Division of Physicians

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FACTORS INFLUENCING ADOLESCENTS’ USE OF SERVICES AT ADOLESCENT HEALTH CORNERS IN THE BRONG AHAFO REGION
(AFREH KUFFOUR OSEI, 2021-03-12) AFREH, KUFFOUR OSEI
Introduction: Adolescents are generally a healthy population. Nonetheless, they face significant health challenges. Low contraceptive use, unplanned pregnancies and Sexually Transmitted Infections (STIs) including HIV/AIDS among adolescents in sub-Saharan Africa are unacceptably high and of public health concern. Complications from pregnancy and childbirth have been identified as the leading cause of death in girls aged 15-19 yrs in low and middle income countries, where almost all the estimated 3 million unsafe abortions occur. Adolescent Health Corners (AHCs) were established at selected public health facilities in the early 2000s to create conducive environments for service delivery and utilisation by adolescents. Consequently, scale up of the AHCs was embarked upon by Ghana Health Service and her partners where UKAID through the Palladium Group’s Ghana Adolescent Reproductive Health (GHARH) Project, refurbished and equipped 54 Adolescent Health Corners in the Brong Ahafo Region. This study sought to examine factors that influence adolescents in using the services provided at the AHCs. Methods A cross-sectional study was used by adopting a mixed method of data collection. Quantitative data was collected randomly from 509 study participants selected from 11 districts sampled randomly from the 27 administrative districts across the Brong Ahafo Region. Two focus group discussions were also conducted for adolescents within two of the selected districts. Eleven in-depth interviews were conducted for health care providers at the AHCs in the selected Districts. Results Majority (73.1%) of the adolescents were aware of the presence of AHCs in their catchment area. Majority (82.5%) of the respondents who were aware of AHCs had used services at the AHCs. Females had a significantly higher odds of awareness of the existence of AHCs compared to males (AOR=2.34, CI=1051-3.62, p=0.003). Adolescents whose mothers and fathers attained a primary education had higher odds [4.25 (1.93, 9.35), 3.94 (1.21, 12.79) respectively] of being aware of AHCs in their area of residence (p<0.05). Only 48.5% of schools had School Health Clubs (SHC). Adolescents who were members of SHC were 5.86 times more likely to use the services at the AHC (p<0.002). 35.2% of respondent said that providing recreational activities in the corners would attract more adolescents and 33.8% stated that services should be provided in a friendly manner. They also called for intensification of awareness creation campaign about the existence of AHCs and services provided (18.6%), provision of regular health screening (10.1%) and abortion services at the corner (2.3%). Conclusion: AHCs are crucial in reaching out to adolescents through the provision of adequate information and services during the period of adolescence. Majority of adolescents interviewed were aware of AHCs and had used the services provided. However, efforts should be made to create more demand for the services. Establishment of SHC in schools with school children being members of the clubs was found to create additional opportunity to reach out to adolescents and improve use of services at AHCs. Services provided at AHCs should be appealing to adolescents with assured privacy and confidentiality. Trained staff should create a friendly environment to address the concerns of adolescents.
NONALCOHOLIC FATTY LIVER DISEASE IN TYPE 2 DIABETES MELLITUS PATIENTS ATTENDING THE DIABETES CLINIC AT THE GREATER ACCRA REGIONAL HOSPITAL
(BAMPOH SALLY AFUA, 2021-08-26) BAMPOH, SALLY AFUA
Background: Nonalcoholic fatty liver disease is currently the leading cause of chronic liver disease and the second leading indication for liver transplantation in developed countries. It may be complicated by cirrhosis and hepatocellular carcinoma. The pathogenesis of primary nonalcoholic fatty liver disease involves insulin resistance, which also occurs in type 2 diabetes mellitus. The prevalence of nonalcoholic fatty liver disease is increasing worldwide. However, published data on this condition in Ghana is scarce. General Objective: To determine the prevalence of, and factors associated with nonalcoholic fatty liver disease in type 2 diabetes mellitus patients attending the diabetes clinic at the Greater Accra Regional Hospital in Accra, Ghana. Methodology: This study was a cross-sectional, hospital-based study conducted at the Greater Accra Regional Hospital from May to October 2018. Two hundred and thirty-five type 2 diabetes mellitus patients with insignificant alcohol history and negative screens for hepatitis B and C infection were recruited using systematic random sampling, after giving informed consent. Socio- demographic and clinical data were obtained using a semi-structured questionnaire. Anthropometric measurements, general and abdominal examinations were performed for each participant. Laboratory investigations included full blood count, fasting blood sugar, glycated haemoglobin, lipids and liver biochemistry. Abdominal ultrasonography was performed to assess for liver size and echogenicity and to measure the abdominal subcutaneous fat thickness. Non- invasive scoring systems were used to predict the presence of nonalcoholic steatohepatitis and fibrosis. Captured data was imputed and analysed using SPSS 23.0. Results: The prevalence of nonalcoholic fatty liver disease among this cohort was 38.7% (91/235). Grade 3 disease was the most prevalent (46.1%). Prevalence of nonalcoholic steatohepatitis and fibrosis using non-invasive methods was estimated to be 23.1% and 26.4% respectively, in the population diagnosed with nonalcoholic fatty liver disease. Factors associated with presence of nonalcoholic fatty liver disease included age (p-value = 0.008), shorter duration of diabetes (p- value = 0.004), body mass index (p-value <0.0001), waist circumference (p-value = 0.006), waist/hip ratio (p-value = 0.001), abdominal subcutaneous fat thickness (p-value <0.0001), hepatomegaly (p-value <0.0001), glycated haemoglobin (p-value = 0.003) and hypertriglyceridaemia (p-value = 0.021). Increasing age (OR = 0.949; 95% CI: 0.918 - 0.980), body mass index (OR = 1.108; 95% CI: 1.048- 1.171), hepatomegaly (OR = 4.230; 95% CI: 1.957 - 9.144) and elevated gamma-glutamyltransferase (OR = 3.591; 95% CI: 1.631 - 7.906) were found to be independent predictors of nonalcoholic fatty liver disease among this cohort. Conclusions: Roughly one-third of type 2 diabetes mellitus patients seen in clinics may have nonalcoholic fatty liver disease. Predictors of nonalcoholic fatty liver disease in this study include established non-modifiable risk factors such as age, as well as modifiable risk factors such as increased body mass index. Recommendations: Clinicians should utilize non-invasive markers to aid in the diagnosis of nonalcoholic fatty liver disease, especially in at-risk patients. Aggressive management of type 2 diabetes mellitus is needed to improve the outcome of the disease in Ghana. Further studies on the performance of non-invasive markers compared to liver biopsy are warranted in order to find alternate forms of diagnosis in low resource settings.
