Postpartum Implanon/Nexplanon continuation rates and associated factors among women who ever used Implanon/Nexplanon in a tertiary hospital in Accra, Ghana

Background: Postpartum Implanon use serves as an important conduit to bridge the wide gap of unmet need for contraception. The study sought to determine the continuation rates of postpartum Implanon/Nexplanon use and factors associated with it.Methods: A retrospective review of electronic data of 391 women who had received postpartum Implanon/Nexplanon insertions from January 2012 to December 2015 was conducted at a family planning hospital in Accra, Ghana. Continuation rates and factors associated with discontinuation at 6 months, one year and two years post-partum were determined. Data were analysed using IBM Statistical Package for Social Science (SPSS) version 20.Results: A total of 391 postpartum Implanon/Nexplanon insertions were done during study period. Their mean age was 28.51±5.29 years and median parity was 2.0. Continuation rates of postpartum Implanon/Nexplanon at 6 months, 1 year and 2 years post uptake were 94.9%, 92.8% and 86.4% respectively. Women with tertiary level education were 64% less likely to continue Implanon/Nexplanon use at one-year post uptake (OR=0.36, CI=0.16-0.85). Women with education up to Senior High School were 62% less likely to continue postpartum Implanon/Nexplanon use at 2 years after uptake (OR=0.38, CI=0.18-0.81). Women between ages 20 and 29 years were 53% less likely to continue postpartum Implanon/Nexplanon use at 2 years (OR=0.47, CI=0.26-0.86). Reasons for discontinuation of postpartum Implanon/Nexplanon use were wishes to get pregnant and side effects of the method.Conclusions: Post -partum Implanon/Nexplanon continuation rates are high and remain as a viable choice for reduction of unplanned pregnancies post- delivery

Postpartum implanon/nexplanon uptake in a tertiary hospital in West Africa

Background: The postpartum period is viewed as an opportune period for uptake of contraception. Ghana has an unmet need for family planning of 30%. This study sought to determine the postpartum Implanon/Nexplanon uptake among women at a tertiary hospital.Methods: This was a retrospective study that analysed 391 Implanon/Nexplanon insertions between 2012 and 2015 at the reproductive health and family planning unit at the Korle-Bu teaching hospital.Results: Almost 69% (391/565) of all Implanon/Nexplanon insertions conducted between 2012 and 2015 were conducted in the postpartum period. Out of these postpartum insertions, 2.3% were done in the immediate postpartum period, 27.6% were done during the interval postpartum period and 70.1% were in the delayed postpartum period. Age and implant insertion status (first time ever or continuing) were significant determinants of postpartum Implanon/Nexplanon insertions. Compared to women less than 20 years of age, women in the age group 20-29 and 30-39 were 76% (AOR=0.24, CI=0.62-0.97) and 80% (AOR=0.20, CI=0.05-0.86) respectively less likely to have postpartum Implanon/Nexplanon  insertions done. Continuing users of implant insertions were 45% (AOR=0.55, CI=0.37-0.82) less likely to have post-partum Implanon/Nexplanon insertions done compared to first ever users.Conclusions: There is a high uptake of postpartum Implanon/Nexplanon use among patients who receive implant insertions at the Korle-Bu Teaching Hospital. However immediate postpartum Implanon/Nexplanon insertions are low. There is the need to educate women and couples on the benefits of immediate postpartum implant insertion to avoid rapid repeat pregnancies

Psychological changes in Africans with kidney disease in Ghana: a comparison of haemodialysis patients and patients with chronic kidney disease not on dialysis

