Background Pediatric heart diseases (PHDs), comprising congenital heart diseases (CHDs) and acqui... more Background Pediatric heart diseases (PHDs), comprising congenital heart diseases (CHDs) and acquired heart diseases (AHDs) are significant contributors to non-communicable diseases in children. CHDs alone occur in 0.8-1.0% live births globally. Data on echocardiogram diagnosed PHDs in Ghana however is lacking. We set out to describe the echocardiogram diagnosed prevalence of the various PHDs, their age profile and change in trends over an eleven-year period in children less than sixteen years seen in Kumasi. MethodsWe retrieved archived first echocardiogram scan reports from January 2010 through December 2020, and extracted the diagnosis, scan date and sex of the patients. PHDs were categorized into CHDs and AHDs and proportions of the top five reported respectively. Observed trends in proportion of types of PHDs and age at first diagnosis were computed. Data was collected using Microsoft® Excel and analyzed with R statistical software. ResultsPHDs were present in 49.9% (2474/4962)...
Background: Malaria is the leading cause of morbidity and mortality in post-conflict Burundi. To ... more Background: Malaria is the leading cause of morbidity and mortality in post-conflict Burundi. To counter the increasing challenge of anti-malarial drug resistance and improve highly effective treatment Burundi adopted artesunate-amodiaquine (AS-AQ) as first-line treatment for uncomplicated Plasmodium falciparum malaria and oral quinine as second-line treatment in its national treatment policy in 2003. Uptake of this policy in the public, private and non-governmental (NGO) retail market sectors of Burundi is relatively unknown. This study was conducted to evaluate access to national policy recommended anti-malarials. Methods: Adapting a standardized methodology developed by Health Action International/World Health Organization (HAI/WHO), a cross-sectional survey of 70 (24 public, 36 private, and 10 NGO) medicine outlets was conducted in three regions of Burundi, representing different levels of transmission of malaria. The availability on day of the survey, the median prices, and aff...
In low-income countries, perinatal depression is common, but longitudinal data on its influence o... more In low-income countries, perinatal depression is common, but longitudinal data on its influence on child health are rare. We examined the association between maternal depression and febrile illness in children. There were 654 mother/child dyads in Ghana and Côte d’Ivoire that were enrolled in a prospective birth cohort in 2010–2011 and underwent 2-years of follow up. Mothers were examined for depression using the Patient Health Question-naire depression module antepartum and 3 and 12 months postpartum. The hazard of febrile illness in children of depressed and nondepressed mothers was estimated using a recurrent event Cox proportional hazards model. The prevalences of antepartum depression in mothers from Côte d’Ivoire and Ghana were 28.3 % and 26.3%, respectively. The prevalences of depression at 3 and 12 months postpartum were 11.8 % and 16.1 % (Côte d’Ivoire) and 8.9 % and 7.2 % (Ghana). The crude and adjusted (for country and socioeconomic status) hazard ratios of febrile illnes...
Background Early initiation of breastfeeding (EIBF), breastfeeding within first hour after birth,... more Background Early initiation of breastfeeding (EIBF), breastfeeding within first hour after birth, is known to have major benefits for both the mother and newborn. EIBF rates, however, tends to vary between and within countries. This study set out to determine the prevalence of EIBF at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, and to evaluate the determinants of EIBF and time to initiation of breastfeeding. Methods A cross-sectional study was conducted at the KATH postnatal wards between August and October 2014. Three hundred and eighty-two mothers delivering at KATH were recruited and data on time to initiation of breastfeeding, antenatal, delivery and immediate postnatal periods were collected. Data analyses using both binary and ordinal logistic regressions with stepwise elimination were used to determine the relationship between EIBF and time to initiation of breastfeeding on one side, and the maternal, pregnancy, delivery and neonatal associated factors. Results ...