EFFECTS OF HYPERHAEMOLYSIS ON FETOMATERNAL OUTCOMES IN PREGNANT WOMEN WITH SICKLE CELL DISEASE
(ASARE EUGENIA VICKY NAA KWARLEY, 2021-09-30) ASARE, EUGENIA VICKY NAA KWARLEY
Background: Sickle cell disease (SCD) is a public health problem in sub-Saharan Africa. Recent improvement in healthcare has ensured significant increase in survival and increased chance of getting pregnant. Chronic haemolysis is a feature of SCD; haemolysis has been linked to chronic uncompensated anaemia, pulmonary hypertension, chronic leg ulcers, priapism, renal impairment, acute vaso-occlusion, venous thromboembolism and death in SCD. Hyperhaemolysis occurs in stressful conditions, and pregnancy can be stressful. Pregnancy in SCD, can be life-threatening and may be associated with poor fetomaternal outcome. Few studies, have looked at hyperhaemolysis during pregnancy and its association with fetomaternal outcome. Methodology: A prospective cohort study with 25 pregnant women with SCD, and their 2 sets of matched controls (23 pregnant women without SCD; 25 non-pregnant women with SCD) was conducted at the Obstetrics department, Korle-Bu Teaching Hospital, and the adult sickle cell clinic, Ghana Institute of Clinical Genetics, Korle-Bu. The pregnant women with and without SCD were matched for gestational age (±2weeks) and enrolled during the second trimester. Most pregnant women presenting to the clinic for their booking visit are unsure of the date of their last menstrual period. As such, the gestational age is determined by an obstetrics scan. During the second trimester an obstetrics scan gives an error margin of 10 to 14 days; hence there will be no difference in the gestational age match using ±2weeks. The SCD group (pregnant/non-pregnant) were matched for age (±2years) and phenotype. The age match was based on convenience. All pregnant women with and without SCD were followed up prospectively till six weeks postpartum. The non-pregnant women with SCD had only baseline samples drawn. The primary outcome of the study was to determine the association between hyperhaemolysis and fetomaternal outcome in pregnant women with SCD using selected markers of haemolysis- haemoglobin, absolute reticulocyte count, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), serum bilirubin and urobilinogen. The maternal outcomes were acute pain, ACS and anaemia. The fetal outcomes were spontaneous abortion, intrauterine fetal death (IUFD), preterm birth and low birthweight. Data was extracted using Excel and analysed by the use of means, standard deviation, analysis of variance and logistic regression using STATA corps version 14. Results: The mean age of the study participants was 30.3 ± 5.3 years. The mean gestational age at enrollment for the pregnant women with and without SCD was 19.4 ± 3.7 weeks. There were 13 acute pain episodes in nine pregnant women with SCD with a pain incidence rate of 1.23 events per patient- years. There was no admission for ACS during the study period. Using the criteria for defining hyperhaemolysis, only one patient each had a drop in Hb ≥20% from baseline at 28 and 36 weeks’ gestation and six weeks postpartum; with no corresponding 25% increase in reticulocyte count and an increase in LDH, indirect bilirubin and AST. There were no significant differences in the concentrations of the haemolytic markers during study follow-up. Compared to the pregnant women without SCD, the pregnant women with SCD had more caesarean deliveries [4(19.0%) vrs 18(72.0%);p=0.01]; preterm births [5(27.8%) vrs 10(41.7%);p=0.35], low birthweight babies [3(16.7%) vrs 7(29.2%); p=0.74] and IUFD [0 (0.0%) vrs 2 (8.0%)] respectively. Conclusion: This study did not demonstrate hyperhaemolysis in pregnant women with SCD; hence no association between hyperhaemolysis and fetomaternal outcome could be determined. There was no difference in steady state laboratory parameters of the selected markers of haemolysis between the SCD cohorts (both pregnant and non-pregnant).
