BackgroundActionable data on antimicrobial use is important when planning strategic interventions... more BackgroundActionable data on antimicrobial use is important when planning strategic interventions such as antimicrobial stewardship to address the challenge of drug resistance, particularly in resource-constrained settings.ObjectivesTo assess the prevalence of antibiotic use, the pattern of commonly used antibiotics and patient factors that may be associated with the increased use of antibiotics in the study hospitals.MethodsThis was a cross-sectional study conducted using the WHO Methodology for Point Prevalence Surveys in hospitals. Chi-squared analysis, Fisher’s exact test and logistic regression were employed to analyse statistically the data obtained.ResultsThe overall prevalence of antibiotic use in the hospitals was 60.5%. The commonest indications for antibiotic recommendations were community-acquired infections (36.5%), surgical prophylaxis (26.1%) and hospital-acquired infections (15.7%), among others. Very few (2.7%) of the patients had their samples taken for culture and...
Objective: To document the demography of paediatric admissions due to severe malaria, presentatio... more Objective: To document the demography of paediatric admissions due to severe malaria, presentation and determinants of clinical symptoms and treatment for the condition at the KNUST Hospital, Ghana. Methods: A prospective, non-randomized, observational study was undertaken at the Children's Ward of the KNUST Hospital, in Kumasi. During a one month period, the symptoms on admission, treatment and treatment outcome of included children were documented. Inclusion criteria were age 0-144 months, verbal informed consent and severe malaria defined by presence of asexual Plasmodium falciparum parasitaemia coupled with at least one criterion suggestive of severe malaria as defined by WHO. Results: Overall, there were 82 malaria admissions with 69 cases being enrolled. On admission, mean haemoglobin levels were consistent for both males and females. Mean body weight was higher for females. Main presentations were anaemia of moderate to severe form (56); fever (52) and convulsions (24). Prostration was observed in all cases. Children under 5 years of age were associated with anaemia (p=0.018) and neurological symptoms (p=0.003). Clinical presentation of severe malaria was found to be independent of patients' sex. Quinine was used as treatment in 17 cases; monotherapy with artemisinin derivatives in 26 cases and artemisinin-amodiaquine combinations in 19 of the cases. No deaths were recorded. Conclusions: Children under 5 years of age presented more often with severe malaria. Prostration, anaemia and neurological symptoms were the most frequent manifestations.
Background: Ghana launched its National Action Plan (NAP) to curb the spread of AMR in 2017. The ... more Background: Ghana launched its National Action Plan (NAP) to curb the spread of AMR in 2017. The current study was designed to gather data on the public perception concerning antibiotic use by surveying a population at Kejetia market in Kumasi with the aim of informing the design and implementation of public health campaigns linked to the NAP in Ghana. Method: A cross sectional study was conducted at the Kejetia market in Kumasi, Ghana between November 2017 and January 2018. Participants were adults over 18 years of age and data were gathered via a questionnaire regarding participants’ perceptions on the acquisition, use and disposal of antibiotics. Results: The number of participants was 302 of which nearly 60% were female. Statistically significant associations were identified between gender and level of education (p<0.05, Fisher’s exact test). Amoxicillin and metronidazole were the most commonly used antibiotics. Females were three times more likely to use these agents for dia...
International Journal Of Community Medicine And Public Health, 2020
Background: The Malaria and HIV rapid diagnostic tests (RDTs) are some of the commonest tests tha... more Background: The Malaria and HIV rapid diagnostic tests (RDTs) are some of the commonest tests that are used in Ghana to support malaria and HIV management/care respectively. When these devices are used, they are categorized as potentially infectious. This paper aims to highlight the availability and management of used malaria and HIV RDTs in various healthcare facilities and by health service providers in the greater Accra region of Ghana.Methods: Data was obtained from 400 health facilities including hospitals, clinics, health centres, and pharmacies and over the counter medicine seller’s shops using purposive sampling technique with the aid of structured questionnaires and observation of practices.Results: Seventy percent of the facilities (n=280) used only malaria RDTs, 29% (n=116) used both malaria and HIV RDTs and 1% (n=4) reported using HIV RDTs only. 81.7% (n=326) which formed the majority used less than 10 RDTs daily. There was poor waste segregation, storage, transportation...
African Journal of Primary Health Care & Family Medicine, 2020
Background Non-communicable diseases (NCDs) remain a global burden and is projected to increase d... more Background Non-communicable diseases (NCDs) remain a global burden and is projected to increase due to aging, rapid urbanization and unhealthy lifestyles. The study was conducted to determine the prevalence of hypertension and diabetes in rural districts in the Ashanti region of Ghana and to determine factors that influence utilization of health care services. Setting Offinso North, Amansie West, Ahafo Ano South, and Asante Akim South. Methods A population based prospective cross-sectional study comprising of adults aged 18 years and above was carried out from January 2016 to March 2016. A multistage sampling method was employed to select four rural districts in the Ashanti region of Ghana. A structured questionnaire was used to collect primary data from respondents. Results A total of 684 participants were recruited in the study. The prevalence of hypertension and diabetes was found to be 16.23% and 5.41% respectively. The prevalence of diabetes and hypertension comorbidity was 1.6...