Abstract Emergently ill infants and children are often inadequately recognized and stabilized by ... more Abstract Emergently ill infants and children are often inadequately recognized and stabilized by health care facilities in low- and middle-income countries. Limited reports have shown that process improvements and prioritization of emergency care for children presenting to the hospital can improve pediatric hospital mortality. A dedicated pediatric emergency unit (PEU) was established for nontrauma emergencies at a busy teaching and referral hospital in Kumasi, Ghana, in response to high inpatient mortality early during hospitalization. The PEU was designed to identify and separate critically ill children from more stable children on admission. Locally available hospital resources were reallocated from other areas of the hospital to prioritize staffing and supplies for the PEU. A multiyear data set of nonnewborn inpatient mortality was analyzed with a change point model to find the point at which mortality changed the most within the Department of Child Health or the maximum likelihood estimate. Relative risk of mortality for the periods 1 and 2 years immediately before and after the implementation of the PEU and each individual year compared with its preceding year was analyzed to further establish a temporal correlation of changes in mortality rates to the PEU implementation. Individual years were also analyzed against preimplementation data to establish the durability of mortality improvements. Patient mortality decreased over the analyzed period with the maximum change point strongly associated with implementation of the PEU. Relative risk values of mortality 1 year and 2 years immediately before and after implementation of the PEU were 0.70 (0.62–0.78) and 0.69 (0.64–0.74) respectively, representing a one-third reduction in mortality. The only other mortality improvements seen in the year-to-year analysis were between July 2004–June 2005 compared with July 2005–June 2006 with a relative risk of 0.86 (0.77–0.96). Prioritizing and redirecting limited resources toward pediatric emergency care in low- and middle-income country hospitals is associated with reductions in inpatient mortality that are both immediate and sustained.
Background: Diarrhoeal diseases are among the most frequent causes of morbidity and mortality in ... more Background: Diarrhoeal diseases are among the most frequent causes of morbidity and mortality in children worldwide, especially in sub-Saharan Africa. This case-control study was conducted to investigate the bacterial, viral and parasitic pathogens associated with acute diarrhoea among children attending three health facilities in Kumasi, Ghana. Methods: Stool specimens were collected from 240 children under 5 years of age visiting hospitals in Kumasi, Ghana due to acute diarrhoea and from 107 healthy controls of similar age. Both intestinal and malaria parasites were diagnosed by microscopy whereas rota-and adenoviruses were identified by stool antigen immunochromatograhic testing. Bacterial enteropathogens were detected by conventional culture techniques. Results: Of all subjects, 23 (6.6%) were positive for malaria parasitaemia, 139 (40.1%) had at least one bacterial agent in their stool and 25 (7.2%) had ova or parasites. Subjects infected with malaria had the highest odds of having diarrhoea [12.0 (95% CI 1.56, 92.35)] followed by those with rotaviruses [4.4 (95% CI 2.05, 9.47)] and bacterial infection [4.99 (95% CI 1.45, 17.17)]. Conclusion: In conclusion, this study was unique as it looked at the three groups of pathogens (parasites, viruses and bacteria) that cause acute diarrhoea in children in the Kumasi metropolis of Ghana. This study has shown for the first time since 2004 that malaria parasitaemia, rotavirus and bacterial infections still remain common pathogens associated with acute childhood diarrhoea in the Kumasi metropolis of Ghana.
International journal of pediatric endocrinology, 2017
Data on normative clitoral sizes in newborns is relatively sparse and racial/ethnic differences h... more Data on normative clitoral sizes in newborns is relatively sparse and racial/ethnic differences have also been reported. This study was performed to establish norms for clitoral size in term Ghanaian female newborns. This was a cross-sectional study of all apparently well full-term newborns of postnatal age < 48 h and birth weight between 2.5 and 4.0 kg delivered at Komfo Anokye Teaching Hospital between May and September, 2014. Anthropometric and genital parameters were documented for study subjects as well as parental socio-demographic indices. In 612 newborn females studied, the mean (±SD) clitoral length (MCL) and the mean (±SD) clitoral width (MCW) were 4.13 ± 1.6 mm and 4.21 ± 1.1 mm, respectively. MCL was inversely related to birth weight (r = -0.62; p < 0.001 ) while MCW was inversely related to both gestational age (r = -0.1; p = 0.02 ) and birth weight (r = -0.54; p < 0.001 ). Babies with a clitoris that was completely covered by the labia majora had relatively lo...