ASSOCIATION BETWEEN FAMILY RESOURCES AND DRUG ADHERENCE IN HYPERTENSIVE MANAGEMENT AT THE CHRONIC CARE CLINIC OF KOMFO ANOKYE TEACHING HOSPITAL
(OPOKU CONSTANCE AFRA, 2021-10-25) OPOKU, CONSTANCE AFRA
Introduction Hypertension is the commonest risk factor for cardiovascular diseases which is currently the leading cause of death globally. Of the almost 1.4 billion people with hypertension worldwide, 71.4% (one billion) are found in low and middle-income countries (LMIC) with the WHO Africa region having the highest current prevalence of hypertension. One of the strongest pillars in the multifactorial approach to the management of hypertension is improving medication adherence to antihypertensives. It is imperative that innovative ways be sought to achieve this goal among health practitioners and especially Family Physicians who aim to provide comprehensive care for any pathology including hypertension. Even though there is information on social determinants of health and their influence on medication adherence and hypertension, little is known about the effect of family resources on medication adherence in hypertension and consequently blood pressure control. Aim To determine the relationship between Family Resources and Medication Adherence in patients with essential hypertension Materials and Methods This was a cross-sectional study carried out at the Chronic Care Clinic of the Family Medicine Directorate at the Komfo Anokye Teaching Hospital. Systematic sampling was used to select 110 patients with essential hypertension attending the clinic. Patients were administered a questionnaire which incorporated the Morisky 8 adherence Scale, the SCREEM questionnaire for measuring family resources and general demographic data. Medical records of the patients were also assessed to obtain current and previous blood pressure control records. The information obtained was entered into epi-info, cleaned and transferred into STATA statistical software (Version 15). Basic demographic data and frequencies were extracted following which Chi square analysis and Fisher exact tests were conducted and multivariate regression performed on specific variables to assess relevant relationships. The results of the analysed data were then presented as frequencies in tables and charts. Results A total of 110 patients with essential hypertension were enrolled in this study majority of whom were female (94, 85.5%), Christian (102, 92.7%), married (54, 49.1%) had basic education (84, 76.4%) and had uncontrolled blood pressure (65, 59.1%). Adequate family resources were reported by most respondents (85, 77.3%) with religious resources most reported as being available (89.1%) while the least available resource was economic (30.9%). The results also showed that married participants were more likely to have adequate family resources (p = 0.04) and Christians were more likely to report adequate social resources (p = 0.04). Majority of participants self-reported medium or high adherence to their antihypertensive medication (68.2%), however participant demographics had no influence on medication adherence or blood pressure control. Conclusion The most available family resource was the religious resource with the least available resource being economic. Self- reported medication adherence was found to be adequate in majority of respondents, with 68.2% of respondents reporting either medium or adequate medication adherence. No association was found between family resources and medication adherence among respondents. It is imperative that further research be conducted to establish how to harness religious resources in the improvement of medication adherence. It is also recommended that other objective adherence measuring tools be used to assess for possible relationships between family resources and medication adherence in the control of essential hypertension.
ULTRASONOGRAPHIC FINDINGS OF THE ACHILLES TENDON IN ASYMPTOMATIC VOLUNTEERS AT THE KORLE BU TEACHING HOSPITAL, ACCRA.
(Ghana College of Physicians and Surgeons, 2022-02-01) NIXON, HAROLD RICKETTS
Introduction: The Achilles tendon (AT) is the thickest and strongest tendon in the human body. It is the conjoint tendon of the gastrocnemius and soleus muscles in the posterior compartment of the leg. It is one of the most commonly injured tendons and is frequently affected by a wide range of inflammatory and degenerative processes. However, AT pathology is often oligosymptomatic and under-evaluated; because symptoms and signs of tendon pathology are open to variable interpretation. Traditional methods of investigating the AT have been magnetic resonance imaging (MRI) and computed tomography (CT) and most of the existing data was obtained from non-African individuals. Noting that genetic differences between the races can result in phenotypic variability, it is likely that the existing data does not fully represent the asymptomatic African AT. Ultrasonography (USG) is a reliable, safe and inexpensive imaging modality for evaluating the AT. In our local setting; USG is the least expensive and most readily available of the available imaging modalities for evaluating the AT. However, there is no definitive work outlining the normal USG features of the AT in our region. This knowledge gap in the USG imaging findings of the AT causes delays in the diagnosis and cost-efficient management of AT pathology. This study sought to determine the USG characteristics of the AT in the asymptomatic population of an African country; thence defining the ‘normal’ USG characteristics of the AT. Objective: To determine the ultrasonographic imaging findings of the Achilles tendon in asymptomatic volunteers at the Korle Bu Teaching Hospital, Accra. Materials and Methods: This was a hospital-based, cross-sectional study at the Radiology department of the Korle Bu Teaching Hospital. The participants (all asymptomatic volunteers above the age of 10 years) were selected with use of standardized questionnaires before inclusion into this study. USG examinations were carried out using a Toshiba Aplio 300 ultrasound machine (Toshiba medical systems corporation, Japan); equipped with a Linear Array 4.8-11 MHz transducer. In all patients, both ATs were scanned. Analysis: Captured data was analyzed in Statistical Package for Social Science (SPSS Inc., Chicago, IL, USA) version 25.0. The main outcome parameters being the echogenicity and thickness of the AT. Ankle dominance and other variables such as age, sex, height and BMI were expressed as percentages and/or graphs. Results: 342 subjects (including 162 males and 180 females) were recruited into the study and underwent bilateral ultrasound examination of their AT. 100% of the ATs reviewed were homogeneously hyperechoic - with mean thickness of 4.84 ± 0.92 mm. Males had thicker AT than females in all groups. 87.7% of dominant AT were thicker than non-dominant AT. Body height had a significant positive correlation with AT thickness. Conclusions: The asymptomatic AT is homogeneously hyperechoic and has mean thickness of 4.84 ± 0.92 mm on USG examination. Departures from these measurements should alert a radiologist to possible pathology when scanning a patient. The results of this study differ from other studies done on non-African populations; suggesting the need for further study on our indigenous population.
