Plasma nitric oxide levels may not play a significant role in the aetiology of pre-eclampsia

Serum Calcium and Magnesium Levels in Normal Ghanaian Pregnant Women: A Comparative Cross-Sectional Study

BACKGROUND: Pregnancy is described as a normal physiologic state associated with various biochemical changes. Magnesium and calcium are essential macronutrients required for foetal growth. Complications associated with their deficiency during normal pregnancy include; low neonatal birth weight, pre-eclampsia, eclampsia and preterm labour. Changes in serum levels of magnesium and calcium in normal pregnancy have not been extensively studied among Ghanaian women. AIM: To determine the variation in serum magnesium and calcium levels with gestational age in normal pregnancy in Ghanaian women. METHODS: A hospital-based comparative cross-sectional study was conducted among 32 normal non-pregnant women (Group A) and 100 normal pregnant women (Group B) attending the clinic at the Korle-Bu Teaching hospital. The group B pregnant women were further divided into Group B1 (n = 33), Group B2 (n = 37) and Group B3 (n = 30) based on their pregnancy gestation as first, second and third trimester respectively. Blood samples were obtained from the antecubital vein of subjects and total serum calcium, magnesium, protein and albumin were estimated. Data obtained were analysed using SPSS for windows version 20. Analysis of variance (ANOVA) was employed to determine the statistical differences between the groups. A p-value of ≤ 0.05 was considered significant. RESULTS: Mean serum total calcium and magnesium in first, second and third trimester normal pregnant women were 2.14 ± 0.16, 2.13 ± 0.44, 2.13 ± 0.35 mmol/L and 0.77 ± 0.11, 0.77 ± 0.16 and 0.76 ± 0.14 mmol/L respectively. Mean serum total calcium and magnesium levels in non-pregnant women were 2.20 ± 0.16 and 0.80 ± 0.10 mmol/L respectively. There was a statistically non-significant difference in serum total calcium and magnesium between non-pregnant and normal pregnant women, with p-values of 0.779 and 0.566 respectively. Mean total serum protein and albumin in first, second and third-trimester normal pregnant women were 68.42 ± 10.37, 70.46 ± 6.84, 66.70 ± 7.83 g/L and 39.92 ± 3.22, 40.75 ± 8.06, 38.26 ± 3.02 g/L respectively. Mean total serum protein and albumin in non-pregnant women were 73.13 ± 7.02 and 42.94 ± 3.03 g/L respectively. Mean total serum protein and albumin levels were lower in pregnant women as compared to non-pregnant women with the difference being significant in the third trimester (p-values of 0.012 and 0.002). CONCLUSION: Total serum calcium and magnesium levels in normal pregnancy were non-significantly lower compared to non-pregnant women in Ghana. There was a reduction in total serum protein, and albumin levels during pregnancy with a significant reduction noticed during the third trimester compared to the non-pregnant state

Person-centred care (PCC) research in Ghana: a scoping review protocol.

INTRODUCTION: Person-centred care (PCC) is provision of care that is respectful of and responsive to individual patient preferences, needs and values, and ensures that patient values guide all clinical decisions. While there is a large body of evidence on the benefits of PCC in high-income countries, little research exists on PCC in Ghana and Sub-Saharan Africa at large. Most studies on PCC have focused on maternity care as part of the global movement of respectful maternity care. The few studies on patient experiences and health system responsiveness beyond maternal health also highlight gaps in patient experience and satisfaction as well as discrimination in health facilities, which leads to the most vulnerable having the poorest experiences. The protocol for this scoping review aims to systematically map the extent of literature focused on PCC in Ghana by identifying patient expectations and preferences, barriers and facilitators, and interventions. METHODS AND ANALYSIS: The protocol will be guided by the Arksey and OMalley methodological framework and recommendations by Levac et al. A comprehensive search strategy will be used to search for published articles in PubMed, EMBASE, Web of Science and the African Journals Online from their inception to August 2022. Grey literature and reference lists of included studies will also be searched. Two independent reviewers will perform the literature search, eligibility assessments and study selection. Any disagreements will be resolved through discussion with a third reviewer. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for the scoping reviews will be used to outline the study selection process. Extracted data from the included articles will be synthesised and reported under key concepts derived from the outcomes of the scoping review. ETHICS AND DISSEMINATION: This scoping review does not require ethical approval. The findings will be disseminated through publications and conference presentations. SCOPING REVIEW REGISTRATION: OSF Registration DOI 10.17605/OSF.IO/ZMDH9

African leaders’ views on critical human resource issues for the implementation of family medicine in Africa

Abstract Background The World Health Organisation has advocated for comprehensive primary care teams, which include family physicians. However, despite (or because of) severe doctor shortages in Africa, there is insufficient clarity on the role of the family physician in the primary health care team. Instead there is a trend towards task shifting without thought for teamwork, which runs the risk of dangerous oversimplification. It is not clear how African leaders understand the challenges of implementing family medicine, especially in human resource terms. This study, therefore, sought to explore the views of academic and government leaders on critical human resource issues for implementation of family medicine in Africa. Method In this qualitative study, key academic and government leaders were purposively selected from sixteen African countries. In-depth interviews were conducted using an interview guide. All interviews were audio-recorded, transcribed and thematically analysed. Results There were 27 interviews conducted with 16 government and 11 academic leaders in nine Sub-Saharan African countries: Botswana, Democratic Republic of Congo, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa and Uganda. Respondents spoke about: educating doctors in family medicine suited to Africa, including procedural skills and holistic care, to address the difficulty of recruiting and retaining doctors in rural and underserved areas; planning for primary health care teams, including family physicians; new supervisory models in primary health care; and general human resource management issues. Conclusions Important milestones in African health care fail to specifically address the human resource issues of integrated primary health care teamwork that includes family physicians. Leaders interviewed in this study, however, proposed organising the district health system with a strong embrace of family medicine in Africa, especially with regard to providing clinical leadership in team-based primary health care. Whilst these leaders focussed positively on entry and workforce issues, in terms of the 2006 World Health Report on human resources for health, they did not substantially address retention of family physicians. Family physicians need to respond to the challenge by respondents to articulate human resource policies appropriate to Africa, including the organisational development of the primary health care team with more sophisticated skills and teamwork