There are many types of β-blockers but not all of them have undergone randomized clinical trials ... more There are many types of β-blockers but not all of them have undergone randomized clinical trials to be licensed for the treatment of heart failure. Examples of β-blockers are as follows; Non-selective agents: Alprenolol, Bucindolol, Carteolol, Carvedilol (has additional α-blocking activity), Labetalol (has additional α-blocking activity), Nadolol, Oxprenolol, Penbutolol (has intrinsic sympathomimetic activity), Pindolol (has intrinsic sympathomimetic activity), Propranolol, Sotalol, Timolol, Eucommia bark (herb) β1-Selective agents: Acebutolol (has intrinsic sympathomimetic activity), Atenolol, Betaxolol, Bisoprolol, Celiprolol, Esmolol, Metoprolol, Nebivolol β2-Selective agents: Butaxamine (weak α-adrenergic agonist activity) - No common clinical applications, but used in experiments, ICI-118,551 Highly selective β2-adrenergic receptor antagonist - No known clinical applications, but used in experiments due to its strong receptor specificity. β3-Selective agents: SR 59230A (has add...
Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid m... more Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid misdiagnosis of hypertension and allow for targeted treatment of patients with hypertension. This study sought to assess the contribution of ABPM to blood pressure (BP) control and antihypertensive therapy at a cardiac clinic in Ghana. Medical records of 97 patients, aged 18-85 years (mean 55), were reviewed. Among patients with clinic BP (CBP) and ambulatory BP recorded on the same day, we assessed for the different hypertension phenotypes, CBP control 6 months following ABPM, and changes to antihypertensive therapy after review of the ABPM records in patients with controlled and uncontrolled ambulatory BP. From the clinic and ambulatory BP records measured at baseline, the proportion of patients with white-coat uncontrolled hypertension (WUCH) was 19.5% (17/87) and those with masked uncontrolled hypertension (MUCH) was 16.1% (n = 14). A significant reduction in average systolic CBP in the overall cohort (−6.2 mm Hg, P < .01) and in the uncontrolled subgroup (−8.8 mm Hg, P < .001) at follow-up was observed. After review of the ABPM records, 51.7% of the patients on treatment had changes made in their antihypertensive therapy. Antihypertensive therapy was deintensified or left unchanged in majority of the patients with WUCH and sustained controlled hypertension. In patients with MUCH and true uncontrolled hypertension (TUCH), therapy was intensified. In conclusion, ABPM improved clinical decision-making for antihypertensive therapy and BP control. ABPM should therefore be used more often in hypertension and cardiac clinics in low/middle-income countries for optimal care.
although national and international efforts to combat malaria have intensified over the years, pr... more although national and international efforts to combat malaria have intensified over the years, problems with availability, distribution, and choice of antimalarials at medicine outlets in africa continue to exist. This article presents the results of an indicator-based assessment of availability and choice of antimalarials at 130 licensed medicine outlets in ghana. We also discuss how the choice of an antimalarial to dispense conforms to recommendations of the national policy for malaria therapy. Data were obtained through face-to-face interviews, by reviewing facility records, and by observing the practices of dispensing staff in the medicine outlets. antimalarials recommended in the policy were not readily available in the most accessible medicine outlets. Few outlets adhered to the policy when choosing antimalarials. interventions targeting medicine outlets should be initiated to improve availability and access to effective medicines in order to support the national program for malaria control.
Background: Malaria is endemic in Ghana, and contributes significantly to infant and maternal dea... more Background: Malaria is endemic in Ghana, and contributes significantly to infant and maternal deaths, as well as to loss of disability adjusted life years. The pharmaceutical sector and in particular the medicine outlets has been identified as accessible units in the health system, where public health initiatives could be targeted to facilitate greater access to interventions for prevention and control of malaria. This study was aimed at assessing medicine outlets and their staff in both public and private sector facilities in Ghana, and how their activities conformed to global and national initiatives for malaria control. Materials and Methods: A preliminary study on the appropriateness of self care and health facilities based management of malaria, and the role played by medicine outlets staff in the supply and utilisation of anti-malarials, was done in a well resourced rural hospital and a city based polyclinic in Southern Ghana. After which an indicator-based assessment of the infrastructure and settings for pharmaceutical services, the staff and material resources and practices for malaria control was done, in a cross section of medicine outlets (n=130) selected from hospitals/clinics and community-based retail outlets in Northern and Southern Ghana. The study indicators were based on international and national standards for pharmaceutical services, as well as the roll back malaria and national policy initiatives for malaria control. Results: The preliminary study indicated high prevalence of inappropriate use of anti-malarials among those who attempted self care before visiting the health facilities, consequently resulting in severe and complicated malaria conditions that were managed appropriately in the health facilities. The later study showed that the infrastructure and practice settings assessed were satisfactory, but could be further improved and utilized as supplementary or alternative channels to facilitate access to effective interventions for malaria control. On the availability and supply of medicines for malaria