ENDOMETRIAL CANCER – A 10-YEAR REVIEW OF CLINICOPATHOLOGICAL FEATURES AND TREATMENT OUTCOME
(DADZIE, MARY – ANN, 2022-03-01) DADZIE, MARY – ANN
Although recently there have been significant advances in the understanding of endometrial cancer biology, the role of lymphadenectomy, adjuvant radiation, and chemotherapy is still not well defined. As a result, variability in the management of endometrial cancer across oncology centres is common and may have an impact on outcomes. There is limited literature on the current incidence of endometrial cancer, its detailed clinicopathological pattern, prognosis and practices in the management of endometrial cancer from Ghana. Lack of such information hampers the development of strategies to improve the outcome. Aim: To assess the treatment outcomes and factors affecting recurrence and survival in endometrial cancer patients treated with curative intent at the Korle Bu Teaching Hospital from January 2009 to December 2018. Methodology: In this retrospective study, data on patients with histological diagnosis of endometrial carcinoma seen at the National Radiotherapy, Oncology and Nuclear Medicine Centre treated between 1st January 2009 and 31st December 2018 were retrieved from the database. All patients had total abdominal hysterectomy with or without pelvic +/- para-aortic lymphadenectomy/sampling. Adjuvant therapy included external beam radiotherapy (EBRT) on cobalt- 60 machine +/-vaginal brachytherapy either with low or high dose rate +/- chemotherapy depending on risk stratification. Information regarding the demographic, clinical and pathological status of patients, type and sequence of treatment and follow-up of the patient after treatment was retrieved from the patients’ medical records. Patients that met the inclusion criteria were assessed. They were then categorized into risks groups based on the PORTEC definition and analyzed for the following endpoints: loco-regional and distant recurrence rates, the overall and disease–free survival rates, and factors affecting recurrence, disease-free and overall survival. Results: A total of 146 out of 269 patients were eligible for the study. The mean age was 61.3 years with majority being postmenopausal (77%) and a high prevalence of hypertension (42%) and diabetes (20%). The commonest presentation was abnormal vaginal bleeding (79%) and major histological type was endometrioid adenocarcinoma (78%). All patients had total abdominal hysterectomy with bilateral salpingo-oophrectomy with a lymph node dissection rate of 11% and a lymph node positivity rate of 62.5%. Less than half (47%) were FIGO stage 1. The 5year overall survival was 87.5%, 69%. 57% and 30% respectively for low, intermediate, high Intermediate and high risk patients (P-value: 0.001) whiles that for disease-free survival was 67%, 59%, 64.5% and 54% (P- value: 0.74). Adjuvant radiotherapy resulted in significantly improved 2year disease-free survival compared to those who had no radiotherapy in intermediate (100% vs 54% p-value: 0.006), high intermediate (87.5% vs 63%, p-value:0.041) and high risk (70.5% vs 45.5% p-value :0.041) but not overall survival. There was no difference in disease free and overall survival between patients who had pelvic lymphadenectomy and those who did not. After a median follow up of 34.5 months, there were 51 (35%) recurrences, majority of which were pelvic. Lymphovascular space invasion was the only factor associated with recurrence(p-value:0.01) whiles FIGO stage (P-value: 0.05), grade(p-value:0.03) and histology(p-calue:0.02) were associated with survival. Marital status was the only sociodemographic factor associated with survival Conclusion: Overall survival outcome for patients with endometrial cancer is comparable to developed countries but not disease-free survival which was poorer due to high recurrence rate. Adjuvant radiotherapy significantly improved the disease-free survival notably in intermediate risk population. Novel molecular testing is needed to better risk stratify and select patients who will benefit from adjuvant therapy to mitigate the high pelvic recurrences observed in the study.
RADIOLOGICAL ANATOMY OF THE ARTERIAL SUPPLY OF THE PROSTATE GLAND
(BABATUNDE BASHIRU JIMAH, 2022-03-01) BABATUNDE, BASHIRU JIMAH
Background: In West Africa and Ghana, prostate arterial embolization (PAE) is a novel procedure. To ensure effective prostatic arterial embolization and selective intervention, a thorough understanding of prostate artery anatomy and its relationship to prostate size is required. Aim: The purpose of this study is to describe the anatomy of adult male prostate arterial supply and correlate them with prostate gland size and artery diameter on Computed Tomography of patients presenting to Euracare Advanced Diagnostic and Heart Centre. Methodology: A prospective cross-sectional study was conducted, at Euracare Advanced Diagnostics and Heart Centre. Patients who presented for Computed Tomography Angiography of the pelvis were included in the study. A total of 104 pelvic halves (52 males) were studied, and pertinent conclusions were reached. The diameter of the prostate artery and the volume of the prostate gland were measured. The Pearson Correlation coefficient was used to calculate the correlation between prostate artery diameter and prostate gland volume. The branching pattern of the prostate artery was classified using the de Assis et al (2015) classification, which serves as the foundation for most classifications. Result: According to the data, 37 (71.15 %) of the patients had enlarged prostate gland with a volume greater than 30ml. All of the patients aged 60 and above had an enlarged prostate gland and were mostly married. A higher proportion of patients with enlarged prostate (18, 94.74 %) had a history of prostate disease. In each pelvic half, one prostate artery was discovered. There were three types of prostate arterial branching. The majority of the pelvic halves (61, 58.7 %) had type 1, followed by type III and type II. In 50% of the pelvic halves, the origin was symmetrical type I. The mean prostate artery diameter was 1.28mm + 0.16 on the right and 1.26mm + 0.18 on the left, which was higher among those over 60. The average prostate gland volume was 42.58+14.17ml. The mean volume was higher in those over 60 (54.22+2.52 ml) compared to those under 60 (32.60+5.11ml), p =0.0000. The prostate gland volume and the diameter of the right (r=0.4771, p=0.0003) and left (r=0.5131, p=0.0001) arteries showed a significant positive correlation. Similar findings were made with those who had enlarged prostate glands with the right (r-0.3559, p=0.0306) and left (r = 0.4176, p=0.0101) prostate arteries.. Conclusion: The prostate arteries in the study population had type I, III, and II origins. The mean prostate artery diameter increases with increasing age and increasing prostate volume.