Background: The prevalence of chronic kidney disease (CKD) is high in sub-Saharan Africa and affects the productive workforce. CKD has been associated with psychological problems such as anxiety and depression; however, there is little published information on the burden of psychological problems among the CKD population in African countries. Our study assessed psychological changes in two groups of patients, one group with end-stage renal disease receiving chronic haemodialysis, and a second with CKD not on dialysis.Methods: A cross-sectional study involving patients on chronic haemodialysis and patients with CKD stages 3–5 (the “CKD” patients) was conducted at the Renal Unit of the Korle-Bu Teaching Hospital in Accra, Ghana. One hundred and sixty-eight participants (82 CKD and 86 haemodialysis patients) were recruited. Demographic, clinical and laboratory information was captured, the Revised Quick Cognitive Screening Test (RQCST) was used to assess cognitive function and the Brief Symptoms Inventory-18 (BSI-18) was used to screen for anxiety, somatization and depression.Results: CKD patients were older than those on haemodialysis, with mean ages of 53.3 and 46.6 years, respectively. Two-thirds (113/167) were male. The median glomerular filtration rate (GFR) of the CKD patients was 21 mL/min/1.73 m2 (interquartile range 9–34). Most of the haemodialysis patients (78.6%) were receiving two sessions of haemodialysis per week and their mean kT/V was 1.16 ± 0.23. The RQCST global scores in the two groups of patients were similar, with almost 90% of haemodialysis patients and 85% of CKD patients obtaining scores above 50. Haemodialysis patients had better scores for immediate recall memory. The haemodialysis patients also had higher BSI-18 global scores than the CKD patients (mean of 0.83 vs 0.70, p = 0.033). Mean anxiety and somatization scores were also higher in the haemodialysis patients.Conclusions: Haemodialysis patients demonstrated higher anxiety and somatization scores than the CKD patients. Clinical psychological support should therefore be included in the treatment of our patients, and especially for those on chronic haemodialysis

Patients’ knowledge and perception of anaesthesia and the anaesthetist at a tertiary health care facility in Ghana

Background: Anaesthesia has always been misconstrued as a ‘behind the scenes’ specialty. Despite advancements in anaesthesia, there is inadequate public knowledge regarding the specialty, the scope of the functions of anaesthetists, and the pivotal role anaesthetists play in the healthcare delivery system. This study therefore assessed the knowledge and perception of anaesthesia and the role of anaesthetists among patients in a tertiary healthcare facility.Methods: A cross-sectional study was conducted over 3 months in 2015 among 279 patients accessing services at the preanaesthetic clinic of the Korle-Bu Teaching Hospital. Patients were interviewed using a structured questionnaire assessing sociodemographic characteristics, their knowledge and perceptions about anaesthesia, and the role of anaesthetists.Results: The majority of patients (62.4%) had heard about anaesthesia. Most (85%) knew that specially trained doctors or nurses were responsible for the delivery of anaesthesia. Nearly half the patients indicated anaesthesia was all about ‘putting people to sleep and waking them up’. Less than 15% of patients had knowledge of the role of anaesthetists outside the confines of the operating theatre suites.Conclusion: A considerable number of patients had heard about anaesthesia and knew the people responsible for the delivery of anaesthesia. The perception of most patients is that anaesthesia is all about ‘putting patients to sleep and waking them up’. There was poor knowledge of patients regarding the role of anaesthetists beyond the confines of the operating theatre.Keywords: anaesthesia, anaesthetist, knowledge, misconceptions, patients, perception

Psychological comorbidities in epilepsy: a cross-sectional survey among Ghanaian epilepsy patients

Objective: To evaluate the prevalence and patterns of psychiatric disorders in epilepsy patients at the Korle-Bu Teaching hospital, Accra, Ghana.Design: The study design was a cross-sectional surveySetting: The study was conducted at the Neurology Clinic of the Department of Medicine and Therapeutics, Korle-nBu Teaching hospital, Accra, Ghana.Participants: A total of one hundred and sixty-six patients diagnosed with epilepsy aged at least 18 years and accessing services at the neurology clinic participated in the study.Main Outcome Measure: Prevalence and patterns of psychiatric disorders among patients diagnosed with epilepsy using the Brief Symptom Inventory.Results: The mean age for onset of epilepsy was 20.1 ± 16.9 years, and generalized epilepsy (73.2%) was the major type of epilepsy identified. The aetiology of the epilepsy condition was unknown in most patients (71.1%). The estimated mean Brief Symptom Inventory scores in all the nine diagnostic psychiatry characteristics (Depression, Anxiety, Somatization, Hostility, Phobic Anxiety, Obsessive Compulsive Disorder, Psychoticism, Interpersonal Sensitivity, and Paranoid Ideation) were higher in the epilepsy patients compared to the normative data scores for non-patients. Global Severity Index scores for females were significantly higher (p=0.002) than the scores for males on all the psychological outcomes except hostility.Conclusion: Psychological disorders were prevalent among epilepsy patients, with females more likely to experience psychological problems than males. The findings call for a holistic approach in managing epilepsy to highlight and manage some exceptional psychological comorbidities