therapy; nonpolicy recommended and mostly ineffective anti-malarials were observed to be highly available and often supplied for malaria therapy, particularly in the retail outlets. The availability of policy-recommended medicines and in particular the artemisinin-based combination products, were rather poor. In addition very few of the outlets (less than 10%) strictly adhered to policy recommendations for the selection and supply of medicines for malaria therapy. On the staff resources; greater than 55% had no professional training as pharmaceutical service providers. The hospitals/clinics had more professional staff per outlet than those in the retail sector. Majority of the staff assessed (over 80%), which included both professionals and non professionals could recognise malaria illness and also advice clients on how to avoid further infections. However, very few (20%) and mainly professionals were adequately skilled to both recognise and manage the malaria cases as recommended by national guidelines. Conclusions: The infrastructure and settings in most of the outlets were satisfactory for pharmaceutical services. However, there were significant shortfalls, regarding the availability and supply of effective medicines for malaria control. Also majority of the staff assessed were inadequately skilled to appropriately manage malaria cases. Pragmatic education and regulatory interventions should be directed CONTENTS 1 INTRODUCTION 2 BACKGROUND 2.1 Health and health care challenges in sub-Saharan Africa 2.2 Pharmaceutical services and health in Societies in sub-Saharan Africa 2.3 Health policy of Ghana 2.4 Health systems in Ghana and organisation of health services 2.5 Regulation of health and pharmaceutical services 2.6 The pharmaceutical sector and services in medicine outlets 2.7 Medicines supply management chain 2.8 Pharmacy education and manpower issues 3 MALARIA AS A PUBLIC HEALTH PROBLEM 3.1 Life cycle of malaria infection 3.2 Symptoms of malaria 3.3 Global burden of malaria and malaria in sub-Saharan Africa 3.4 Impact of malaria on well-being and socioeconomic development 3.5 Global strategies for prevention and control of malaria 3.6 Malaria control in Ghana and the role of medicine outlet practitioners 4 AIMS AND OBJECTIVES OF THE STUDY 5 MATERIALS AND METHODS 5.1 Context of the study 5.2 Overview of methods used and study design 5.3 Self care and health facilities-based management of malaria (I) 5.3.1 Study setting and participants 5.3.2 Data collection and analysis 5.4 Assessments of the pharmaceutical settings and practices for malaria control (IIIV) 5.4.1 Sampling of facilities 5.4.2 Indicators for assessments of the pharmaceutical settings and malaria control practices 5.5 Data collection (II-IV) 5.5.1 Infrastructure and settings for pharmaceutical services 5.5.2 Availability and supply of medicines for chemotherapy and malaria prevention in pregnancy (IPTp) 5.5.3 Human resources in the outlets, their knowledge, skills and practices for malaria control 5.6 Coding of data and data analysis 6 RESULTS 6.1 Self care and the health facilities-based management of malaria (I) 6.1.1 Self-care for malaria and appropriateness of use of anti-malarials 6.1.2 Malaria therapy at the health facilities and therapeutic outcomes 6.2 Assessment of the infrastructure and settings for pharmaceutical services (IV) 6.2.1 Diagnostics, dispensing tools and packaging of anti-malarials 6.2.2 Medicine outlet records, tools for communication and reference literature 6.3 The availability of medicines for malaria chemotherapy and IPTp (II) 6.3.1 Non policy recommended medicines and anti-malarials not registered with FDB 6.3.2 Policy recommended medicines 6.3.3 Other commodities stocked for mosquito control in the outlets 6.3.4 Adherence to policy recommendations when supplying medicines 6.4 The staff resources, their knowledge and practices for malaria therapy (III) 6.4.1 Staff resources in the outlets and their professional status 6.4.2 Knowledge, skills and practices of staff for malaria therapy 7 DISCUSSION 7.1 Appropriateness of self-care and the role of medicine outlets 7.2 Infrastructure and the settings for pharmaceutical services (IV) 7.2.1 Packaging and dispensing of anti-malarials 7.2.2 Tools to aid the identification of malaria cases and optimization of anti-malaria therapy 7.2.3 Records maintained in medicine outlets and tools for communication 7.2.4 Reference materials and its relevance to pharmaceutical services 7.3 Availability and accessibility of medicines and other commodities 87 7.3.1 Malaria prevention 7.3.2 Malaria treatment 7.3.3 Adherence to policy when choosing anti-malarials for chemotherapy or IPTp 7.4 Staff resources and their training as pharmaceutical service providers 7.4.1 Knowledge, skills and practices of staff for malaria control 7.5 Methodological considerations and limitations 8 CONCLUSIONS 8.1 Policy implications and applicability of study findings 9 RECOMMENDATIONS FOR FURTHER RESEARCH 100
Objectives: Antimicrobial resistance (AMR) is one of the biggest challenges facing mankind. Inapp... more Objectives: Antimicrobial resistance (AMR) is one of the biggest challenges facing mankind. Inappropriate uses of antibiotics including self-medication promote the increase and spread of AMR. Self-medication has not been well-studied among students. This study was undertaken to determine students of healthcare programmes self-medication practices and attitudes in relation to AMR.Materials and Methods: This was a cross-sectional survey that used a pretested self-administered questionnaire to elicit responses from first-year students of healthcare programmes at the Kwame Nkrumah University of Science and Technology, Ghana from January 2018 to August 2019.Results: Two hundred and eighty students were recruited with 264 of them returning the questionnaire, giving a response rate of 94.3%. Majority were female (68.9%) and participants ages ranged from 16 to 34 years with a mean age (SD) of 19.5 (1.88) years. 136 students (56.2%) had previously purchased antibiotics without a prescription...