OUTCOMES AND DETERMINANTS OF PSA BASED HIGH RISK PROSTATE CANCER PATIENTS TREATED WITH CURATIVE RADIATION AT KORLE BU TEACHING HOSPITAL ACCRA, GHANA
(ARYEETEY NAA ADORKOR, 2022-03-01) ARYEETEY, NAA ADORKOR
BACKGROUND: Prostate cancer (CAP) is one of the commonest male cancers worldwide. Usually described as a slow growing malignancy, treatment outcomes are often favourable with five-year overall survival quoted at 80% even in the metastatic setting of disease. Risk categorisation prior to treatment using several parameters including but not limited to prostate specific antigen (PSA), Gleason score, clinical stage and recently molecular features allows for tailored treatment predicated on life expectancy and the risk of recurrence. Local treatment is with radical prostatectomy, external beam radiotherapy and brachytherapy. The management of high risk localised prostate cancer patients with high PSA remains a challenge as there is paucity of data on treatment outcomes. External beam radiotherapy (EBRT) to doses above 70Gy with peri-radiotherapy androgen deprivation therapy (ADT) in the neoadjuvant, concurrent and adjuvant setting for 2-3 years is the recommended standard treatment for high risk disease. Partial implant brachytherapy, low dose rate permanent implant of radioactive isotopes (I125, Cs-131 and Pd 103), augmented with EBRT (45Gy-50Gy) is an alternative for local treatment of high risk disease. High dose rate brachytherapy (Ir-192 and Co-60) currently in use delivers doses upwards of 12Gy per fraction to the prostate gland. This can be used in the stead of low dose rate brachytherapy. Both options allow for dose escalation with reduced side effects to organs at risk. Treatment outcomes for patients with increasing PSA maybe inferior compared to those with low pre-treatment PSA levels represented by short time to biochemical failure and high biochemical failure rates, assuming the suspicion that patients with high pre-treatment PSA harbour early micro metastatic disease holds true. With evidence suggesting improved outcomes for localised treatment even in the presence of clinically evident metastasis, treatment outcomes are expected to be improved irrespective of pre-treatment PSA. The question though is whether outcomes will differ with increasing PSA levels. Aim: To compare the treatment outcomes of localised high risk prostate cancer patients treated with curative intent using radiation therapy based on their pre-treatment PSA levels and the effect of a Gleason grade of 5 as primary grade on treatment outcomes METHODOLOGY: In this retrospective chart review that combined descriptive and inferential study design, a cohort of patients treated from January 2010 to December 2014 were described for their demographic, tumour and treatment characteristics. A core group with localised high risk prostate cancer based on their PSA levels between 20-200ng/ml treated with curative intent with external beam radiotherapy alone (EBRT) or brachytherapy augmented by external beam radiotherapy(BRACHY+EBRT) with or without androgen deprivation therapy (ADT) were grouped based on their pre-treatment PSA levels. Group A had PSA 20-49.9 ng/ml Group B 50-99.9ng/ml and C 100-200ng/ml and followed up from date of diagnosis to 31st December 2020. The patients were analysed using inferential statistic for treatment outcomes; biochemical and overall survival using Kaplan Meier curves and compared using log rank test. Patients were also compared for biochemical and overall survival outcomes based on their primary Gleason grade and combined Gleason score. Kruskal Wallis test of means was used for univariate analysis of non-parametric data and Cox regression analysis for multivariate analysis. RESULTS: Eighty three percent of patients seen were evaluable for descriptive statistics (486 of 584). The median age at presentation was 67 years (range of 44-85 years). Adenocarcinoma was the commonest histology forming more than 99.6% of histologically diagnosed patients. The median PSA at presentation was 31.9ng/ml (interquartile range 20ng/ml-95ng/ml). Clinical stage T2N0 was the modal stage at diagnosis. Combined Gleason score was available for all but one patient with localised disease but only 88% of the patients had primary and secondary Gleason grades recorded. Majority of the patients seen had high risk disease (53%), 7% low risk, 21% intermediate risk and 18% patients with metastatic disease. Data was inadequate to risk categorise 1% of the patients. Approximately half of patients with localised disease did not receive their intended curative treatment. High risk patients had the highest default rate of 58%. External beam radiotherapy was the most used treatment modality. The mean dose for EBRT only was 72.42Gy, mean D90 was168.68Gy for brachytherapy only and for combination therapy the mean D90 of 109.60Gy and 45.35Gy for brachytherapy and EBRT respectively. Mean duration of treatment was for EBRT only was 8.9 weeks for the intended 7.5 weeks. Medical castration was the most used form of ADT. ADT was used for a mean of 14.6 months mainly in the high risk group. Four patients had bilateral total orchiectomy as lifelong ADT while 2 patients had radiotherapy concurrent with diethylstilbesterol (DES) and then for a total of 36 months. The core group was followed up for a median of 7.25 years (range 4-10.5 years). There was a statistically significant difference in biochemical failure free survival when patients were stratified on pre- treatment PSA with p-value of 0.033. Based on combined Gleason score, biochemical failure free survival approached statistical significance with a p-value of 0.083. There was no difference in biochemical failure free survival when compared based on primary Gleason grade The 5 and 10-year biochemical free survival ranged from 46-68% and 36%-62% respectively, highest for Group B. Group C did not reach the 10 year mark for follow-up. Stratified for primary Gleason grade, biochemical failure free survival was about 55% at 10 years for primary Gleason grade 2-3. Primary Gleason 5 had biochemical failure free survival of 52% at 10years. Gleason 4 did not reach the 10-year follow-up mark but it was below that for Gleason 5 at 6 years, 38%. The curves were not statistically significantly different from each other with a pvalue of 0.311. Nadir PSA value was found to be statistically significant for predicting biochemical failure free survival on both univariate and multivariate analysis. A Receiver operator characteristic (ROC) curve drawn to predict 4 year biochemical failure free survival based on the nadir PSA found 0.07ng/ml as the threshold PSA (p-value 0.047). Estimated overall survival rates were above 70% at 10 years irrespective of patient stratification; pre-treatment PSA, primary Gleason grade or combined Gleason score. Overall survival showed a trend towards statistical