Yearly pediatric cardiac surgery missions to Ghana are of tremendous benefit to local children, b... more Yearly pediatric cardiac surgery missions to Ghana are of tremendous benefit to local children, but may create thorny ethical dilemmas for local clinicians who refer and screen children for the mission and who provide care to the children after the mission concludes for the year. This article presents the experiences and concerns of a pediatrician who is a local member of the Hearts and Minds of Ghana project.
Background. Childhood poisoning is an important cause of morbidity in both developed and developi... more Background. Childhood poisoning is an important cause of morbidity in both developed and developing countries. Epidemiological studies on accidental poisoning in children show a consistent pattern regarding age and gender. Childhood poisoning is predominant in children <6 years of age and has a male preponderance, as boys are more active with a drive to explore the environment. Objective. To document the epidemiology of home poisonings in Kumasi and its environs. Methods. We conducted a retrospective study from January 2007 to January 2012 at the Komfo Anokye Teaching Hospital, a tertiary hospital in Ghana. Results. Poisoning is a significant health problem in the study area. A total of 253 children reported to the hospital with poisoning over the 61month period, with an average of four cases per month. The male to female ratio was 1.58:1. The median age of the children was 24 months (interquartile range 24 48 months). Kerosene was the leading cause of poisoning (39.5%). Concl...
Little is known about the course of perinatal anxiety, particularly in low and middle income coun... more Little is known about the course of perinatal anxiety, particularly in low and middle income countries. This study aimed at examining trajectories of ante- and postpartum generalized anxiety symptoms in West-African women and their associations with mother and child characteristics. 778 women from Côte d'Ivoire and Ghana were investigated between 04/2010 and 03/2014. Anxiety symptoms were measured using the seven-item Generalized Anxiety Disorder scale (GAD-7) at three months antepartum and three, 12 and 24 months postpartum. Growth mixture modeling was applied to identify latent trajectory classes of anxiety. Multinomial logistic regression was used to investigate the associations of psychosocial, sociodemographic, obstetric and clinical characteristics with different trajectories. Four distinct trajectories of anxiety were identified. The majority of women (79.8%) had consistent low anxiety symptoms, while 11.4% had elevated anxiety scores before and around childbirth that dec...
Maternal mortality ratio averages 230 per 100,000 live births in developing countries. Obstructed... more Maternal mortality ratio averages 230 per 100,000 live births in developing countries. Obstructed labour, which is a major cause results from prolonged, neglected labour. The partograph as recommended by the World Health Organization is a graphical tool used to monitor the progress of the first stage of labour, thereby preventing prolonged labour. The partograph has been in use in Ghana since 1989. The study was conducted to ascertain the proportion and correct use of the partograph in monitoring labours in 4 hospitals in a metropolitan area of Ghana. Partograph use for labour monitoring averaged 54% in this study. Midwives formed 90% of birth attendants. For the progress of labour, parameters were monitored to standard in 55-60% of cases. Parameters pertaining to fetal well being were correctly monitored in 30-50%. Maternal well being was monitored to standard in 40% of cases. Apgar scores at 1 and 5 minutes did not differ whether parameters were recorded to standard or not. We conclude from our study that almost half of labour cases were not monitored with the partograph. In those that were monitored with the partograph monitoring to standard was done in 40-60%. Birth attendants either lack the skill in charting the partograph to standard protocols or do not appreciate the use of the partograph in monitoring the progress of labour. In resourcelimited centres in the developing world the use of the partograph to monitor the progress of labour cannot be overemphasized. Skilled attendants at deliveries must therefore be given regular updates on the proper use of the partograph during labours.