Objective The purpose was to determine whether Heart Rate (HR), Blood Pressure (B.P) and Cardioth... more Objective The purpose was to determine whether Heart Rate (HR), Blood Pressure (B.P) and Cardiothoracic ratio (CTR) reduction with β-blockers as adjunct therapy in advanced heart failure patients are indicators of achieving control of heart failure i.e. improved outcome and neurohormonal status. Introduction Detailed examination of advanced heart failure patients’ documentation in the hospital shows that many of the patients have had untreated and/or uncontrolled blood pressure. Controlling blood pressure is essential across all heart failure stages. Heart rate (HR) reduction under Beta-Blocker therapy in advanced heart failure has beneficial effects, mainly as a consequence of improved myocardial energetic balance, subendocardial perfusion and lengthening of the diastolic phase. In patients with advanced heart failure, an increased cardiac size, as judged by a cardiothoracic ratio >0•50, and the presence of pulmonary venous congestion are useful indicators of abnormal cardiac fu...
Heart failure (HF) is characterised by frequent hospital admissions and prolonged length of hospi... more Heart failure (HF) is characterised by frequent hospital admissions and prolonged length of hospital stay. Admissions for HF have increased over the last decade while length of stay has decreased; the reasons for this change in length of stay are uncertain. This study investigates the effect of patient-related variables, in-hospital progress and complications on length of stay. Patients admitted to Auckland Hospital general medical service and randomised into the Auckland Heart Failure Management Programme were included in this study. One hundred and ninety-seven patients were included in this study. Mean age 73 years, mean left ventricular ejection fraction 32%; 52% had one or more previous HF admissions and 75% were New York Heart Association class IV at admission. Median length of hospital stay was 6 days (IQR 4, 9) which is comparable to the national average from New Zealand admission databases. Longer than average length of stay, defined as &amp;amp;amp;amp;amp;amp;gt;6 days, was associated with the presence of peripheral congestion, duration of treatment with intravenous diuretic, the development of renal impairment, other acute medical problems at admission, iatrogenic complications during hospital stay, and social problems requiring intervention. Factors independently associated with length of stay in the top quartile (&amp;amp;amp;amp;amp;amp;gt;10 days) on logistic regression included the presence of oedema at admission (OR 10.5), change in weight during stay (OR 1.3), duration of treatment with iv diuretic (OR 7.5), the development of renal impairment (OR 9.8), concurrent respiratory problems requiring specific treatment (OR 3.8), and social problems requiring intervention (OR 6.8). Peripheral congestion, concomitant acute medical problems requiring specific treatment, the development of renal impairment and the presence of social problems were related to a longer than average length of hospital stay. Multivariate models only partly explained variance in hospital stay, suggesting the importance of pre-admission and post-discharge factors, including the healthcare environment, the availability of primary and secondary care resources, and the threshold for hospital admission.
Background: Cardiovascular disease (CVD) is a major cause of morbidity and hypertension is the si... more Background: Cardiovascular disease (CVD) is a major cause of morbidity and hypertension is the single most important modifiable risk. Assessment of an individual’s “total” predicted risk of developing a CVD event in 5- or 10-years using risk scores has been identified as an accurate measure of CVD risk. Using the latest Framingham risk score we assessed the risk among patients attending two cardiac clinics in Kumasi.Methods: We conducted a hospital-based cross-sectional study among 441 patients attending two cardiac clinics in Kumasi, the Ashanti region of Ghana. Hospital records were reviewed and information on demography, social history and laboratory results for the lipid profile tests were extracted.Results: The prevalence of low, medium and high risk were 41.5%, 28.1% and 30.4% respectively. More men were at high risk compared to females (36.0% vs 23.9%, p=0.003). The risk score showed good discrimination for cardiovascular risk stratification with an overall area under the cur...
Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid m... more Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid misdiagnosis of hypertension and allow for targeted treatment of patients with hypertension. This study sought to assess the contribution of ABPM to blood pressure (BP) control and antihypertensive therapy at a cardiac clinic in Ghana. Medical records of 97 patients, aged 18-85 years (mean 55), were reviewed. Among patients with clinic BP (CBP) and ambulatory BP recorded on the same day, we assessed for the different hypertension phenotypes, CBP control 6 months following ABPM, and changes to antihypertensive therapy after review of the ABPM records in patients with controlled and uncontrolled ambulatory BP. From the clinic and ambulatory BP records measured at baseline, the proportion of patients with white-coat uncontrolled hypertension (WUCH) was 19.5% (17/87) and those with masked uncontrolled hypertension (MUCH) was 16.1% (n = 14). A significant reduction in average systolic CBP in the overall cohort (−6.2 mm Hg, P < .01) and in the uncontrolled subgroup (−8.8 mm Hg, P < .001) at follow-up was observed. After review of the ABPM records, 51.7% of the patients on treatment had changes made in their antihypertensive therapy. Antihypertensive therapy was deintensified or left unchanged in majority of the patients with WUCH and sustained controlled hypertension. In patients with MUCH and true uncontrolled hypertension (TUCH), therapy was intensified. In conclusion, ABPM improved clinical decision-making for antihypertensive therapy and BP control. ABPM should therefore be used more often in hypertension and cardiac clinics in low/middle-income countries for optimal care.