significance when patients were assessed based on their combined Gleason score (p-value 0.06). This was not the case for pre-treatment PSA or primary Gleason grade. The biochemical failure free survival for group A, did not translate into overall survival benefit. A planned systematic analysis to predict PSA cut off for curative treatment for localised high risk prostate cancer was abandoned due to the lack of difference in overall survival outcomes when patients were grouped based initial PSA. CONCLUSION: Demography (age) and histological types of prostate cancer patients seen at the hospital compares to the rest of the world. Survival outcomes for localised high risk prostate cancer patients treated with radiotherapy and ADT at the National Radiotherapy Oncology and Nuclear Medicine Centre (NRONMC) of the Korle Bu Teaching Hospital (KBTH) is also comparable to existing published datasets. In our analysis a high initial presenting PSA up to 200ng/ml influenced biochemical outcomes in favour of low initial PSA. There was no difference in overall survival outcomes. This suggests all patients should receive curative treatment irrespective of pre-treatment PSA (up to 200ng/ml) provided there is no clinical or radiologic evidence of metastasis. There were no predictors of overall survival but nadir PSA
EVALUATION OF UPPER GASTROINTESTINAL ENDOSCOPIC FINDINGS IN PATIENTS WITH LIVER CIRRHOSIS AT THE KOMFO ANOKYE TEACHING HOSPITAL, GHANA
(OPPONG, BRIGHT, 2022-09-01) OPPONG, BRIGHT
Introduction: Liver cirrhosis remains an important cause of hospitalization, morbidity, and mortality in sub-Saharan Africa. A common complication of liver cirrhosis is acute upper gastrointestinal bleeding. The objective of this study was to assess the prevalence of upper gastrointestinal endoscopic findings and to correlate the presence of these findings with the severity of liver cirrhosis in patients at the Medicine Directorate, Komfo Anokye Teaching Hospital (KATH). Methods: This was a descriptive cross-sectional study of patients accessing care at the KATH. Consecutive sampling was used to recruit patients with cirrhosis of the liver, diagnosed by transabdominal ultrasound scan. A structured questionnaire was administered to assess socio-demographic characteristics and clinical information. Liver chemistry, full blood count, HBsAg, anti-HCV antibodies and INR tests were done for all the patients. An upper gastrointestinal tract endoscopy was performed for all patients and the severity of the cirrhosis was assessed using the Child-Turcotte-Pugh score. Data was collected with the REDcap tool and exported to STATA statistical software for analysis. Descriptive analysis was performed by using frequencies, percentages and means. Chi-square and Fisher exact tests were used to determine the association between severity of cirrhosis and other predictor variables. Logistic regression and partial proportional odds assumption model were used to determine the odds ratio and possible factors that influenced the severity of cirrhosis. Results: The study included 145 participants. The mean age (standard deviation) of participants was 46.5 ± 12.0. the ratio of males to females was 3:1. Seventy percent had oesophageal varices and 46.2% and 47.6% had portal hypertensive gastropathy and gastritis respectively. Other lesions were gastric ulcer (23.5%) and duodenal ulcer (10.3%). Seventy five percent had hepatitis B infection. Majority of the participants (76.5%) had class C disease and Helicobacter. Pylori (H. pylori) was detected in 87.6%. The presence of oesophageal varices and lax Lower Oesophageal Sphincter (LES) correlated positively with severity of the liver cirrhosis. Oesophageal varices was strongly associated with patients who had finger clubbing (p-value, <0.001), leukonychia (p-value, <0.001), silky hair(p-value, <0.001),, ascites(p-value, <0.036),, palmar erythema(p-value, <0.001),, and spider naevi(p-value, <0.003), Conclusion: Hepatitis B infection is the leading cause of liver cirrhosis at KATH. The most prevalent endoscopic finding was oesophageal varices (mostly medium and large varices) but a significant number of participants had non-variceal lesions. H. pylori infection is common in this population. Screening endoscopy is recommended in cirrhosis to detect lesions which can predispose to upper GIT bleeding.
CORRELATION OF EMBOLIC BURDEN AND RIGHT HEART DYSFUNCTION PARAMETERS WITH SHORT-TERM MORTALITY IN ACUTE PULMONARY EMBOLISM USING COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY
(ASAMOAH, NANA AKUA KONAMA, 2022-10-15) ASAMOAH, NANA AKUA KONAMA
Introduction: Various parameters, as identified on computed tomography pulmonary angiography (CTPA) in patients with acute pulmonary embolism (PE) are being used internationally to categorize patient into low or high risk to enhance choice of management by physicians. Data on Computed tomography (CT) pulmonary angiographic parameters as predictors of mortality in patients with acute pulmonary embolism and how they correlate with patient outcome in Ghana is minimal in comparison to developed countries. Aim: The main aim of the study was to identify the most significant parameter on CTPA that predicts short-term mortality in patients with acute PE. Material and Methods: The study was a prospective cross-sectional design assessing the right heart dysfunction parameters and clot/embolic burden as predictors of short term mortality in patients with Acute pulmonary embolism. 60 patients presenting to spectra health with CTPA findings consistent with acute PE were Conveniently sampled. Additionally, Student t-test and logistics regression were conducted to compare and predict the best radiological parameter for mortality. A chi-square test was used in addition to Fisher’s exact test at a 95% level of significance to test for the association of age and duration of death, age and outcome of patient. Results: Sixty patient (60) patients, comprising 26 (43.3%) males and 34 (56.67%) females were enrolled in the study with a mean age of 58 years which ranges from 29 years to 89 years. Out of the 60 patients, 20 (33.33%) died, 40 (66.66%) survived. Of all the parameters evaluated on CTPA, the Rv/Lv ratio (P-value 0.001), Rv diameter (P-value 0.003), and clot load score (P-value 0.001), were highly associated with short term mortality on bi-variate analysis. However, on multivariate analysis of Rv/Lv ratio (P-value 0.118), Rv diameter (P-value 0.381), and clot load (P-value 0.03), the clot load score was found to be the most significant parameter for predicting short term mortality. Conclusion: Right ventricular short axis diameter (Rv), Rv/Lv ratio (RV enlargement), and clot load score are significantly associated with short term mortality. The results of this present study, hopefully serve as a baseline upon which future studies build to improve outcomes in patients with acute PE.