Maternal mortality ratio averages 230 per 100,000 live births in developing countries. Obstructed... more Maternal mortality ratio averages 230 per 100,000 live births in developing countries. Obstructed labour, which is a major cause results from prolonged, neglected labour. The partograph as recommended by the World Health Organization is a graphical tool used to monitor the progress of the first stage of labour, thereby preventing prolonged labour. The partograph has been in use in Ghana since 1989. The study was conducted to ascertain the proportion and correct use of the partograph in monitoring labours in 4 hospitals in a metropolitan area of Ghana. Partograph use for labour monitoring averaged 54% in this study. Midwives formed 90% of birth attendants. For the progress of labour, parameters were monitored to standard in 55-60% of cases. Parameters pertaining to fetal well being were correctly monitored in 30-50%. Maternal well being was monitored to standard in 40% of cases. Apgar scores at 1 and 5 minutes did not differ whether parameters were recorded to standard or not. We con...
Background: Severe malaria in children remains the commonest clinical disease in the paediatric e... more Background: Severe malaria in children remains the commonest clinical disease in the paediatric emergency units of most hospitals in sub-Saharan Africa. Anaemia and nutritional deficiency are associated with severe malaria. The aim of the study was to describe the haematological indices, nutritional status and mortality among children admitted in a tertiary hospital in Ghana with severe malaria. Methods: We conducted a prospective cross-sectional study documenting the haematological, nutritional indices and mortality outcomes of children less than five years reporting to the Komfo Anokye Teaching Hospital with severe malaria. Results: The study recruited four-hundred-and-eight (408) children between April, 2005 and July, 2006. There were 231 males (57%). The median age was 21 months, (1QR: 4-54months). 36 (8.8%) patients had weight-forage zscore <-3; 101 (24.7%) had z-score ≥-3 to <-2; 130 (31.9%) had z-scores ≥-2 to <-1 and 141 (34.6%) had z-scores ≥-1. The mean haemoglobin level was 6.2g/dl (SD=2.2, 95% CI: 6.0-6.4). The mean haemoglobin levels of children with normal, mild, moderate, and severe malnutrition were 6.5g/dl, 6.0g/dL, 6.0g/dL, and 6.0g/dL, respectively, p=0.15. The overall case fatality rate was 4.9%. Children with malnutrition (weight-forage z-score ≤-2) had a significantly higher case fatality rate of 8.0% (11/126) compared to those with z-score >-2, 3.3% (RR=1.7, 95%CI: 1.1-2.6, P=0.038). Conclusion: Malaria in children under five remains a principal cause of morbidity and mortality. The study did not find any association between the haemoglobin levels and the nutritional status. However, Mortality was associated with malnutrition (weight-forage z-score ≤-2) in this study.
Background: While several anti-malarials are known to affect the electric conduction system of th... more Background: While several anti-malarials are known to affect the electric conduction system of the heart, less is known on the direct effects of Plasmodium falciparum infection. Some earlier studies point to a direct impact of Plasmodium falciparum infection on the electric conduction system of the heart. The aim of this study was to analyse infection-and drug-induced effects on the electric conduction system. Methods: Children aged 12 months to 108 months with severe malaria were included in Kumasi, Ghana. In addition to basic demographic, clinical, biochemical and parasitological, biochemical data were measured data upon hospitalization (day 0) and 12-lead electrocardiograms were recorded before (day 0) and after (day 1) initiation of quinine therapy as well as after 42 (±3) days. Results: A total of 180 children were included. Most children were tachycardic on day 0 but heart rate declined on day 1 and during follow up. The corrected QT intervals were longest on day 1 and shortest on day 0. Comparison of QT intervals with day 42 (healthy status) after stratification for age demonstrated that in the youngest (<24 months) this was mainly due to a QT shortage on day 0 while a QT prolongation on day 1 was most pronounced in the oldest (≥48 months). Nearly one third of the participating children had measurable 4-aminoquinoline levels upon admission, but no direct effect on the corrected QT intervals could be shown. Conclusion: Severe P. falciparum infection itself can provoke changes in the electrophysiology of the heart, independent of anti-malarial therapy. Especially in young-thus non immune-children the effect of acute disease associated pre-treatment QT-shortage is more pronounced than quinine associated QT-prolongation after therapy. Nevertheless, neither malaria nor anti-malarial induced effects on the electrophysiology of the heart were associated with clinically relevant arrhythmias in the present study population.
