Clinical presentations and outcomes of ectopic pregnancy at a tertiary referral hospital in Ghana

Background: Ectopic gestation is a major cause of morbidity and mortality among women of reproductive age. The clinical presentations vary depending on whether it is ruptured or not. Understanding the various modes of presentation is therefore critical to early detection and management to reduce associated morbidity and mortality. We determined the patterns of presentation and outcomes of ectopic pregnancy in the Korle Bu Teaching Hospital (KBTH) of Ghana.Objective: This study aimed to determine patterns of presentation of ectopic pregnancy in the KBTH of Ghana and the outcomes for patients presenting with the condition.Methods: We collected data from pregnant women presenting to the Obstetrics and Gynaecology Department of the KBTH during the study period and diagnosed with ectopic pregnancy. A case of ectopic pregnancy was any woman diagnosed by an obstetrician/gynaecologist either by clinical features or pelvic ultrasound. Data were collected on sociodemographic characteristics, as well as clinical history, examination findings, treatment, and outcomes. Data were analyzed descriptively to determine the patterns of presentation of ectopic gestations.Results: A total of 104 ectopic pregnancies representing 8.81% (n = 104/1,180) of gynaecological emergencies were recorded during the study period. Of the 104 ectopic pregnancies recorded, 6.7% (n = 7) were diagnosed as unruptured. The mean (± standard deviation) gestational age at diagnosis of ectopic pregnancy was 7.2 ±1.9 weeks. About 94.2% (n = 98) of patients with ectopic pregnancy had visited a health facility before the visit at which the diagnosis was eventually made, and 76.9% (n = 80) of the ectopic cases had ruptured at diagnosis. For 1.9% (n = 2) of the participants, ectopic pregnancy was detected by ultrasound. The triad of amenorrhoea in 91.3% (n = 95), lower abdominal pains in 91.3% (n = 95) and irregular vaginal bleeding in 47.1% (n = 49) of the ectopic pregnancies were the main presenting symptoms of ruptured ectopic pregnancy.Conclusion: The incidence of ruptured ectopic pregnancy in the KBTH was high. Primary health care practitioners should rule out ectopic pregnancy in women of the reproductive age group who present with the triad of amenorrhoea, lower abdominal pain and irregular vaginal bleeding

Maternal mortality at the Korle Bu Teaching Hospital, Accra, Ghana: A five-year review

Maternal death is a major global health issue with the highest impact in low-income countries. Despite some modest decline in the maternal mortality rates in Ghana since the 1990’s, this has been below expectation. The aim of this study was to describe the trends and contributory factors to maternal mortality at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. We performed a retrospective chart review of all maternal deaths at KBTH from 2015 to 2019. Data were analyzed using SPSS version 23. A p-value of <0.05 was considered statistically significant. Over the period, there were 45,676 live births, 276 maternal deaths and a maternal mortality ratio of 604/100,000 live births (95% CI: 590/100,000 - 739/100,000). The leading causes of maternal death were hypertensive disorders (37.3%), hemorrhage (20.6%), Sickle cell disease (8.3%), sepsis (8.3%), and pulmonary embolism (8.0%). Significant factors associated with maternal mortalities at the KBTH were: women with no formal education [AOR 3.23 (CI: 1.73 - 7.61)], women who had less than four antenatal visits [AOR 1.93(CI: 1.23-3.03)], and emergency cesarean section [AOR 3.87(CI: 2.51-5.98)]. Hypertensive disorders remain the commonest cause of the high maternal mortality at KBTH. Formal education and improvement in antenatal visits may help prevent these deaths. La mortalité maternelle est un problème de santé mondial majeur ayant le plus grand impact dans les pays à faible revenu.Malgré une légère baisse du taux de mortalité maternelle au Ghana depuis les années 1990, cela a été au-dessous des attentes. Le but de cette étude était de décrire les tendances et les facteurs qui contribuent à la mortalité maternelle à l’Hôpital Universitaire de Korle Bu (KBTH), Accra Ghana. Nous avons effectué un examen rétrospectif des dossiers concernant les décès maternels à KBTH de 2015 à 2019. Les données ont analysé à l’aide de SPSS version 23. Une valeur p de <0,05 était considérée comme statistiquement significatif. Sur la période, il y a eu 45 676 naissances, 276 décès maternels et un taux de mortalité maternelle de 604/100 000 naissances (IC à 95% : 590/100 000 – 739/100 000). Les causes principales des décès maternels étaient les troubles hypertensifs (37,3%), les hémorragies (20,6%), la drépanocytose (8,3%) la septicémie (8,3%) et l’embolie pulmonaire (8,0%). Les facteurs importants associés aux mortalités maternelles à KBTH étaient : les femmes sans éducation formelle [AOR 3,23 (IC : 1,73-7,61)], les femmes qui ont eu moins de quatre visites prénatales [AOR 1.93 (IC : 1,23-3,03)] et l’urgence césarienne [AOR 3,87(IC : 2,51- 5,98)]. Les troubles hypertensifs restent la cause le plus fréquente de la mortalité maternelle à KBTH. Une éducation formelle et une amélioration des visites prénatales peuvent aider à éviter ces décès

