The Ghanaian woman’s experience and perception of ultrasound use in antenatal care

Objective: To evaluate how Ghanaian women perceive the use, and their assessment of the experience, of antenatal ultrasound scanning.Design: Cross-sectional study, using interviewer administered  questionnaire, from 25th February to 16th April, 2011Setting: Obstetrics Units of Korle Bu Teaching Hospital, Accra, University of Ghana Hospital, Legon and Ga South District Hospital, Weija.Methods: A total of 337 clients were randomly selected after delivery and interviewed. Issues addressed included why women went for antenatal ultrasound, their knowledge of the uses of ultrasound in pregnancy, information provided by health care  providers, clients’ eagerness to know the sex of their fetuses, and their overall assessment of the ultrasound scanning experience.Results: The mean number of scans was 2.2(1.1). Most were performed on the request of a doctor or midwife; 154(45.7%) were not told the reasons for the request and 185(54.9%) did not have the results explained to them. For 239(70.9%) women the sonographer did not explain the procedure before the examination; 89(26.4%) were allowed to ask questions and 61(18.1%) were allowed to see their fetuses on themonitor. One hundred and sixty respondents (47.5%) asked for and were told the sex of their fetuses, with accuracy at delivery of 86.5%.Conclusion: Most respondents perceived antenatal ultrasound as a useful tool. There is lack of information flow from health care providers to clients concerning the indications for the ultrasound, the processes involvedand the results of the procedure. Improvements in these areas are needed to enhance the experience of antenatal ultrasound among Ghanaian  women.Keywords: ultrasound examination, pregnancy, antenatal, Ghan

Outcome of barium enema in patients with colorectal symptoms

Background: For many years, double contrast barium enema has been an effective way to evaluate the large bowel. With the development of the colonoscope, the role of barium enema has been questioned. However itis still useful in investigating patients with colorectal symptoms especially in the developing world where colonoscopy is widely unavailable and fraught with challenges in completely evaluating the colon.Objective: This study aimed at reviewing double contrast barium enema investigations in our centre.Methods: This was a retrospective study on patients who underwent double contrast barium enema at the Korle Bu Teaching Hospital from May 2003 to April 2007 on account of symptoms referable to the large bowel.Results: A total of 362 investigation reports were studied, of which 205 were for males and 154 for females, the mean age of the patients was 55.3 years (S.D 15.3years). Majority of the investigations, 228 (61.96%), were normal. Diverticular disease diagnosed in 88 (23.91%) cases was the commonest finding, followed by neoplasm 27 (7.34%) cases and Ulcerative colitis 6 (1.63%) cases, non-specific narrowing of the bowel in 4 (1.09%) and in 5 (1.36%) cases their investigations were inconclusive due to poor bowel preparation. Rectal bleeding was the most frequent symptom prompting barium enema studies.Conclusion: Double contrast barium enema study of the large bowel is an important evaluation of patients with colorectal symptoms

Establishing the cardiothoracic ratio using chest radiographs in an indigenous Ghanaian population: a simple tool for cardiomegaly screening

Background: Cardiothoracic ratio is a simple and cheap tool in the estimation of heart size. It is a useful index of cardiac size evaluation, and a value of 50% is generally considered to indicate the upper limit of normal.Study Objective: This study is to ascertain the normal mean value in cardiothoracic ratio of Ghanaians using chest radiography to serve as baseline for screening for cardiomegaly.Methodology: Standard postero-anterior radiographs of the -clients/patients were used in the study. The cardiothoracic ratio (CTR) was obtained by dividing the transverse cardiac diameter [sum of the horizontal distances from the right and left lateral-most margins of the heart to the midline (spinous processes of the vertebral bodies)] by the maximum internal thoracic diameter. Systematic sampling with appropriate inclusion and exclusion criteria were used to obtain a sample size of 1989.Results: The mean transverse cardiac diameter and cardiothoracic ratio increased with age. The transverse thoracic diameter increased with age until the sixth decade when it reduced with age. The mean CTR increased gradually with age with females having greater values than males. The mean CTR of the study population were 0.459, 0.467 and 0.452 for the general population, females and males respectively.Conclusion: This study has been able to establish 0.459 as the mean CTR values for Ghanaians. It has also shown the relationship between age and clients /patient’s cardiothoracic ratio which compares favourably with findings of a similar study in Nigeria, a neighbouring country in the West African sub region with similar ethnic and social structure.Keywords: Radiography, Indigenous Ghanaian, cardiomegaly, cardiothoracic ratio, Screenin

Detailed Review of CT Scans Aids Assessment of the Airway in Patients Scheduled for Maxillofacial Surgery

Two cases are presented that illustrate the importance of information gained from CT scans of the head and neck taken in patients presenting for maxillo-facial surgery. The first case involved a 25 year old with a massive tumour filling his mouth. Pre-operative assessment was done without reviewing the CT scans of his head and neck. This was unfortunately overlooked as the CT scans were not available at the patient's bedside when the pre-operative assessment was carried out. An awake nasal fibreoptic intubation was planned but this was unsuccessful as the scope could not be passed through the nasopharynx. Review of the CT scan showed severe narrowing of the nasopharynx and a tracheostomy was done under local anaesthesia prior to anaesthetizing the patient. No attempt would have been made to carry out a fibreoptic intubation if the CT scan had been studied earlier and the narrowing of the pharynx appreciated.The second case involved a 12 year old girl with massive fibreosseous lesions involving the maxilla and mandible. The maxillary lesion had been excised two years previously when the child was 10 years old. At that time a tracheostomy was done, as attempted intubation was unsuccessful. On this occasion, detailed study of her CT scans showed that the left nostril was indented and occluded by the fibreosseous lesion but the right nostril, though narrow, was patent. Under sedation, a nasal fibreoptic intubation was successfully done through the right nostril