Musings on malaria morbidity and mortality after the new Mosquirix® vaccine

There are some facts relating to the new malaria vaccine (Mosquirix® or RTS,S/AS01) recently introduced in Ghana, which need to be more widely known. Contrary to expectations based on mathematical modelling and on the vaccine’s effect on clinical malaria and severe malaria, mortality was not reduced in children receiving the Mosquirix® vaccine in the phase 3 trial.1 This (surprising) result has been attributed to the fact that mortality was reduced in both the vaccinated and unvaccinated children due to better implementation of malaria control measures such as use of bed nets and prompt treatment of malaria.2 The startling implication of thisfinding is that when the existing malaria control measures are implemented more effectively, the vaccine in its current form does not offer any measurable mortality advantages.This means that if there were a willingness to implement malaria control measures intensively, there would be no need to expose our children to the unknown effects of a new vaccine

Admissions and mortality over a 5-year period in a limited-resource neonatal unit in Ghana

Objective: To review admissions and deaths at the neonatal intensive care unit (NICU) of the Korle Bu Teaching Hospital (KBTH), Ghana from 2011 to 2015, for the purposes of documentation of outcomes and identification of areas for improvement.Design: A retrospective descriptive study of NICU Admissions & Discharges from 2011 to 2015. All data in the NICU Admissions & Discharge books were transferred into a spreadsheet and analysed.Setting – The NICU of KBTH provides secondary and tertiary care for premature and critically ill term babies in the southern half of Ghana.Results: Over the 5-year period, 9213 babies were admitted to the NICU. Admission weights ranged from 300 to 6700g with median of 2400g. Overall mortality rate was 19.2%. Mortality rates were progressively and significantly higher in babies with lower admission weights and earlier gestations.Conclusions: We report a high NICU mortality rate of 19.2%, compared to the worldwide range of 3.1% to 29%. This wide range of outcomes is attributable to differences in the severity of illness of patients and to the organisation of resources devoted to obstetric and neonatal care. To substantially improve perinatal and neonatal outcomes, there is a need for wider coverage and better quality of health care; and to consider rationing of care. Complex interventions are necessary to improve outcomes, not just an increase in the allocation of particular resources.Keywords: Intensive Care, Neonatal; developing countries; mortality rateFunding: None declare

Audit of antenatal steroid use in mothers of preterms admitted to a neonatal intensive care unit in Ghana.

Background: Antenatal corticosteroids (ACS) are established as an effective method of reducing preterm morbidity and mortality. At the Korle Bu Teaching Hospital (KBTH), a tertiary referral centre in Ghana, it is recommended that a course of ACS should be given to mothers before delivery between 24 weeks to 34 weeks gestation.Objectives: The study was performed primarily to determine the level of adherence to guidelines on administration of ACS.Methods: All babies with gestational ages up to 34 weeks admitted to the neonatal unit (NICU) during the period of the study were eligible for inclusion.Results: There were 214 eligible admissions during the study period, of which 93 babies (43%) were studied due to poor access to medical records. Dexamethasone was the only steroid used, and mothers of 65 (70%) of the 93 babies received at least one dose; 17 (18%) received only one dose, 35 (38%) - 2 doses, 9 (10%) – 3 doses, and 4 (4%) - 4doses.Conclusions: This study has shown a low uptake of antenatal corticosteroids, similar to other low-income and middle-income countries. To improve preterm survival and morbidity, there is an urgent need to increase the use of corticosteroids before preterm deliveries in Ghana and other low-income and middle-income countries.Funding: Not indicatedKeywords: Antenatal corticosteroids, prematurity, neonatal intensive care, audit, low-income countries