BackgroundActionable data on antimicrobial use is important when planning strategic interventions... more BackgroundActionable data on antimicrobial use is important when planning strategic interventions such as antimicrobial stewardship to address the challenge of drug resistance, particularly in resource-constrained settings.ObjectivesTo assess the prevalence of antibiotic use, the pattern of commonly used antibiotics and patient factors that may be associated with the increased use of antibiotics in the study hospitals.MethodsThis was a cross-sectional study conducted using the WHO Methodology for Point Prevalence Surveys in hospitals. Chi-squared analysis, Fisher’s exact test and logistic regression were employed to analyse statistically the data obtained.ResultsThe overall prevalence of antibiotic use in the hospitals was 60.5%. The commonest indications for antibiotic recommendations were community-acquired infections (36.5%), surgical prophylaxis (26.1%) and hospital-acquired infections (15.7%), among others. Very few (2.7%) of the patients had their samples taken for culture and...
Objective: To document the demography of paediatric admissions due to severe malaria, presentatio... more Objective: To document the demography of paediatric admissions due to severe malaria, presentation and determinants of clinical symptoms and treatment for the condition at the KNUST Hospital, Ghana. Methods: A prospective, non-randomized, observational study was undertaken at the Children's Ward of the KNUST Hospital, in Kumasi. During a one month period, the symptoms on admission, treatment and treatment outcome of included children were documented. Inclusion criteria were age 0-144 months, verbal informed consent and severe malaria defined by presence of asexual Plasmodium falciparum parasitaemia coupled with at least one criterion suggestive of severe malaria as defined by WHO. Results: Overall, there were 82 malaria admissions with 69 cases being enrolled. On admission, mean haemoglobin levels were consistent for both males and females. Mean body weight was higher for females. Main presentations were anaemia of moderate to severe form (56); fever (52) and convulsions (24). Prostration was observed in all cases. Children under 5 years of age were associated with anaemia (p=0.018) and neurological symptoms (p=0.003). Clinical presentation of severe malaria was found to be independent of patients' sex. Quinine was used as treatment in 17 cases; monotherapy with artemisinin derivatives in 26 cases and artemisinin-amodiaquine combinations in 19 of the cases. No deaths were recorded. Conclusions: Children under 5 years of age presented more often with severe malaria. Prostration, anaemia and neurological symptoms were the most frequent manifestations.
Background: Ghana launched its National Action Plan (NAP) to curb the spread of AMR in 2017. The ... more Background: Ghana launched its National Action Plan (NAP) to curb the spread of AMR in 2017. The current study was designed to gather data on the public perception concerning antibiotic use by surveying a population at Kejetia market in Kumasi with the aim of informing the design and implementation of public health campaigns linked to the NAP in Ghana. Method: A cross sectional study was conducted at the Kejetia market in Kumasi, Ghana between November 2017 and January 2018. Participants were adults over 18 years of age and data were gathered via a questionnaire regarding participants’ perceptions on the acquisition, use and disposal of antibiotics. Results: The number of participants was 302 of which nearly 60% were female. Statistically significant associations were identified between gender and level of education (p<0.05, Fisher’s exact test). Amoxicillin and metronidazole were the most commonly used antibiotics. Females were three times more likely to use these agents for dia...
International Journal Of Community Medicine And Public Health, 2020
Background: The Malaria and HIV rapid diagnostic tests (RDTs) are some of the commonest tests tha... more Background: The Malaria and HIV rapid diagnostic tests (RDTs) are some of the commonest tests that are used in Ghana to support malaria and HIV management/care respectively. When these devices are used, they are categorized as potentially infectious. This paper aims to highlight the availability and management of used malaria and HIV RDTs in various healthcare facilities and by health service providers in the greater Accra region of Ghana.Methods: Data was obtained from 400 health facilities including hospitals, clinics, health centres, and pharmacies and over the counter medicine seller’s shops using purposive sampling technique with the aid of structured questionnaires and observation of practices.Results: Seventy percent of the facilities (n=280) used only malaria RDTs, 29% (n=116) used both malaria and HIV RDTs and 1% (n=4) reported using HIV RDTs only. 81.7% (n=326) which formed the majority used less than 10 RDTs daily. There was poor waste segregation, storage, transportation...
African Journal of Primary Health Care & Family Medicine, 2020
Background Non-communicable diseases (NCDs) remain a global burden and is projected to increase d... more Background Non-communicable diseases (NCDs) remain a global burden and is projected to increase due to aging, rapid urbanization and unhealthy lifestyles. The study was conducted to determine the prevalence of hypertension and diabetes in rural districts in the Ashanti region of Ghana and to determine factors that influence utilization of health care services. Setting Offinso North, Amansie West, Ahafo Ano South, and Asante Akim South. Methods A population based prospective cross-sectional study comprising of adults aged 18 years and above was carried out from January 2016 to March 2016. A multistage sampling method was employed to select four rural districts in the Ashanti region of Ghana. A structured questionnaire was used to collect primary data from respondents. Results A total of 684 participants were recruited in the study. The prevalence of hypertension and diabetes was found to be 16.23% and 5.41% respectively. The prevalence of diabetes and hypertension comorbidity was 1.6...