Healthcare provider perspectives on HIV cure research in Ghana

INTRODUCTION: Antiretroviral therapy (ART) has reduced mortality and improved life expectancy among HIV patients but does not provide a cure. Patients must remain on lifelong medications and deal with drug resistance and side effects. This underscores the need for HIV cure research. However, participation in HIV cure research has risks without guaranteed benefits. We determined what HIV healthcare providers know about HIV cure research trials, the risks involved, and what kind of cure interventions they are likely to recommend for their patients. METHODS: We conducted in-depth qualitative interviews with 39 HIV care providers consisting of 12 physicians, 8 counsellors, 14 nurses, 2 pharmacists, 2 laboratory scientists, and 1 community advocate from three hospitals. Interviews were transcribed verbatim and coded, and thematic analysis was performed independently by two investigators. RESULTS: Participants were happy about the success of current treatments and hopeful that an HIV cure will be found in the near future, just as ART was discovered through research. They described cure as total eradication of the virus from the body and inability to test positive for HIV or transmit the virus. In terms of risk tolerance, respondents would recommend to their patients\u27 studies with mild to moderate risks like what patients on antiretroviral therapy experience. Participants were reluctant to recommend treatment interruption to patients as part of a cure study and wished trials could be performed without stopping treatment. Healthcare providers categorically rejected death or permanent disability as an acceptable risk. The possibility of finding a cure that will benefit the individual or future generations was strong motivations for providers to recommend cure trials to their patients, as was transparency and adequate information on proposed trials. Overall, the participants were not actively seeking knowledge on cure research and lacked information on the various cure modalities under investigation. CONCLUSION: While hopeful for an HIV cure, healthcare providers in Ghana expect a cure to be definitive and pose minimal risk to their patients

Peripheral neuropathy in patients with human immunodeficiency viral infection at a tertiary hospital in Ghana

Peripheral neuropathy (PN) is the most frequent neurological complication in people living with HIV/AIDS. Neurological damage was identified to not only be caused by the viral infection itself but also through neurotoxic antiretroviral therapy (ART). PN is associated with a variety of risk factors; however, detailed knowledge is scarce for sub-Saharan African populations, bearing among the highest HIV/AIDS infection burden.In a cross-sectional study, we assessed the prevalence of PN in 525 adult outpatients suffering from HIV/AIDS and admitted to the largest tertiary hospital in Ghana. Through a detailed questionnaire and clinical examination including neurologic assessment and laboratory blood sample testing, this study investigated associations of PN with demographic and health determinants and identified risk factors associated with sensory neuropathy.The prevalence of PN in the Ghanaian cohort was 17.7% and increased odd ratios (OR) when patients were taller (> 1.57 m; OR = 3.84; 95% CI 1.38-10.66) or reached the age > 34 years (p = 0.124). Respondents with longer education duration had significantly less PN (≥ 9 years of education; OR = 0.49; 95% CI 0.26-0.92). The study also identified significant association of PN to both waist and hip girth and neutrophil counts. Curiously, higher adjusted odd ratios (aOR) of PN of patients under ART treatment were observed when CD4 lymphocytes were elevated (aOR = 0.81; 95% CI 0.36-1.83 and aOR = 2.17; 95% CI 0.93-5.05, for 300 and 600 counts, respectively). For patients on ART, an increase of 10 CD4 cell count units increased their chance of developing PN by 1% (aOR = 1.01; 95% CI 1.00 to 1.03).Despite current drug application regulations, prevalence of PN is still unacceptably high in sub-Saharan African populations. Reduction in chronic morbidity through a health system with routine monitoring, early diagnosis and prompt intervention, and effective case management can improve people living with HIV/AIDS' quality of life

Clinical characteristics of COVID-19 patients admitted at the Korle-Bu Teaching Hospital, Accra, Ghana