Background Pediatric heart diseases (PHDs), comprising congenital heart diseases (CHDs) and acqui... more Background Pediatric heart diseases (PHDs), comprising congenital heart diseases (CHDs) and acquired heart diseases (AHDs) are significant contributors to non-communicable diseases in children. CHDs alone occur in 0.8-1.0% live births globally. Data on echocardiogram diagnosed PHDs in Ghana however is lacking. We set out to describe the echocardiogram diagnosed prevalence of the various PHDs, their age profile and change in trends over an eleven-year period in children less than sixteen years seen in Kumasi. MethodsWe retrieved archived first echocardiogram scan reports from January 2010 through December 2020, and extracted the diagnosis, scan date and sex of the patients. PHDs were categorized into CHDs and AHDs and proportions of the top five reported respectively. Observed trends in proportion of types of PHDs and age at first diagnosis were computed. Data was collected using Microsoft® Excel and analyzed with R statistical software. ResultsPHDs were present in 49.9% (2474/4962)...
Background: Malaria is the leading cause of morbidity and mortality in post-conflict Burundi. To ... more Background: Malaria is the leading cause of morbidity and mortality in post-conflict Burundi. To counter the increasing challenge of anti-malarial drug resistance and improve highly effective treatment Burundi adopted artesunate-amodiaquine (AS-AQ) as first-line treatment for uncomplicated Plasmodium falciparum malaria and oral quinine as second-line treatment in its national treatment policy in 2003. Uptake of this policy in the public, private and non-governmental (NGO) retail market sectors of Burundi is relatively unknown. This study was conducted to evaluate access to national policy recommended anti-malarials. Methods: Adapting a standardized methodology developed by Health Action International/World Health Organization (HAI/WHO), a cross-sectional survey of 70 (24 public, 36 private, and 10 NGO) medicine outlets was conducted in three regions of Burundi, representing different levels of transmission of malaria. The availability on day of the survey, the median prices, and aff...
In low-income countries, perinatal depression is common, but longitudinal data on its influence o... more In low-income countries, perinatal depression is common, but longitudinal data on its influence on child health are rare. We examined the association between maternal depression and febrile illness in children. There were 654 mother/child dyads in Ghana and Côte d’Ivoire that were enrolled in a prospective birth cohort in 2010–2011 and underwent 2-years of follow up. Mothers were examined for depression using the Patient Health Question-naire depression module antepartum and 3 and 12 months postpartum. The hazard of febrile illness in children of depressed and nondepressed mothers was estimated using a recurrent event Cox proportional hazards model. The prevalences of antepartum depression in mothers from Côte d’Ivoire and Ghana were 28.3 % and 26.3%, respectively. The prevalences of depression at 3 and 12 months postpartum were 11.8 % and 16.1 % (Côte d’Ivoire) and 8.9 % and 7.2 % (Ghana). The crude and adjusted (for country and socioeconomic status) hazard ratios of febrile illnes...
Background Early initiation of breastfeeding (EIBF), breastfeeding within first hour after birth,... more Background Early initiation of breastfeeding (EIBF), breastfeeding within first hour after birth, is known to have major benefits for both the mother and newborn. EIBF rates, however, tends to vary between and within countries. This study set out to determine the prevalence of EIBF at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana, and to evaluate the determinants of EIBF and time to initiation of breastfeeding. Methods A cross-sectional study was conducted at the KATH postnatal wards between August and October 2014. Three hundred and eighty-two mothers delivering at KATH were recruited and data on time to initiation of breastfeeding, antenatal, delivery and immediate postnatal periods were collected. Data analyses using both binary and ordinal logistic regressions with stepwise elimination were used to determine the relationship between EIBF and time to initiation of breastfeeding on one side, and the maternal, pregnancy, delivery and neonatal associated factors. Results ...
