Quality of acute coronary syndrome care and in hospital outcome in a resource-poor setting in Northern Ghana

Introduction: African countries are facing an epidemic of cardiovascular diseases. Information on the quality of acute coronary syndrome care offered in underserved communities in Ghana is limited. Using objective criteria, we examined the quality of acute coronary syndrome care offered to patients presenting to a tertiary referral center in Northern Ghana. Methods: we conducted a retrospective review of patients ≥ 18 years old with acute coronary syndrome managed in Tamale Teaching Hospital. We assessed in-hospital outcomes and the extent of compliance to key performance and quality indicators as contained in the 2017 American Heart Association/American College of Cardiology guideline for adults with myocardial infarction. Results: sixty-two (62) patients with a mean age of 56.0 ± 16.1 years were recruited. The median delay to presentation was 24 hours (IQR 15-96 hours). 33.9% had ST-elevation myocardial infarction, of which only 14.3% received reperfusion therapy. About three-quarters of patients received dual antiplatelet therapy at discharge, with fewer patients receiving recommended high-intensity statin therapy (65.5%) or beta-blockers (69.1%). Only 38.2% of patients had their left ventricular ejection fraction documented. No cardiac rehabilitation program existed. Risk stratification of patients with non-ST-elevation myocardial infarction or stress testing for conservatively managed patients was not part of routine practice. Conclusion: acute coronary syndrome management remains a challenging issue in Northern Ghana. Several gaps exist in the care quality, timeliness of interventions and rehabilitation of affected patients. There is an urgent need for measures to improve the delivery of acute coronary syndrome care alongside primary prevention strategies.

Compliance with spectacle wear among learners with hearing impairment in Ghana

Background: Hearing-impaired learners with refractive problems require correction because poor vision hinders their development and educational pursuits. Objectives: To determine the level of compliance with spectacle wear in learners with hearing impairment in Ghana. Method: A descriptive cross-sectional study design was used to investigate the level of compliance with spectacle wear in hearing-impaired learners with uncorrected refractive errors (URE). The participants were from six schools for the hearing impaired, comprising three schools from each sector (Northern and Southern) of Ghana. Results: Of the 1914 learners screened, 69 (3.61% CI: 2.82­4.54%) had URE. Sixty-two (89.9%) learners with URE had myopia (-0.50 Dioptre Sphere (DS) to -2.00DS), and 7 (10.1%) had hyperopia (+2.00DS to +10.00DS). There were more females (53.6%) with URE than males, and their ages ranged from 8 to 35 years, with a mean of 17.35 ± 5.19 years. Many (56.5%) learners complied with spectacle wear after 3 months of reassessment, with females being more compliant than males, but the difference was not significant (p = 0.544). Learners who complied well with the spectacle wear were those with moderate visual impairment (VI), followed by mild VI, while those with no VI were the least compliant. A significant difference was observed between spectacle compliance and presenting VI (p = 0.023). Conclusion: The spectacle wear compliance level was high compared to a previous study (33.7%) in Ghana. Contribution: This study highlights the importance of addressing URE among learners with hearing impairment in Ghana and Africa.

Indications for echocardiography and confirmation rates of cardiovascular diseases: experience of a specialist cardiac outpatient clinic in Kumasi, Ghana

Background: Transthoracic echocardiography is a very helpful noninvasive cardiovascular imaging technique for the diagnosis and risk stratification in the management of patients with cardiovascular diseases. We aimed to review the clinical indications for transthoracic echocardiography and the confirmation rate of cardiovascular diseases by echocardiography at a specialist cardiac clinic in Ghana. Methods: Using a cross sectional study design, the echocardiography reports of all patients above the age of 15 who were assessed at the clinic were analyzed. Data on patient demographics, clinical history, clinical indication for echocardiography, and the echocardiographic findings were analyzed using version 25.0 of the Statistical Package for Social Sciences (SPSS). Results: A total of 594 participants were studied. The age range of participants was 15­96 years, with a mean (± standard deviation) age of 53.72 (± 17.25) years. There were more females (50.17%) than males (49.83%). Most (54.21%) of the participants had echocardiography for cardiac evaluation. Other indications included hypertension/hypertensive heart disease (HHD) (n = 131; 22.06%), heart failure (n = 69; 11.62%), chest pains (n = 12; 2.02%), and valvular heart disease (VHD) (n = 11; 1.85%). Three hundred and eight nine (70.30%) of the participants had their clinical diagnoses confirmed by echocardiography; echocardiographic confirmation rates for heart failure, VHD, and HHD were 92.75%, 90.91%, and 88.54%, respectively. Conclusion: Echocardiography showed high confirmation rates for our patients with heart failure, VHD, and HHD. Prompt usage of this noninvasive cardiovascular imaging for the initial evaluation of patients with cardiovascular diseases is highly recommended.