Design: Study design was a retrospective single-center review of hospital data.Setting: The study was conducted at the COVID-19 Treatment Center of the Department of Medicine and Therapeutics of the Korle-Bu Teaching hospital in Accra, Ghana.Participants and study tools: A total of fifty patients with laboratory (rRT-PCR) confirmed COVID-19 infection were involved in the study. A chart review of the medical records of the patients was conducted and the data obtained was documented using a data extraction form.Results: The median age was 53 years and most (36% (18/50)) of the patients were at least 60 years of age. Eighty percent (40/50) of the patients were symptomatic, with cough and difficulty in breathing being the commonest presenting symptoms. The mean duration of hospitalization was 12.3 ± 7.3 days. Hypertension and Diabetes Mellitus were the commonest co-morbidities occurring in 52% (26/50) and 42% (21/50) of patients respectively. Fifty percent of patients developed COVID-19 pneumonia as a complication. The mortality rate was 12% (6/50).Conclusion: In this study, SARS-CoV2 infection affected older adults with hypertension and diabetes mellitus being the common comorbidities. Patients with these comorbid conditions should be counselled by their clinicians to strictly observe the COVID-19 prevention protocols to reduce their risk of acquiring the infection. There is a need to pay critical and prompt attention to the management of patients with COVID-19 pneumonia particularly among people with diabetes to improve outcomes

Unwillingness of patients in Ghana to interrupt antiretroviral therapy for HIV cure research

OBJECTIVES: Though antiretroviral therapy (ART) has reduced HIV infection into a manageable chronic disease, it does not provide for a cure. HIV cure trials may carry risks for patients who are generally doing well on ART, making it imperative that their input is sought as various types of cure methods and trials are designed. Few studies have sought the views of African patients on HIV cure studies. The objective of this study was to determine the views and preferences of people living with HIV (PLWH) in Ghana on cure research. METHODS: We used a questionnaire to interview 251 PLWH in Ghana about their willingness to engage in HIV cure research. We investigated their motivations, the types of cure they would prefer and which risks were acceptable to them. RESULTS: Most participants were enthusiastic about participating in cure research and driven by both altruistic and personal motives. Patients preferred a cure where they would continue follow-up with their doctor (88%) compared to being assured that they have been completely cured and did not need further follow-up (11%). The vast majority of the respondents were risk averse. Most patients (67%) would decline to interrupt ART as part of a protocol for HIV cure research. In bivariate analysis, participants above the age of 40 years were more likely to agree to treatment interruption during cure studies (OR 2.77; 95% CI 1.21-.6.34. CONCLUSIONS: Our results show that preferred cure modalities and risk tolerance for patients in Africa may be different from those of other parts of the world. Extensive social science and behavioural studies are needed on the continent to help inform future cure trials

Management of dog bites by frontline service providers in primary healthcare facilities in the Greater Accra Region of Ghana, 2014–2015

Abstract Background Dog bites are common in developing countries including Ghana, with the victims often being children. Although some breeds of dogs have been identified as being more aggressive than others, all dog bites carry a risk of infection. Immediate and initial assessment of the risk for tetanus and rabies infection with appropriate interventions such as wound management and subsequent selection of prophylactic antibiotics are essential in the management of dog bites. This study examined the management of patients with dog bites by frontline service providers at primary healthcare facilities in the Greater Accra Region, Ghana. Methods We conducted a cross-sectional study in 66 public health facilities in the Greater Accra Region from July 2014 to April 2015. Up to four frontline service providers were randomly selected to participate from each facility. A structured questionnaire was administered to all consenting participants. Continuous variables were presented as means and standard deviations. The frontline service providers’ knowledge was assessed as a discrete variable and values obtained presented as percentages and proportions. The chi-square test of proportions was used to determine any significant associations between the various categories of the frontline service providers and their knowledge about the management of rabies. Results Regarding the frontline service providers’ knowledge about rabies, 57.8% (134/232) were correct in that the rabies virus is the causative agent of rabies, 39.2% (91/232) attributed it to a dog bite, 2.6% (6/232) did not know the cause, and one person (0.4%) attributed it to the herpes virus. Only 15.5% (36/232) knew the incubation period in dogs and the period required to observe for signs of a rabies infection. With respect to the administration of rabies immunoglobulin, 42.2% (98/232) of the frontline service providers did not know how to administer it. Of the facilities visited, 76% (50/66) did not have the rabies vaccines and 44% (102/232) of frontline service providers did not know where to get the rabies vaccines from. Most of the service providers (87.9%; 204/232) had never reported either a dog bite or a suspected case of rabies. Overall, there was gross underreporting of dog bites and suspected rabies cases at public healthcare facilities in the Greater Accra Region of Ghana. Conclusions In view of the high morbidity and mortality associated with bites from rabid dogs and the poor knowledge and practices of frontline service providers, there is an urgent need for capacity-building such as training in the management of dog bites and subsequent potential rabies infection