Perceptions on the effect of small electric fans on comfort inside bed nets in southern Ghana : a qualitative study

Long-lasting insecticidal nets (LLINs) are known to be highly effective in reducing malaria transmission, morbidity and mortality. However, among those owning an LLIN, use rates are often suboptimal. A reported barrier to bed net use is discomfort due to heat. This qualitative study was part of a larger evaluation conducted in communities without electricity in rural Ghana to assess whether 0.8 W solar powered net fans can increase net use.; Twenty-three key informant interviews with household heads in the study communities in Shai-Osudoku District, southern Ghana, were conducted from July to August 2015. The purpose of the interviews was to obtain insight into perceptions of participants about the net fan system in relation to LLIN use.; While all study participants reported using LLINs, with mosquito nuisance prevention as the prime motivation, heat was also mentioned as a key barrier to net use. Respondents appreciated the net fans because they improved comfort inside bed nets. The LED light on the fan stand became the main source of light at night and positively influenced the perception of the intervention as a whole.; The general acceptance of the net fan system by the study participants highlights the potential of the intervention to improve comfort inside mosquito nets. This, therefore, has a potential to increase bed net use in areas with low access to electricity

The effect of small solar powered 'Bͻkͻͻ' net fans on mosquito net use : results from a randomized controlled cross-over trial in southern Ghana

Long-lasting insecticidal nets (LLINs) are ineffective malaria transmission prevention tools if they are unused. Discomfort due to heat is the most commonly reported reason for not using nets, but this problem is largely unaddressed. With increasing rural electrification and the dropping price of solar power, fans could improve comfort inside nets and be affordable to populations in malaria endemic areas. Here, results are presented from a pilot randomized controlled cross-over study testing the effect of fans on LLIN use.; Eighty-three households from two rural communities in Greater Accra, Ghana, randomized into three groups, participated in a 10-month cross-over trial. After a screening survey to identify eligible households, all households received new LLINs. Bͻkͻͻ net fan systems (one fan per member) were given to households in Group 1 and water filters were given to households in Group 2. At mid-point, Group 1 and 2 crossed over interventions. Households in Group 1 and 2 participated in fortnightly surveys on households' practices related to nets, fans and water filters, while households in Group 3 were surveyed only at screening, mid-point and study end. Entomological and weather data were collected throughout the study. Analysis took both 'per protocol' (PP) and 'intention to treat' (ITT) approaches. The mid- and end-point survey data from Group 1 and 2 were analysed using Firth logistic regressions. Fortnightly survey data from all groups were analysed using logistic regressions with random effects.; Provision of fans to households appeared to increase net use in this study. Although the increase in net use explained by fans was not significant in the primary analyses (ITT odds ratio 3.24, p > 0.01; PP odds ratio = 1.17, p > 0.01), it was significant in secondary PP analysis (odds ratio = 1.95, p < 0.01). Net use was high at screening and even higher after provision of new LLINs and with follow up. Fan use was 90-100% depending on the fortnightly visit.; This pilot study could not provide definitive evidence that fans increase net use. A larger study with additional statistical power is needed to assess this association across communities with diverse environmental and socio-demographic characteristics

Bulk genetic characterization of Ghanaian maize landraces using microsatellite markers

Maize (Zea mays L) was first introduced into Ghana over five centuries ago and remains the most important cereal staple, grown in all agro-ecologies across the country. Yield from farmers’ fields are low, which is attributed in part to farmer’s preferences and/or reliance on local landraces for cultivation. Efforts are underway to improve some of these landraces for improved productivity. Seeds of maize landraces cultivated in all agro-ecologies were col¬lected for genetic characterization using a bulked fingerprinting technique and 20 SSR markers. In all, 20 popula¬tions of 15 plants each from Ghana and 4 control populations from Latin America were characterized. The cluster analysis grouped the 20 landraces into two major groups corresponding to the vegetation/climatic conditions of the north and south of the country. Genotypes from Ashanti, which is centrally located, fell into both major clus¬ters, which suggest its importance in maize seed distribution in Ghana and also the diverse climate/vegetation. A Structure analyses grouped the genotypes into two major clusters similar to the UPGMA cluster, and populations were not fully distinct according to F statistics. The results suggest that breeders should make performance data available to seed dealers for better productivity

Developing a modified low-density lipoprotein (M-LDL-C) Friedewald’s equation as a substitute for direct LDL-C measure in a Ghanaian population: a comparative study