QUALITY OF LIFE OF PATIENTS WITH PARKINSON’S DISEASE IN THE CENTRAL BELT OF GHANA
(OBESE VIDA, 2023-01-03) OBESE, VIDA
Rationale/objectives of the study: The complications of Parkinson’s Disease (PD) have been found to impact on the patients’ Quality of life (QoL). There is a paucity of studies assessing QoL in developing countries such as Ghana. This study principally sought to examine the factors associated with the QoL in patients with idiopathic PD in the neurology clinic of Komfo Anokye Teaching Hospital (KATH) in Ghana. It assessed the associations between QoL and the extent of motor and non-motor complications, stigma, depression, and cognitive impairment among patients with Parkinson’s disease. Materials and methods: A cross-sectional study was conducted with a consecutive sample of 161 PD patients receiving treatment from the neurology clinic at KATH. Structured questionnaires were used for data collection. Parkinson’s disease Questionnaire (PDQ-39) was used, motor and non-motor symptoms assessed using the MDS-UPDRS and Beck depression inventory (BDI) for assessment of depression. Global cognitive performance was assessed using the Montreal Cognitive Assessment Scale (MoCA) and stigma evaluated withthe 24-item stigma scale for chronic illness (SSCI). Ethical clearance was obtained from the Kwame Nkrumah University of Science and Technology Institutional Review Board. The consent of patients was sought, and data gathered was password protected. The data were organized under the research objectives for analysis. ANOVA and independent sampled t-test was used to analyse differences in QoL among patients with different socio-demographic characteristics. Stepwise multiple regression analysis was used to determine the factors that best account for variance in QoL scores. Multivariate linear regression model analysis was used to assess the effects of motor and non-motor variables on the QoL of PD patients. Results: There were 161 participants in this study with an average age of men (n = 114) and women (n = 47) being 65.2 ± 4.96 and 65.5 ± 5.01 respectively. The mean (± SD) non-motor severity score was 41.8 ± 21.6 and that for the motor severity score was 37.1± 20.5 On the Hoehn and Yahr scale, nearly a third (31.7%) of participants were in stage 3. Overall, the mean PDQ-39 Summary Index (PD8-39 SI) was 37.2 ± 17.1 The mean score of the items on the stigma scale was 62.36±14.49. Majority (65.8%) of the study participants had mild cognitive impairment and almost half (44.1%) were moderately depressed. Multivariate linear regression analysis showed that participant’s cognition (β= -0.65, p-value= 0.031), depression(β = 0.52, p-value =0.013) and stigma status (β= 0.51, p-value <0.0001) were independently associated with overall QoL. Conclusions: This study has identified stigma, depression and cognitive performance as independent factors significantly associated with overall health related QoL of individuals living with idiopathic PD in the central belt of Ghana. While non-motor complications were associated with QoL in limited multivariate linear regression models conducted in our study, their associations were lost in the fully adjusted regression models. Screening for depression, stigma and cognitive impairment should be done routinely at neurology clinics and integration of psychosocial support into the care of PD.
FAMILY FUNCTIONING, COPING STRATEGIES AND SEXUAL DYSFUNCTION AMONG CERVICAL CANCER PATIENTS IN THE KUMASI METROPOLIS, GHANA
(Ghana Consllege of Physicians and Surgeons, 2023-03-15) ACQUAH-HAGAN, GERTRUDE
Introduction: Cervical cancer is arguably the most common cancer among women in Ghana, and it is associated with 16% of mortality due to cancer. In the Kumasi metropolis, it is the second most diagnosed gynecological cancer after breast cancer. This study assessed the extent of sexual dysfunction in women diagnosed with cervical cancer in the Kumasi metropolis; and explored the role of family functioning and coping strategies in dealing with the diagnosis of cervical cancer. Methods: The study was conducted from June to December 2020 among women who had a confirmed diagnosis of cervical cancer at the Komfo Anokye Teaching Hospital, Kumasi, by employing a concurrent triangulation design where both qualitative and quantitative data was collected at the same time. In all, 181 and 15 women were included in the quantitative and qualitative aspects, respectively. Data was collected using a structured questionnaire and in-depth interview guides. Sexual dysfunction, coping strategies and family functioning were measured using the Female Sexual Functional Index (FSFI), the brief-COPE and the Family APGAR scale respectively. Data was analyzed using STATA (version 16.0) statistical software package. Bivariate associations were tested using the chi-square test and fisher exact tests. The relationship between family functioning, sexual dysfunction and coping strategies was assessed using logistic and linear regression models where appropriate. Inferences were made with 95% confidence interval with 5% error margin and a p-value of <0.05. Data from the in-depth interviews were analyzed thematically using variable matrix, flow charts, and relevant quotes to highlight result. Results: The mean age of the women was 58 years (±12.85). More than two-thirds (124; 68.5%) had between 2 – 3 sexual partners and about two-thirds (119; 65.7%) had their first sexual intercourse at age 18. Participants frequently engaged in adaptive coping strategies with religious coping being the most adopted (mean =7.81, SD =0.60). Almost all (96.1%) the respondents had sexual dysfunction. Nearly two-thirds (65.7%) had highly dysfunctional families and nearly one-third (31.5%) had moderately dysfunctional families. Women with parity of 4 – 7 [OR=2.14, 95% CI: 1.12 – 4.07] and 8-13 children [OR=5.52, 95% CI: 1.50 – 20.4] had higher odds of having a functional family compared to those with 0 – 3 children. Having dysfunctional family was associated with a higher mean active coping [β=5.99; 95% CI: 4.54 – 7.46] and lower mean avoidant coping [β= -1.49; 95% CI: -2.60 – -0.38], compared with women who had functional families. There was no significant association between sexual functioning and family functioning. In the qualitative study, the women recounted difficulties with sexual intercourse due to bleeding, pain, fear and advice from doctors. Most of the women coped with their conditions by praying about it. Social support was mainly received from the husbands and children of women with cervical cancer. Almost all the women however disclosed having financial challenges because of the high cost of treatment. Conclusions: This research provides evidence of the prevalence and lived realities of sexual-related challenges and coping strategies among women diagnosed with cervical cancer. Majority of the respondents frequently engaged in adaptive coping strategies, with religious coping being the most engaged coping strategy among the women. There was high prevalence of sexual dysfunction and dysfunctional families among the women studied. Family function was positively associated with adaptive coping and negative associated with maladaptive coping strategies. Health campaigns on cervical cancer should be intensified to demystify the disease and its effects on patients, and also to harness support for women with cervical cancer.