Ophthalmic services utilisation and associated factors in the Ashanti region, Ghana

Objective: This survey determined the utilisation of eye care services and associated factors among adults in the Ashanti region of Ghana. Design: A population-based cross-sectional descriptive study Method: Data for this study was collected from 1615 randomly selected individuals in the Ashanti region of Ghana, using a structured, pretested interviewer-guided questionnaire. Information regarding the accessibility and determinants of, and barriers to, eye care services was based on self-reports, using the WHO Eye Care Services Assessment Questionnaire. Inferential analyses were performed using the chi-square test for statistical significance, set at p=0.05.Setting: Ashanti Region, Ghana Participants: One thousand six hundred and fifteen randomly selected adults Results: Public eye care facilities were used by 58.2% of the participants for their last eye exam. Of the participants, 47.0% had travelled less than five kilometres for their last eye exam. Waiting time and service cost were participants' most frequently cited challenges in seeking care. No need felt (40.1%), self-medication (37.7%) and cost (22.2%) were the most frequently mentioned barriers to seeking ophthalmic services. Conclusion: The major challenges encountered in seeking eye care services were waiting time and cost of service. Major barriers to ophthalmic services utilisation were no need felt, self-medication and cost. Factors such as cost, lack of felt need and self-medication, which serve as barriers to utilising eye care services, should be addressed by stakeholders through eye health education and promotion

Knowledge of physical activity, physical activity level and waist-to-hip ratio in adults with diabetes in a Ghanaian municipality

Objectives: To investigate the knowledge about physical activity, physical activity levels and waist-to-hip ratio among persons living with diabetes in the Ho Municipality. Design: Cross-sectional observation study. Setting: The researcher collected data from two diabetes clinics in the Ho Municipality of Ghana. Participants: Consenting persons living with diabetes who attended the diabetes clinics. Main outcome measures: Participants' waist-to-hip ratio, knowledge of the physical activity and level of activity according to the International Physical Activity Questionnaire. Results: There were 106 participants, and the modal age was 60 years or older (50.94% (n= 54)). Of the total, 62.3% (n = 66) were women, and the mean knowledge level was 12.7±1.58 (range: 0-17). Mean waist-to-hip ratio was 0.92 ± 0.10) with 25.5% (n = 27) men and 48.1% (n = 51) women recording abnormally increased waist-to-hip ratios. Additionally, 44% of participants engaged in low physical activity levels, whereas 10% participated in high levels. There were no significant associations between physical activity levels and waist-to-hip ratios (r = 0.176, p=0.071). Conclusion: Persons with diabetes in the Ho Municipality mostly engaged in low and moderate physical activity levels and had abnormally increased waist-to-hip ratios suggesting abdominal obesity. Knowledge of physical activity may be associated with physical activity performance and waist-to-hip ratio, bearing an inverse association with physical activity levels.

Contributory factors to early neonatal deaths in the Upper East Regional Hospital in Ghana

Objective: This study examined factors identified during early neonatal death audits contributing to preventable newborn deaths at the Upper East Regional Hospital. Method: Data for this study was collected retrospectively from perinatal death audit forms using three data collectors. Data collection lasted two weeks, from 18th June to 2nd July 2021. The data collectors submitted 113 filled hard copy data collection forms. This was then entered into a designed Excel sheet and exported to STATA software version 15.0 for analysis. The analysis was descriptive statistics with cross-tabulation. The results were presented in charts and tables focusing on percentages. Results: Most of the 113 neonatal deaths were from birth asphyxia (63%). Forty-six (40.7%) of the deaths occurred within 24 hrs after birth. There were 38 factors reported 254 times in the audits as contributory to all the newborn deaths; 17 health personnel-related factors stated 141 (55.5%) times, four transportation and communication-related factors stated 43 (16.9%) times, seven health facility factors stated 31 (12.2%) times. Inappropriate care during transportation to the regional hospital was reported most - 21 times, followed by delay in referral - 18 times. Conclusion: The study identified many factors, such as medical personnel-related factors, transportation and communication factors, family-related factors, and health facility administration factors, contributing to early neonatal deaths. Effective implementation of neonatal death audit-based recommendations arising from these contributory factors is critical to preventing avoidable newborn deaths.

