Retrospective Cohort Study of Antenatal Care and Pregnancy Outcomes in Kadjebi District of Ghana

Antenatal care is essential strategy for improving maternal and pregnancy outcome. We determined the association between antenatal attendance and pregnancy outcome using low birth weight and preterm birth. We conducted retrospective cohort study using data from antenatal and delivery records of all the maternity units in Kadjebi District from October 2012 to January 2013. The study subjects were a cohort of women who delivered in maternity units in the district from 1st January to 31st December 2011.The study participants were 663 pregnant women with mean age of 25.8 years, ranging between 15-45 years. Most of the women, 53.9% were between 20-29 years and 16.2% were teenagers. The mean parity of the women was 2.1. Almost all the pregnant women, 99.2% had at least one antenatal care but only 48.2% of them made the optimum antenatal visits recommended by WHO. About 55.5% of the deliveries were preterm. Pregnant women with height <145cm were most likely to have good antenatal attendance (LR, OR:  0.65, CI: 0.45-0.95, P= 0.0246). Preterm delivery was more among Sickling positive pregnant women (LR, OR: 4.37, CI: 1.55-12.33, P: 0.0052). Low birth weight was most common among the unemployed (OR: 5.17, CI: 1.72-15.60, P: 0.0035). Early antenatal registration was protective against low birth weight (OR: 0.27, CI: 0.07-0.95, P: 0.0415). Analysis of data collected in the antenatal and delivery registers can yield valuable information for public health action. Antenatal attendance was almost universal however, optimum antennal visits was undesirably lower than expected. Early registration for antenatal care would reduce low birth weight and improve pregnancy outcome. Keywords: Ghana, Antenatal care, Prenatal care, Retrospect cohort study, pregnancy outcom

Parasite clearance dynamics in children hospitalised with severe malaria in the Ho Teaching Hospital, Volta Region, Ghana.

Over 90% of severe malaria (SM) cases occur in African children. Parenteral artesunate is currently the recommended treatment for SM. Studies of parasite clearance in paediatric SM cases are needed for assessment of therapeutic outcomes but are lacking in Africa. Severe malaria patients were recruited in the children's emergency ward at Ho Teaching Hospital, Ghana, in 2018. Blood samples were taken upon admission, every 24 h for 3 days and 1 week after treatment, and DNA extracted. Parasitaemia and parasite densities were performed by microscopy at enrolment and the follow-up days wherever possible. Relative parasite density was measured at each timepoint by duplex qPCR and parameters of parasite clearance estimated. Of 25 evaluable SM patients, clearance of qPCR-detectable parasites occurred within 48 h for 17 patients, but three out of the remaining eight were still qPCR-positive on day 3. Increased time to parasite clearance was seen in children ≥5 years old, those with lower haemoglobin levels and those with a high number of previous malaria diagnoses, but these associations were not statistically significant. We examined parasite clearance dynamics among paediatric cases of SM. Our observations suggest that daily sampling for qPCR estimation of peripheral density is a useful method for assessing treatment response in hospitalised SM cases. The study demonstrated varied parasite clearance response, thus illuminating the complex nature of the mechanism in this important patient group, and further investigations utilizing larger sample sizes are needed to confirm our findings

Plasmodium falciparum malaria cases detected for prompt treatment by rapid diagnostic tests in the Ho Teaching Hospital of the Volta Region of Ghana

Background: Prompt diagnosis and effective treatment of malaria cases with efficacious drugs is an important strategy in the management and control of malaria in endemic populations. As part of a study investigating the factors modulating the development of Plasmodium falciparum gametocytes in the human host, we assessed the rate of RDT positivity of patients in different departments of the Ho Teaching Hospital and the relation with age and anaemia. Materials and methods: Eight-hundred and ten individuals attending clinic at various departments within the Ho Teaching Hospital were screened for malaria antigenaemia using RDT as a point-of-entry investigation. RDT positive individuals were immediately treated for malaria whereas RDT negative individuals were treated for other ailments. Haematological analyses were performed for 69 of these patients and the relationship between RDT results and haemoglobin levels were investigated. Results: The overall RDT positivity rate was 19.8% (160/810) of all individuals screened. There was no significant difference in the haemoglobin levels of RDT-positive and RDT-negative individuals (p value = 0.272). The highest number of attendees screened was children in the paediatric outpatient department and paediatric ward, 62% (507/810), with RDT positivity rate of 17% (91/507). We found the highest RDT positivity rate of 51% (19/37) in the male medical ward. Conclusions: This study shows that RDT is a useful tool in promoting prompt diagnosis and management of malaria and though children form a majority of hospital attendees and malaria infections, the frequency of malaria detection may be higher in adults as compared to children. Keywords: Plasmodium falciparum malaria, Rapid diagnostic test, Anaemi