FACTOR VIII INHIBITOR STATUS OF HAEMOPHILIA A PATIENTS AT THE KORLE-BU TEACHING HOSPITAL
(Ghana College of Physicians and Surgeons, 2023-03-31) AWUKU, NANA AGYEIWAH
Background: Haemophilia is an inherited bleeding disorder resulting from mutations in the Factor VIII (FVIII), Factor IX (FIX) or Factor XI (FXI) gene. These mutations give rise to Haemophilia A, B or C respectively. Haemophilia A and B clinically manifest as bleeding into joints, soft tissues, and muscles spontaneously or after minor trauma whilst Haemophilia C is commonly associated with mucosal bleeding which is usually provoked. Recombinant factor replacement is the mainstay of treatment for Haemophilia A, with inhibitor formation remaining the major challenge in the treatment with factor concentrate. General Aim: This study determined the factor VIII inhibitor status among patients with Haemophilia A at the Korle-Bu Teaching Hospital Methods: Cross-sectional study involving all haemophilia A patients attending both adult and paediatric clinics at Korle-Bu Teaching Hospital (KBTH). Patients were recruited after giving informed consent or assent and or parental permission where appropriate. A data extraction form was used to extract clinical data from the patient’s medical records/folder.4.5mls of blood was taken for measuring residual FVIII activity and inhibitor assay using Bethesda Assay. Statistical analysis was done using STATA version 14. Results: All eighty-one (81) participants were male with 70.4%, 14.8%, 14.8% having severe, moderate, and mild disease respectively. The mean age of participants was 17.1 years (±13.5). Majority (93.8%) of participants had received some form of therapy which included recombinant FVIII concentrate, plasma derived FVIII concentrate, cryoprecipitate and emicizumab. A small number (6.2%) of participants had never been exposed to any form of therapy. Prevalence of inhibitors in this study was found to be 11.1% with 85.7% (n=6) having low titre inhibitors and 14.3% (n=1) having high titre inhibitors. All inhibitor positive participants were on on-demand therapy with majority (85.7%) having severe disease. Inhibitor positive participants had had higher bleeding episodes in the past year 2.14 (p=0.286). Most (57.1%) of the inhibitor positive participants had received only recombinant factor concentrate and 42.9% had received both recombinant and plasma derived concentrates (p=0.211). xiv Bleeding from the oral cavity was the commonest presentation at diagnosis (32.1%) followed by joint swelling and pain (21.0%). Almost half (46.9%) presented with spontaneous bleeding at diagnosis and 53.1% had provoked bleeding out of which 60% was trauma related and 40% from surgical/medical procedure. A small percentage (6.2%) of participants were on prophylactic therapy. Conclusion: This study reported prevalence of FVIII inhibitor in haemophilia A patients to be 11.1% with majority of participants classified as severe haemophilia A. There is the need for education and increased awareness for early diagnosis and prevention of complications of haemophilia A; especially the development of inhibitors in Ghana to enable institution of appropriate therapy.
SPATIOTEMPORAL RELATIONSHIPS BETWEEN DOG BITES, DOG VACCINATION COVERAGES, DOG AND HUMAN RABIES IN GHANA: IMPLICATIONS FOR ONE HEALTH COLLABORATION
(ODEI ERIC, 2024-10-17) ODEI, ERIC
Introduction Rabies is preventable, yet globally, about 59,000 people die from the disease annually. About forty percent (40%) of these deaths occur in Sub-Saharan Africa (SSA). Rabies remains an important public health concern to human and veterinary health professionals in SSA. In line with the global strategic framework to eliminate dog-mediated human rabies by 2030, Ghana has committed to eliminating human rabies by improving dog vaccination coverages, creating awareness and providing prompt post-exposure treatment using the One Health approach. The study aimed to investigate the spatiotemporal relationships between dog bites, dog vaccination coverages, dog and human rabies cases in Ghana for the period 2015-2021 and to identify existing mechanisms, barriers and enablers of One Health collaboration for elimination of dog-mediated human rabies. Methods A mixed-methods approach was employed. Rabies surveillance data from the Disease Surveillance Department (DSD) of Ghana Health Service (GHS) and Veterinary Services Directorate (VSD) were abstracted for all 260 districts in Ghana and modelled using Besag-Yorke-Mollie model in R-INLA and SaTScan for spatial, temporal and spatiotemporal mapping and cluster analysis. Key informant interviews (KIIs) were conducted with 35 purposively selected officers in GHS and VSD at the national, regional and district levels to determine extent of data-sharing and collaboration between the two sectors. Concurrently, a cross-sectional survey was conducted among 468 frontline staff of the animal health and human health sectors in the same 12 purposively selected districts where KIIs were being conducted to assess their knowledge, perception and practices with respect to One Health collaboration for rabies elimination. A desk review of national policy documents on dog and human rabies elimination in Ghana was conducted to understand the policy environment. Results In the period 2015-2021, average annual reported dog bites, human rabies cases, dog rabies cases, and dogs vaccinated were 16,675, 19, 86, and 60,952 respectively translating into average annual dog bite incidence of 58.9 per 100,000 population, average annual human rabies incidence of 0.07 per 100,000 population, average annual dog rabies incidence of 8 per 100,000 dogs and vaccination coverage of 5.7%. Dog bites were spatiotemporally associated with dog vaccination coverage (RR:1.77; 95% Credible Interval (CI):1.26-2.46) but much less significantly so with dog rabies (RR:1.03; 95% CI:1.01-1.06) and human rabies cases (RR: 1.03; 95% CI: 1.00-1.06). Key Informant Interviews revealed that the approach to dog vaccinations were more reactionary than proactive with vaccinations being carried out in response to suspected rabies cases or dog bites. There was poor collaboration for routine data-sharing between the human health and veterinary services due to lack of a clear policy. Unwillingness and inability of pet owners to bear cost of vaccination and inadequate law enforcement regarding responsible pet ownership contributed to the low dog vaccination coverage. Conclusion and Recommendations Lack of One Health policy accounts for the poor collaboration for routine data sharing between the two sectors. Weak legislation and inadequate law enforcement are major drivers of the low dog vaccination coverages. Finalizing and implementing the One Health policy alongside stronger legislation with law enforcement on dog vaccinations are urgently required to ensure the achievement of ‘zero by 30’ target.

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