Abstract Emergently ill infants and children are often inadequately recognized and stabilized by ... more Abstract Emergently ill infants and children are often inadequately recognized and stabilized by health care facilities in low- and middle-income countries. Limited reports have shown that process improvements and prioritization of emergency care for children presenting to the hospital can improve pediatric hospital mortality. A dedicated pediatric emergency unit (PEU) was established for nontrauma emergencies at a busy teaching and referral hospital in Kumasi, Ghana, in response to high inpatient mortality early during hospitalization. The PEU was designed to identify and separate critically ill children from more stable children on admission. Locally available hospital resources were reallocated from other areas of the hospital to prioritize staffing and supplies for the PEU. A multiyear data set of nonnewborn inpatient mortality was analyzed with a change point model to find the point at which mortality changed the most within the Department of Child Health or the maximum likelihood estimate. Relative risk of mortality for the periods 1 and 2 years immediately before and after the implementation of the PEU and each individual year compared with its preceding year was analyzed to further establish a temporal correlation of changes in mortality rates to the PEU implementation. Individual years were also analyzed against preimplementation data to establish the durability of mortality improvements. Patient mortality decreased over the analyzed period with the maximum change point strongly associated with implementation of the PEU. Relative risk values of mortality 1 year and 2 years immediately before and after implementation of the PEU were 0.70 (0.62–0.78) and 0.69 (0.64–0.74) respectively, representing a one-third reduction in mortality. The only other mortality improvements seen in the year-to-year analysis were between July 2004–June 2005 compared with July 2005–June 2006 with a relative risk of 0.86 (0.77–0.96). Prioritizing and redirecting limited resources toward pediatric emergency care in low- and middle-income country hospitals is associated with reductions in inpatient mortality that are both immediate and sustained.
Background: Diarrhoeal diseases are among the most frequent causes of morbidity and mortality in ... more Background: Diarrhoeal diseases are among the most frequent causes of morbidity and mortality in children worldwide, especially in sub-Saharan Africa. This case-control study was conducted to investigate the bacterial, viral and parasitic pathogens associated with acute diarrhoea among children attending three health facilities in Kumasi, Ghana. Methods: Stool specimens were collected from 240 children under 5 years of age visiting hospitals in Kumasi, Ghana due to acute diarrhoea and from 107 healthy controls of similar age. Both intestinal and malaria parasites were diagnosed by microscopy whereas rota-and adenoviruses were identified by stool antigen immunochromatograhic testing. Bacterial enteropathogens were detected by conventional culture techniques. Results: Of all subjects, 23 (6.6%) were positive for malaria parasitaemia, 139 (40.1%) had at least one bacterial agent in their stool and 25 (7.2%) had ova or parasites. Subjects infected with malaria had the highest odds of having diarrhoea [12.0 (95% CI 1.56, 92.35)] followed by those with rotaviruses [4.4 (95% CI 2.05, 9.47)] and bacterial infection [4.99 (95% CI 1.45, 17.17)]. Conclusion: In conclusion, this study was unique as it looked at the three groups of pathogens (parasites, viruses and bacteria) that cause acute diarrhoea in children in the Kumasi metropolis of Ghana. This study has shown for the first time since 2004 that malaria parasitaemia, rotavirus and bacterial infections still remain common pathogens associated with acute childhood diarrhoea in the Kumasi metropolis of Ghana.
International journal of pediatric endocrinology, 2017
Data on normative clitoral sizes in newborns is relatively sparse and racial/ethnic differences h... more Data on normative clitoral sizes in newborns is relatively sparse and racial/ethnic differences have also been reported. This study was performed to establish norms for clitoral size in term Ghanaian female newborns. This was a cross-sectional study of all apparently well full-term newborns of postnatal age < 48 h and birth weight between 2.5 and 4.0 kg delivered at Komfo Anokye Teaching Hospital between May and September, 2014. Anthropometric and genital parameters were documented for study subjects as well as parental socio-demographic indices. In 612 newborn females studied, the mean (±SD) clitoral length (MCL) and the mean (±SD) clitoral width (MCW) were 4.13 ± 1.6 mm and 4.21 ± 1.1 mm, respectively. MCL was inversely related to birth weight (r = -0.62; p < 0.001 ) while MCW was inversely related to both gestational age (r = -0.1; p = 0.02 ) and birth weight (r = -0.54; p < 0.001 ). Babies with a clitoris that was completely covered by the labia majora had relatively lo...