There are many types of β-blockers but not all of them have undergone randomized clinical trials ... more There are many types of β-blockers but not all of them have undergone randomized clinical trials to be licensed for the treatment of heart failure. Examples of β-blockers are as follows; Non-selective agents: Alprenolol, Bucindolol, Carteolol, Carvedilol (has additional α-blocking activity), Labetalol (has additional α-blocking activity), Nadolol, Oxprenolol, Penbutolol (has intrinsic sympathomimetic activity), Pindolol (has intrinsic sympathomimetic activity), Propranolol, Sotalol, Timolol, Eucommia bark (herb) β1-Selective agents: Acebutolol (has intrinsic sympathomimetic activity), Atenolol, Betaxolol, Bisoprolol, Celiprolol, Esmolol, Metoprolol, Nebivolol β2-Selective agents: Butaxamine (weak α-adrenergic agonist activity) - No common clinical applications, but used in experiments, ICI-118,551 Highly selective β2-adrenergic receptor antagonist - No known clinical applications, but used in experiments due to its strong receptor specificity. β3-Selective agents: SR 59230A (has add...
Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid m... more Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid misdiagnosis of hypertension and allow for targeted treatment of patients with hypertension. This study sought to assess the contribution of ABPM to blood pressure (BP) control and antihypertensive therapy at a cardiac clinic in Ghana. Medical records of 97 patients, aged 18-85 years (mean 55), were reviewed. Among patients with clinic BP (CBP) and ambulatory BP recorded on the same day, we assessed for the different hypertension phenotypes, CBP control 6 months following ABPM, and changes to antihypertensive therapy after review of the ABPM records in patients with controlled and uncontrolled ambulatory BP. From the clinic and ambulatory BP records measured at baseline, the proportion of patients with white-coat uncontrolled hypertension (WUCH) was 19.5% (17/87) and those with masked uncontrolled hypertension (MUCH) was 16.1% (n = 14). A significant reduction in average systolic CBP in the overall cohort (−6.2 mm Hg, P < .01) and in the uncontrolled subgroup (−8.8 mm Hg, P < .001) at follow-up was observed. After review of the ABPM records, 51.7% of the patients on treatment had changes made in their antihypertensive therapy. Antihypertensive therapy was deintensified or left unchanged in majority of the patients with WUCH and sustained controlled hypertension. In patients with MUCH and true uncontrolled hypertension (TUCH), therapy was intensified. In conclusion, ABPM improved clinical decision-making for antihypertensive therapy and BP control. ABPM should therefore be used more often in hypertension and cardiac clinics in low/middle-income countries for optimal care.
although national and international efforts to combat malaria have intensified over the years, pr... more although national and international efforts to combat malaria have intensified over the years, problems with availability, distribution, and choice of antimalarials at medicine outlets in africa continue to exist. This article presents the results of an indicator-based assessment of availability and choice of antimalarials at 130 licensed medicine outlets in ghana. We also discuss how the choice of an antimalarial to dispense conforms to recommendations of the national policy for malaria therapy. Data were obtained through face-to-face interviews, by reviewing facility records, and by observing the practices of dispensing staff in the medicine outlets. antimalarials recommended in the policy were not readily available in the most accessible medicine outlets. Few outlets adhered to the policy when choosing antimalarials. interventions targeting medicine outlets should be initiated to improve availability and access to effective medicines in order to support the national program for malaria control.
Background: Malaria is endemic in Ghana, and contributes significantly to infant and maternal dea... more Background: Malaria is endemic in Ghana, and contributes significantly to infant and maternal deaths, as well as to loss of disability adjusted life years. The pharmaceutical sector and in particular the medicine outlets has been identified as accessible units in the health system, where public health initiatives could be targeted to facilitate greater access to interventions for prevention and control of malaria. This study was aimed at assessing medicine outlets and their staff in both public and private sector facilities in Ghana, and how their activities conformed to global and national initiatives for malaria control. Materials and Methods: A preliminary study on the appropriateness of self care and health facilities based management of malaria, and the role played by medicine outlets staff in the supply and utilisation of anti-malarials, was done in a well resourced rural hospital and a city based polyclinic in Southern Ghana. After which an indicator-based assessment of the infrastructure and settings for pharmaceutical services, the staff and material resources and practices for malaria control was done, in a cross section of medicine outlets (n=130) selected from hospitals/clinics and community-based retail outlets in Northern and Southern Ghana. The study indicators were based on international and national standards for pharmaceutical services, as well as the roll back malaria and national policy initiatives for malaria control. Results: The preliminary study indicated high prevalence of inappropriate use of anti-malarials among those who attempted self care before visiting the health facilities, consequently resulting in severe and complicated malaria conditions that were managed appropriately in the health facilities. The later study showed that the infrastructure and practice settings assessed were satisfactory, but could be further improved and utilized as supplementary or alternative channels to facilitate access to effective interventions for malaria control. On the availability and supply of medicines for malaria