A review of Intra-uterine foetal deaths at the Cape Coast Teaching Hospital

Aim: To estimate the rate of IUFD/Stillbirths (SB)Study design: This is a retrospective review of delivery suite records from Jan 1 2013 to Dec 31 2014.Methods: Study was undertaken at the Cape Coast Teaching Hospital (CCTH) in the Central region of Ghana. All pregnant women who had their babies at the delivery suite of CCTH have their records hand written in Ghana health service approved and distributed delivery records book. We identified all patients with IUFD/SB from this delivery suite record book which is kept on the delivery suite. The data collected included the age, parity, mode of delivery, total blood loss, sex of the foetus and condition of foetus i.e. Macerated stillbirth (MSB) or fresh still birth (FSB). Of the 315 IUFDs found in the records book, 26 were incompletely filled, and 13 were abortions (<28 weeks) and therefore excluded. The analysis is therefore based on 276 completed documentations. The data collected from thedelivery suite records were analysed using STATA version 11.0.Results: Of the 315 IUFD/SBs documented in the delivery suite record book, 13 were abortions (<28 weeks), leaving 302 IUFD/SBs. Of this number, 26 had incomplete data and were excluded from the analysis. The analysis was thus based on 276 IUFD/SBs with complete data. Over the study period there were 5176 deliveries, giving a stillbirthrate of 58.5/1000 deliveries. Majority of the IUFD occurred in women 20-35 years of age (74.7%), and who have had two or less births (66.7%). The mean maternal age at which IUFD occurred was 29 years.Conclusion: Our review shows that the SBR of 58.5/1000, over the two years, at CCTH is high. We suggest further studies to focus on the reasons for IUFDs and what interventions can be applied to reduce it.Funding: No internal or external funds sourced.Keywords: Stillbirth, foetal death, pregnancy outcome, parity, caesarean delivery

Zero malaria: a mirage or reality for populations of sub-Saharan Africa in health transition

The global burden of malaria continues to be a significant public health concern. Despite advances made in therapeutics for malaria, there continues to be high morbidity and mortality associated with this infectious disease. Sub-Saharan Africa continues to be the most affected by the disease, but unfortunately the region is burdened with indigent health systems. With the recent increase in lifestyle diseases, the region is currently in a health transition, complicating the situation by posing a double challenge to the already ailing health sector. In answer to the continuous challenge of malaria, the African Union has started a "zero malaria starts with me” campaign that seeks to personalize malaria prevention and bring it down to the grass-root level. This review discusses the contribution of sub-Saharan Africa, whose population is in a health transition, to malaria elimination. In addition, the review explores the challenges that health systems in these countries face, that may hinder the attainment of a zero-malaria goal

Breast cancer treatment and outcomes at Cape Coast Teaching Hospital, Ghana

Objectives: This study sought to determine the presentation, treatment and outcomes of breast cancer among women in Cape Coast, Ghana.Design: Retrospective medical record reviewSetting: Cape Coast Teaching Hospital, Cape Coast, GhanaParticipants: Female breast cancer patientsInterventions: NoneMain outcome measures: Proportion of female breast cancer patients presenting with advanced disease.Results: Approximately 84% of women had a primary presentation of breast cancer, with metastatic disease present in 34% of patients. Surgical management mainly involved partial mastectomy (21.7%) and total mastectomy (78.6%), with the most common postoperative complications being surgical site infections (3.8%). Non-surgical management involved chemotherapy, radiation therapy and anti-estrogen therapy, with Stage 3 and 4 patients twofold more likely to receive neoadjuvant chemotherapy than earlier stages (OR= 2.0 95% CI (1.4, 3.0, p<0.001). Grade 1 cancers were diagnosed in 11.0%, Grade 2 in 43.8%, and Grade 3 in 45.2%. The mean cancer size was 6.5 centimetres (range 1.5 to 20.0). Lymphatic vascular invasion was present in 59/125 (47.2%), estrogen receptor status was positive in 32.6%, progesterone receptors were positive in 22.1%, and Her-2/neu was positive in 32.6%. Triple-negative breast cancer was identified in 41/89 (46.1%).Conclusions: Women with breast cancer typically present to the Cape Coast Teaching Hospital with advanced stage disease and experience poor outcomes