Yearly pediatric cardiac surgery missions to Ghana are of tremendous benefit to local children, b... more Yearly pediatric cardiac surgery missions to Ghana are of tremendous benefit to local children, but may create thorny ethical dilemmas for local clinicians who refer and screen children for the mission and who provide care to the children after the mission concludes for the year. This article presents the experiences and concerns of a pediatrician who is a local member of the Hearts and Minds of Ghana project.
Background. Childhood poisoning is an important cause of morbidity in both developed and developi... more Background. Childhood poisoning is an important cause of morbidity in both developed and developing countries. Epidemiological studies on accidental poisoning in children show a consistent pattern regarding age and gender. Childhood poisoning is predominant in children <6 years of age and has a male preponderance, as boys are more active with a drive to explore the environment. Objective. To document the epidemiology of home poisonings in Kumasi and its environs. Methods. We conducted a retrospective study from January 2007 to January 2012 at the Komfo Anokye Teaching Hospital, a tertiary hospital in Ghana. Results. Poisoning is a significant health problem in the study area. A total of 253 children reported to the hospital with poisoning over the 61month period, with an average of four cases per month. The male to female ratio was 1.58:1. The median age of the children was 24 months (interquartile range 24 48 months). Kerosene was the leading cause of poisoning (39.5%). Concl...
Little is known about the course of perinatal anxiety, particularly in low and middle income coun... more Little is known about the course of perinatal anxiety, particularly in low and middle income countries. This study aimed at examining trajectories of ante- and postpartum generalized anxiety symptoms in West-African women and their associations with mother and child characteristics. 778 women from Côte d'Ivoire and Ghana were investigated between 04/2010 and 03/2014. Anxiety symptoms were measured using the seven-item Generalized Anxiety Disorder scale (GAD-7) at three months antepartum and three, 12 and 24 months postpartum. Growth mixture modeling was applied to identify latent trajectory classes of anxiety. Multinomial logistic regression was used to investigate the associations of psychosocial, sociodemographic, obstetric and clinical characteristics with different trajectories. Four distinct trajectories of anxiety were identified. The majority of women (79.8%) had consistent low anxiety symptoms, while 11.4% had elevated anxiety scores before and around childbirth that dec...
Maternal mortality ratio averages 230 per 100,000 live births in developing countries. Obstructed... more Maternal mortality ratio averages 230 per 100,000 live births in developing countries. Obstructed labour, which is a major cause results from prolonged, neglected labour. The partograph as recommended by the World Health Organization is a graphical tool used to monitor the progress of the first stage of labour, thereby preventing prolonged labour. The partograph has been in use in Ghana since 1989. The study was conducted to ascertain the proportion and correct use of the partograph in monitoring labours in 4 hospitals in a metropolitan area of Ghana. Partograph use for labour monitoring averaged 54% in this study. Midwives formed 90% of birth attendants. For the progress of labour, parameters were monitored to standard in 55-60% of cases. Parameters pertaining to fetal well being were correctly monitored in 30-50%. Maternal well being was monitored to standard in 40% of cases. Apgar scores at 1 and 5 minutes did not differ whether parameters were recorded to standard or not. We conclude from our study that almost half of labour cases were not monitored with the partograph. In those that were monitored with the partograph monitoring to standard was done in 40-60%. Birth attendants either lack the skill in charting the partograph to standard protocols or do not appreciate the use of the partograph in monitoring the progress of labour. In resourcelimited centres in the developing world the use of the partograph to monitor the progress of labour cannot be overemphasized. Skilled attendants at deliveries must therefore be given regular updates on the proper use of the partograph during labours.