therapy; nonpolicy recommended and mostly ineffective anti-malarials were observed to be highly available and often supplied for malaria therapy, particularly in the retail outlets. The availability of policy-recommended medicines and in particular the artemisinin-based combination products, were rather poor. In addition very few of the outlets (less than 10%) strictly adhered to policy recommendations for the selection and supply of medicines for malaria therapy. On the staff resources; greater than 55% had no professional training as pharmaceutical service providers. The hospitals/clinics had more professional staff per outlet than those in the retail sector. Majority of the staff assessed (over 80%), which included both professionals and non professionals could recognise malaria illness and also advice clients on how to avoid further infections. However, very few (20%) and mainly professionals were adequately skilled to both recognise and manage the malaria cases as recommended by national guidelines. Conclusions: The infrastructure and settings in most of the outlets were satisfactory for pharmaceutical services. However, there were significant shortfalls, regarding the availability and supply of effective medicines for malaria control. Also majority of the staff assessed were inadequately skilled to appropriately manage malaria cases. Pragmatic education and regulatory interventions should be directed CONTENTS 1 INTRODUCTION 2 BACKGROUND 2.1 Health and health care challenges in sub-Saharan Africa 2.2 Pharmaceutical services and health in Societies in sub-Saharan Africa 2.3 Health policy of Ghana 2.4 Health systems in Ghana and organisation of health services 2.5 Regulation of health and pharmaceutical services 2.6 The pharmaceutical sector and services in medicine outlets 2.7 Medicines supply management chain 2.8 Pharmacy education and manpower issues 3 MALARIA AS A PUBLIC HEALTH PROBLEM 3.1 Life cycle of malaria infection 3.2 Symptoms of malaria 3.3 Global burden of malaria and malaria in sub-Saharan Africa 3.4 Impact of malaria on well-being and socioeconomic development 3.5 Global strategies for prevention and control of malaria 3.6 Malaria control in Ghana and the role of medicine outlet practitioners 4 AIMS AND OBJECTIVES OF THE STUDY 5 MATERIALS AND METHODS 5.1 Context of the study 5.2 Overview of methods used and study design 5.3 Self care and health facilities-based management of malaria (I) 5.3.1 Study setting and participants 5.3.2 Data collection and analysis 5.4 Assessments of the pharmaceutical settings and practices for malaria control (IIIV) 5.4.1 Sampling of facilities 5.4.2 Indicators for assessments of the pharmaceutical settings and malaria control practices 5.5 Data collection (II-IV) 5.5.1 Infrastructure and settings for pharmaceutical services 5.5.2 Availability and supply of medicines for chemotherapy and malaria prevention in pregnancy (IPTp) 5.5.3 Human resources in the outlets, their knowledge, skills and practices for malaria control 5.6 Coding of data and data analysis 6 RESULTS 6.1 Self care and the health facilities-based management of malaria (I) 6.1.1 Self-care for malaria and appropriateness of use of anti-malarials 6.1.2 Malaria therapy at the health facilities and therapeutic outcomes 6.2 Assessment of the infrastructure and settings for pharmaceutical services (IV) 6.2.1 Diagnostics, dispensing tools and packaging of anti-malarials 6.2.2 Medicine outlet records, tools for communication and reference literature 6.3 The availability of medicines for malaria chemotherapy and IPTp (II) 6.3.1 Non policy recommended medicines and anti-malarials not registered with FDB 6.3.2 Policy recommended medicines 6.3.3 Other commodities stocked for mosquito control in the outlets 6.3.4 Adherence to policy recommendations when supplying medicines 6.4 The staff resources, their knowledge and practices for malaria therapy (III) 6.4.1 Staff resources in the outlets and their professional status 6.4.2 Knowledge, skills and practices of staff for malaria therapy 7 DISCUSSION 7.1 Appropriateness of self-care and the role of medicine outlets 7.2 Infrastructure and the settings for pharmaceutical services (IV) 7.2.1 Packaging and dispensing of anti-malarials 7.2.2 Tools to aid the identification of malaria cases and optimization of anti-malaria therapy 7.2.3 Records maintained in medicine outlets and tools for communication 7.2.4 Reference materials and its relevance to pharmaceutical services 7.3 Availability and accessibility of medicines and other commodities 87 7.3.1 Malaria prevention 7.3.2 Malaria treatment 7.3.3 Adherence to policy when choosing anti-malarials for chemotherapy or IPTp 7.4 Staff resources and their training as pharmaceutical service providers 7.4.1 Knowledge, skills and practices of staff for malaria control 7.5 Methodological considerations and limitations 8 CONCLUSIONS 8.1 Policy implications and applicability of study findings 9 RECOMMENDATIONS FOR FURTHER RESEARCH 100
Objectives: Antimicrobial resistance (AMR) is one of the biggest challenges facing mankind. Inapp... more Objectives: Antimicrobial resistance (AMR) is one of the biggest challenges facing mankind. Inappropriate uses of antibiotics including self-medication promote the increase and spread of AMR. Self-medication has not been well-studied among students. This study was undertaken to determine students of healthcare programmes self-medication practices and attitudes in relation to AMR.Materials and Methods: This was a cross-sectional survey that used a pretested self-administered questionnaire to elicit responses from first-year students of healthcare programmes at the Kwame Nkrumah University of Science and Technology, Ghana from January 2018 to August 2019.Results: Two hundred and eighty students were recruited with 264 of them returning the questionnaire, giving a response rate of 94.3%. Majority were female (68.9%) and participants ages ranged from 16 to 34 years with a mean age (SD) of 19.5 (1.88) years. 136 students (56.2%) had previously purchased antibiotics without a prescription...