Person-Centered Care Research in Ghana: a Scoping Review Protocol

Abstract Background: Person-centered care (PCC) is provision of care that is respectful of and responsive to in­dividual patient preferences, needs, and values, and ensures that patient values guide all clinical decisions. While there is a large body of evidence on the benefits of PCC in high-income countries, little research exists on PCC in Ghana and Sub-Saharan Africa at large. Most studies on PCC have focused on maternity care as part of the global movement of respectful maternity care. The few studies on patient experiences and health system responsiveness beyond maternal health also highlight gaps in patient experience and satisfaction, as well as discrimination in health facilities which leads to the most vulnerable having the poorest experiences. This scoping review aims to systematically map the extent of literature focused on PCC in Ghana by identifying patient expectations and preferences, barriers and facilitators, and interventions regarding PCC in Ghana.Methods: This protocol will be guided by the Arksey and O’Malley methodological framework and recommendations by Levac, Colquhoun and O'Brien. A comprehensive search strategy will be used to search for published articles in PubMed, EMBASE, Web of Science, and the African Journals Online (AJOL) from their inception to December 2021. Grey literature and reference lists of included studies will also be searched. Two independent reviewers will perform the literature search, eligibility assessments, and study selection. Any disagreements will be resolved through discussion with a third reviewer. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for the scoping reviews (PRISMA-ScR) will be used to outline the study selection process. Extracted data from the included articles will be synthesised and reported under key concepts derived from the outcomes of the scoping review.Discussion: The findings from this proposed scoping review on documented person-centeredness of care and patient expectations and preferences regarding PCC will be useful information for policymakers to consider in rolling out healthcare strategies that are driven by patient interest. Also, identification of various barriers and facilitators and evidence of effective PCC interventions will have implications on policy, practice, and further research in Ghana.Scoping review registration: OSF Registration DOI 10.17605/OSF.IO/ZMDH

Serum nitric oxide levels in healthy pregnant women: a case- control study in a tertiary facility in Ghana

Abstract Background Pregnancy is associated with significant changes in maternal cardiovascular system which regulates oxygen and nutrient supply to the growing foetus. Nitric oxide, a physiologic vascular smooth muscle relaxant regulates blood flow and therefore may play a role in the cardiovascular changes in pregnancy. The study aimed to determine the levels and changes in maternal serum nitric oxide levels during healthy pregnancy. Methods A case-control study was conducted among 32 healthy non-pregnant women as controls and 100 healthy pregnant women (consisting of 33 first trimester, 37 s trimester, and 30 third trimester) as cases. Subjects were consecutively recruited into the study after obtaining an informed consent and meeting the inclusion criteria. Griess Reagent method was used to determine serum nitric oxide levels. Results There were no statistically significant difference in the ages and parity of recruited cases and controls. Mean arterial blood pressures were significantly lower (p = 0.009) and serum nitric oxide levels were significantly higher (p < 0.001) in healthy pregnant women compared to healthy non-pregnant women. There was a non-significant progressive increase in serum nitric oxide levels during healthy normal pregnancy. Conclusions The finding of a significantly reduced blood pressures and a significant increase in serum nitric oxide levels in healthy pregnancy may suggest a role of nitric oxide in vascular adaptation in pregnancy

Estimating the incidence of tuberculosis cases reported at a tertiary hospital in Ghana: a time series model approach

Abstract Background The incidence of Tuberculosis (TB) differs among countries and contributes to morbidity and mortality especially in the developing countries. Trends and seasonal changes in the number of patients presenting with TB have been studied worldwide including sub-Saharan Africa. However, these changes are unknown at the Korle-Bu Teaching Hospital (KBTH). The aim of this study was to obtain a time series model to estimate the incidence of TB cases at the chest clinic of the Korle-Bu Teaching hospital. Methods A time series analysis using a Box-Jenkins approach propounded as an autoregressive moving average (ARIMA) was conducted on the monthly TB cases reported at the KBTH from 2008 to 2017. Various models were stated and compared and the best was found to be based on the Akaike Information Criterion and Bayesian Information Criterion. Results There was no evidence of obvious increasing or decreasing trend in the TB data. The log-transformed of the data achieved stationarity with fairly stable variations around the mean of the series. ARIMA (1, 0, 1) or ARMA (1,1) was obtained as the best model. The monthly forecasted values of the best model ranged from 53 to 55 for the year 2018; however, the best model does not always produce the best results with respect to the mean absolute and mean square errors. Conclusions Irregular fluctuations were observed in the 10 -year data studied. The model equation to estimate the expected monthly TB cases at KBTH produced an AR coefficient of 0.971 plus an MA coefficient of − 0.826 with a constant value of 4.127. The result is important for developing a hypothesis to explain the dynamics of TB occurrence so as to outline prevention programmes, optimal use of resources and effective service delivery