Maternal mortality ratio averages 230 per 100,000 live births in developing countries. Obstructed... more Maternal mortality ratio averages 230 per 100,000 live births in developing countries. Obstructed labour, which is a major cause results from prolonged, neglected labour. The partograph as recommended by the World Health Organization is a graphical tool used to monitor the progress of the first stage of labour, thereby preventing prolonged labour. The partograph has been in use in Ghana since 1989. The study was conducted to ascertain the proportion and correct use of the partograph in monitoring labours in 4 hospitals in a metropolitan area of Ghana. Partograph use for labour monitoring averaged 54% in this study. Midwives formed 90% of birth attendants. For the progress of labour, parameters were monitored to standard in 55-60% of cases. Parameters pertaining to fetal well being were correctly monitored in 30-50%. Maternal well being was monitored to standard in 40% of cases. Apgar scores at 1 and 5 minutes did not differ whether parameters were recorded to standard or not. We con...
Background: Severe malaria in children remains the commonest clinical disease in the paediatric e... more Background: Severe malaria in children remains the commonest clinical disease in the paediatric emergency units of most hospitals in sub-Saharan Africa. Anaemia and nutritional deficiency are associated with severe malaria. The aim of the study was to describe the haematological indices, nutritional status and mortality among children admitted in a tertiary hospital in Ghana with severe malaria. Methods: We conducted a prospective cross-sectional study documenting the haematological, nutritional indices and mortality outcomes of children less than five years reporting to the Komfo Anokye Teaching Hospital with severe malaria. Results: The study recruited four-hundred-and-eight (408) children between April, 2005 and July, 2006. There were 231 males (57%). The median age was 21 months, (1QR: 4-54months). 36 (8.8%) patients had weight-forage zscore <-3; 101 (24.7%) had z-score ≥-3 to <-2; 130 (31.9%) had z-scores ≥-2 to <-1 and 141 (34.6%) had z-scores ≥-1. The mean haemoglobin level was 6.2g/dl (SD=2.2, 95% CI: 6.0-6.4). The mean haemoglobin levels of children with normal, mild, moderate, and severe malnutrition were 6.5g/dl, 6.0g/dL, 6.0g/dL, and 6.0g/dL, respectively, p=0.15. The overall case fatality rate was 4.9%. Children with malnutrition (weight-forage z-score ≤-2) had a significantly higher case fatality rate of 8.0% (11/126) compared to those with z-score >-2, 3.3% (RR=1.7, 95%CI: 1.1-2.6, P=0.038). Conclusion: Malaria in children under five remains a principal cause of morbidity and mortality. The study did not find any association between the haemoglobin levels and the nutritional status. However, Mortality was associated with malnutrition (weight-forage z-score ≤-2) in this study.
Background: While several anti-malarials are known to affect the electric conduction system of th... more Background: While several anti-malarials are known to affect the electric conduction system of the heart, less is known on the direct effects of Plasmodium falciparum infection. Some earlier studies point to a direct impact of Plasmodium falciparum infection on the electric conduction system of the heart. The aim of this study was to analyse infection-and drug-induced effects on the electric conduction system. Methods: Children aged 12 months to 108 months with severe malaria were included in Kumasi, Ghana. In addition to basic demographic, clinical, biochemical and parasitological, biochemical data were measured data upon hospitalization (day 0) and 12-lead electrocardiograms were recorded before (day 0) and after (day 1) initiation of quinine therapy as well as after 42 (±3) days. Results: A total of 180 children were included. Most children were tachycardic on day 0 but heart rate declined on day 1 and during follow up. The corrected QT intervals were longest on day 1 and shortest on day 0. Comparison of QT intervals with day 42 (healthy status) after stratification for age demonstrated that in the youngest (<24 months) this was mainly due to a QT shortage on day 0 while a QT prolongation on day 1 was most pronounced in the oldest (≥48 months). Nearly one third of the participating children had measurable 4-aminoquinoline levels upon admission, but no direct effect on the corrected QT intervals could be shown. Conclusion: Severe P. falciparum infection itself can provoke changes in the electrophysiology of the heart, independent of anti-malarial therapy. Especially in young-thus non immune-children the effect of acute disease associated pre-treatment QT-shortage is more pronounced than quinine associated QT-prolongation after therapy. Nevertheless, neither malaria nor anti-malarial induced effects on the electrophysiology of the heart were associated with clinically relevant arrhythmias in the present study population.
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Papers by Samuel Nguah