Objective The purpose was to determine whether Heart Rate (HR), Blood Pressure (B.P) and Cardioth... more Objective The purpose was to determine whether Heart Rate (HR), Blood Pressure (B.P) and Cardiothoracic ratio (CTR) reduction with β-blockers as adjunct therapy in advanced heart failure patients are indicators of achieving control of heart failure i.e. improved outcome and neurohormonal status. Introduction Detailed examination of advanced heart failure patients’ documentation in the hospital shows that many of the patients have had untreated and/or uncontrolled blood pressure. Controlling blood pressure is essential across all heart failure stages. Heart rate (HR) reduction under Beta-Blocker therapy in advanced heart failure has beneficial effects, mainly as a consequence of improved myocardial energetic balance, subendocardial perfusion and lengthening of the diastolic phase. In patients with advanced heart failure, an increased cardiac size, as judged by a cardiothoracic ratio >0•50, and the presence of pulmonary venous congestion are useful indicators of abnormal cardiac fu...
Heart failure (HF) is characterised by frequent hospital admissions and prolonged length of hospi... more Heart failure (HF) is characterised by frequent hospital admissions and prolonged length of hospital stay. Admissions for HF have increased over the last decade while length of stay has decreased; the reasons for this change in length of stay are uncertain. This study investigates the effect of patient-related variables, in-hospital progress and complications on length of stay. Patients admitted to Auckland Hospital general medical service and randomised into the Auckland Heart Failure Management Programme were included in this study. One hundred and ninety-seven patients were included in this study. Mean age 73 years, mean left ventricular ejection fraction 32%; 52% had one or more previous HF admissions and 75% were New York Heart Association class IV at admission. Median length of hospital stay was 6 days (IQR 4, 9) which is comparable to the national average from New Zealand admission databases. Longer than average length of stay, defined as &amp;amp;amp;amp;amp;amp;gt;6 days, was associated with the presence of peripheral congestion, duration of treatment with intravenous diuretic, the development of renal impairment, other acute medical problems at admission, iatrogenic complications during hospital stay, and social problems requiring intervention. Factors independently associated with length of stay in the top quartile (&amp;amp;amp;amp;amp;amp;gt;10 days) on logistic regression included the presence of oedema at admission (OR 10.5), change in weight during stay (OR 1.3), duration of treatment with iv diuretic (OR 7.5), the development of renal impairment (OR 9.8), concurrent respiratory problems requiring specific treatment (OR 3.8), and social problems requiring intervention (OR 6.8). Peripheral congestion, concomitant acute medical problems requiring specific treatment, the development of renal impairment and the presence of social problems were related to a longer than average length of hospital stay. Multivariate models only partly explained variance in hospital stay, suggesting the importance of pre-admission and post-discharge factors, including the healthcare environment, the availability of primary and secondary care resources, and the threshold for hospital admission.
Background: Cardiovascular disease (CVD) is a major cause of morbidity and hypertension is the si... more Background: Cardiovascular disease (CVD) is a major cause of morbidity and hypertension is the single most important modifiable risk. Assessment of an individual’s “total” predicted risk of developing a CVD event in 5- or 10-years using risk scores has been identified as an accurate measure of CVD risk. Using the latest Framingham risk score we assessed the risk among patients attending two cardiac clinics in Kumasi.Methods: We conducted a hospital-based cross-sectional study among 441 patients attending two cardiac clinics in Kumasi, the Ashanti region of Ghana. Hospital records were reviewed and information on demography, social history and laboratory results for the lipid profile tests were extracted.Results: The prevalence of low, medium and high risk were 41.5%, 28.1% and 30.4% respectively. More men were at high risk compared to females (36.0% vs 23.9%, p=0.003). The risk score showed good discrimination for cardiovascular risk stratification with an overall area under the cur...
Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid m... more Ambulatory blood pressure monitoring (ABPM) is considered a good intervention strategy to avoid misdiagnosis of hypertension and allow for targeted treatment of patients with hypertension. This study sought to assess the contribution of ABPM to blood pressure (BP) control and antihypertensive therapy at a cardiac clinic in Ghana. Medical records of 97 patients, aged 18-85 years (mean 55), were reviewed. Among patients with clinic BP (CBP) and ambulatory BP recorded on the same day, we assessed for the different hypertension phenotypes, CBP control 6 months following ABPM, and changes to antihypertensive therapy after review of the ABPM records in patients with controlled and uncontrolled ambulatory BP. From the clinic and ambulatory BP records measured at baseline, the proportion of patients with white-coat uncontrolled hypertension (WUCH) was 19.5% (17/87) and those with masked uncontrolled hypertension (MUCH) was 16.1% (n = 14). A significant reduction in average systolic CBP in the overall cohort (−6.2 mm Hg, P < .01) and in the uncontrolled subgroup (−8.8 mm Hg, P < .001) at follow-up was observed. After review of the ABPM records, 51.7% of the patients on treatment had changes made in their antihypertensive therapy. Antihypertensive therapy was deintensified or left unchanged in majority of the patients with WUCH and sustained controlled hypertension. In patients with MUCH and true uncontrolled hypertension (TUCH), therapy was intensified. In conclusion, ABPM improved clinical decision-making for antihypertensive therapy and BP control. ABPM should therefore be used more often in hypertension and cardiac clinics in low/middle-income countries for optimal care.
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