Hiv/Aids prevalence at the accident & emergency centre of a tertiary and referral health institution in Ghana

Background: Ghana has an estimated HIV prevalence of 1.4%, but the HIV prevalence of patients presenting at emergency departments in Ghana is not well documented in published literature. This study evaluated the prevalence of HIV infection at the Accident & Emergency Department, Komfo Anokye Teaching Hospital (KATH A&E), Kumasi, Ghana.Methods: A descriptive cross-sectional survey was carried out on patients aged 18 and above presenting to KATH A&E. An opt-in testing approach was used; consenting patients were screened for HIV using rapid HIV finger-stick testing with HIV 1-2 STAT-PAK. Sero-positivity was confirmed by OraQuick HIV 1-2 test. Data was analysed using multivariate logistic regression.Results: 1125 patients presenting at the KATH A&E during the study period were offered the Rapid HIV test. 667 of these patients consented to have the test. HIV prevalence was 13.5% (90/667). 53 females (58.9%) were HIV positive compared to 37 males (41.1%). The age group 30-50 years had the highest risk of being HIV-positive. Other socio-demographic variables such as educational level and occupation were significantly associated with HIV-infection (Pvalue = 0.001 at 95% CI).Conclusion: This study shows that emergency department HIV testing in Ghana is feasible. The prevalence of HIV sero-positive patients presenting at KATH A&E was tenfold higher than national estimates. We conclude that this study showed a high prevalence among patients seeking emergency care in our setting. Testing in the emergency department could lead to early detection of HIV-infected patients for linkage to care.Keywords: HIV Infections; HIV Screening; Prevalence, Diagnosis, Emergency Departmen

Health-seeking behaviors and self-care practices of Dominican women with lymphoedema of the leg: implications for lymphoedema management programs

BACKGROUND: In the Dominican Republic, a Latin American country with filariasis-endemic areas, more than 63,000 people have lymphatic filariasis and more than 400,000 people are at risk of future infection. In this paper, we explore the health beliefs, health-seeking behaviors and self-care practices of women with lymphoedema in filariasis-endemic areas to better understand the needs of women when developing lymphoedema morbidity control programs. METHODS: Qualitative data were collected through semi-structured interviews of 28 women, 3 focus group discussions with 28 women, field notes and photographs. RESULTS: Women described exhaustive and expensive attempts at seeking a cure for their lymphoedema. Family members were influential in providing women with initial care seeking referrals to indigenous healers credited with influence over physical, mental, spiritual and supernatural properties of illness. When indigenous treatments proved to be ineffectual, the women sought care from trained healthcare providers. Most healthcare providers incorrectly diagnosed the edema, failed to adequately treat and meet the needs of women and were viewed as expensive. Most women resorted to self-prescribing injectable, oral, or topical antibiotics along with oral analgesics as a standard practice of self-care. CONCLUSION: Healthcare providers must understand a woman's cultural perspectives of illness, her natural networks of support and referral, her behavioural practices of care-seeking and self-care and the financial burden of seeking care. In the culture of the Dominican Republic family members and traditional healthcare providers are influential advisors on initial health-seeking behaviors and self-care practices. For this reason family-oriented interventions, support groups for women and their families, community education and training on simple, low cost lymphoedema management techniques for indigenous healers are viable ways to influence the early detection, diagnosis and treatment of women with lymphoedema. The extensive use of injectable, oral and topical antibiotics by indigenous healers and women without medical supervision suggests a need for health education messages related to the risks of such practices

‘In this job, you cannot have time for family’: Work–family conflict among prison officers in Ghana

This paper documents the experience of work-family conflict (WFC) among prison officers in Ghana. Although the term WFC has been used in relation to prison officers in the UK (Crawley, 2002) and the US (Triplett et al., 1999), the context of WFC in Ghana is unusual. In this predominantly collectivist culture, family responsibilities include obligations to the extended family. WFC is mainly unidirectional, with interference running from work to the family. Officers are thus impaired in fulfilling their family responsibilities, which consequently impairs their daily work and mental well-being. The ‘crisis controlling’ or ‘paramilitary’ organisational structure of the Ghana Prisons Service (GPS) makes it very difficult for the work domain of prison officers to accommodate family responsibilities. Female officers appear to bear a heavier WFC burden than male officers, mainly on account of their traditionally unpaid housekeeping role in addition to their paid employment in a masculine organisational culture. The findings are significant, as they show that the promulgation of family-friendly policies to alleviate WFC-associated stress lies in the hands of the GPS, since WFC emanates solely from the work domain