Despite the availability of several homogenous LDL-C assays, calculated Friedewald\u27s LDL-C equation remains the widely used formula in clinical practice. Several novel formulas developed in different populations have been reported to outperform the Friedewald formula. This study validated the existing LDL-C formulas and derived a modified LDL-C formula specific to a Ghanaian population. In this comparative study, we recruited 1518 participants, derived a new modified Friedewald\u27s LDL-C (M-LDL-C) equation, evaluated LDL-C by Friedewald\u27s formula (F-LDL-C), Martin\u27s formula (N-LDL-C), Anandaraja\u27s formula (A-LDL-C), and compared them to direct measurement of LDL-C (D-LDL-C). The mean D-LDL-C (2.47±0.71 mmol/L) was significantly lower compared to F-LDL-C (2.76±1.05 mmol/L), N-LDL-C (2.74±1.04 mmol/L), A-LDL-C (2.99±1.02 mmol/L), and M-LDL-C (2.97±1.08 mmol/L) p \u3c 0.001. There was a significantly positive correlation between D-LDL-C and A-LDL-C (r=0.658, p\u3c0.0001), N-LDL-C (r=0.693, p\u3c0.0001), and M-LDL-C (r=0.693, p\u3c0.0001). M-LDL-c yielded a better diagnostic performance [(area under the curve (AUC)=0.81; sensitivity (SE) (60%) and specificity (SP) (88%)] followed by N-LDL-C [(AUC=0.81; SE (63%) and SP (85%)], F-LDL-C [(AUC=0.80; SE (63%) and SP (84%)], and A-LDL-C (AUC=0.77; SE (68%) and SP (78%)] using D-LDL-C as gold standard. Bland-Altman plots showed a definite agreement between means and differences of D-LDL-C and the calculated formulas with 95% of values lying within ±0.50 SD limits. The modified LDL-C (M-LDL-C) formula derived by this study yielded a better diagnostic accuracy compared to A-LDL-C and F-LDL-C equations and thus could serve as a substitute for D-LDL-C and F-LDL-C equations in the Ghanaian population

Henipavirus RNA in African Bats

BACKGROUND: Henipaviruses (Hendra and Nipah virus) are highly pathogenic members of the family Paramyxoviridae. Fruit-eating bats of the Pteropus genus have been suggested as their natural reservoir. Human Henipavirus infections have been reported in a region extending from Australia via Malaysia into Bangladesh, compatible with the geographic range of Pteropus. These bats do not occur in continental Africa, but a whole range of other fruit bats is encountered. One of the most abundant is Eidolon helvum, the African Straw-coloured fruit bat. METHODOLOGY/PRINCIPAL FINDINGS: Feces from E. helvum roosting in an urban setting in Kumasi/Ghana were tested for Henipavirus RNA. Sequences of three novel viruses in phylogenetic relationship to known Henipaviruses were detected. Virus RNA concentrations in feces were low. CONCLUSIONS/SIGNIFICANCE: The finding of novel putative Henipaviruses outside Australia and Asia contributes a significant extension of the region of potential endemicity of one of the most pathogenic virus genera known in humans

Two Novel Parvoviruses in Frugivorous New and Old World Bats

Bats, a globally distributed group of mammals with high ecological importance, are increasingly recognized as natural reservoir hosts for viral agents of significance to human and animal health. In the present study, we evaluated pools of blood samples obtained from two phylogenetically distant bat families, in particular from flying foxes (Pteropodidae), Eidolon helvum in West Africa, and from two species of New World leaf-nosed fruit bats (Phyllostomidae), Artibeus jamaicensis and Artibeus lituratus in Central America. A sequence-independent virus discovery technique (VIDISCA) was used in combination with high throughput sequencing to detect two novel parvoviruses: a PARV4-like virus named Eh-BtPV-1 in Eidolon helvum from Ghana and the first member of a putative new genus in Artibeus jamaicensis from Panama (Aj-BtPV-1). Those viruses were circulating in the corresponding bat colony at rates of 7–8%. Aj-BtPV-1 was also found in Artibeus lituratus (5.5%). Both viruses were detected in the blood of infected animals at high concentrations: up to 10E8 and to 10E10 copies/ml for Aj-BtPV-1 and Eh-BtPV-1 respectively. Eh-BtPV-1 was additionally detected in all organs collected from bats (brain, lungs, liver, spleen, kidneys and intestine) and spleen and kidneys were identified as the most likely sites where viral replication takes place. Our study shows that bat parvoviruses share common ancestors with known parvoviruses of humans and livestock. We also provide evidence that a variety of Parvovirinae are able to cause active infection in bats and that they are widely distributed in these animals with different geographic origin, ecologies and climatic ranges

Evidence for Novel Hepaciviruses in Rodents

Hepatitis C virus (HCV) is among the most relevant causes of liver cirrhosis and hepatocellular carcinoma. Research is complicated by a lack of accessible small animal models. The systematic investigation of viruses of small mammals could guide efforts to establish such models, while providing insight into viral evolutionary biology. We have assembled the so-far largest collection of small-mammal samples from around the world, qualified to be screened for bloodborne viruses, including sera and organs from 4,770 roden