From talk to action: Developing a model to foster effective integration of traditional medicine into the Ghanaian healthcare system / 中西医结合学报

This research assessed the experience of stakeholders and the efficacy of integrating traditional medicine into the Ghanaian health system using the Ashanti Region as the focal point. Elements of an integrative healthcare delivery model including philosophies/values, structure, process and outcome were used to conduct a quality assessment of the integrated health system in Ghana. Each element clearly showed that Ghana is currently not running a coordinated health practice model, thus making it a tolerant, rather than an inclusive, health system. Therefore, the primary purpose of this research is to discuss the development of a new and appropriately customised model that could enhance the practice of integrated healthcare in Ghana. The model we present has flexibility and far-reaching applicability in other African countries because such countries share similar socio-cultural and economic characteristics. As such, governments and health practitioners could adapt this model to improve the practice of integrated healthcare in their specific settings. Hospital administrators and health system researchers could also adapt the model to investigate or to monitor the progress and efficacy of integrated healthcare practices within their settings. This might help to understand the relationships between the integration of traditional medicine and health outcomes for a given population. Please cite this article as: Ampomah IG, Malau-Aduli BS, Malau-Aduli AEO, Emeto TI. From talk to action: Developing a model to foster effective integration of traditional medicine into the Ghanaian healthcare system. J Integr Med. 2023; 21(5): 423-429.

A Comparative Study of Dashamooladi Nasya & Dashamooladi Ghana Vati in the Management of Vishvachi w.s.r to Cervical Spondylosis

The advent of civilization and overuse of life modifying gadgets like cell phones, computers, etc. leads to greater incidence of neck pain worldwide, of which Cervical spondylosis is the prime cause, which is a natural ageing process characterized by sequence of degenerative changes in the spinal structure. In Ayurveda, it can be closely correlated with Vishvachi, which is a Nanatmaja vatavyadhi, in which there is restriction of movement in arms associated with Ruk, Stambha, etc. features. Aims and Objectives: 1. To study etiopathogenesis, symptomatology, and progress of Vishvachi w.s.r. to cervical spondylosis. 2. To assess the efficacy of Dashamooladi taila nasya and Dashamooladi ghana vati individually and compare the effect of both schedules clinically. Materials and Methods: After proper identification, the selected raw herbs are used for Taila (oil) preparation according to Taila paka vidhi for Nasya and Kwatha was made for oral medication. The study was carried out in two parts- a). Literary- Textual references from various books, journal and papers on Internet were studied. b). Clinical- After considering the selection criteria, a total of 60 patients were treated in two groups- i) Group A: 30 patients were treated with Dashamooladi taila nasya for consecutive 21 days preceded by Abhyanga (oleation) & Svedana (fomentation). ii) Group B: 30 patients were treated with Dashamooladi Ghana vati consecutively for 21 days. Scoring was done on the basis of 09 parameters and statistical analysis was done. Result: Group A patients showed marked effect on Avamotana, Sanchari, Spandana, Aruchi & moderate effect on Ruk, Toda, Stambha & Tandra. Group B showed marked effect on Toda, Stambha, Spandana; and moderate effect on Ruk, Avamotana, Sanchar. Conclusion: Dashamooladi yoga (Dashamoola, Bala, Masha) is used both for shamana and Nasya medicine. These are effective in Vata-kaphaja ailments, Sotha, Shula, etc., and possess Balya, Brimhana, Rasayana, Vrishya etc., qualities.

The Sanitary Conditions of Bakeries and Food Safety Practices Assessment of Bakers in Tamale Metropolis, Ghana

There is a lack of research on the safety of bread in Ghana, although it is one of the foods consumed by most Ghanaians daily. The study, therefore, assessed the sanitary conditions of bakeries in the Tamale Metropolis and further evaluated the food safety practices of bakers in these bakeries. The study employed the use of a questionnaire to collect data in 24 carefully selected bakeries and then the food safety practices of bakers in these bakeries. Results showed that 91.7% of the bakeries had bakers wearing protective gears while working. All (100%) the bakeries were free of domestic animals and a visible presence of insects, rodents or vectors. However, 6(25%) bakeries placed their solid waste containers in the bakery premises. Also, 89.5% of the bakers indicated that they always wash their hands with soap and water before working or handling baking ingredients and materials. All (100%) bakers indicated that they check the expiry dates of their bakery ingredients before using them. 29.8% of the bakers, however, did not make it a practice of refrigerating bakery ingredients that require to be stored in the fridge when not in use. In conclusion, most bakeries had good sanitary conditions and were managed in a manner that ensure food safety. Bakers also exhibited a good level of food safety adherence. Managers should continue to ensure that good sanitary standards are followed and food risk analysis concepts like HACCP are implemented in the bakery to check new and complex food safety threats.

Low-fidelity simulation for management of postpartum haemorrhage in a Ghanaian teaching hospital

We conducted a pre/post study of a post-partum hemorrhage (PPH) simulation exercise at Korle Bu Hospital, using a low-fidelity birthing simulator and questionnaires. We aimed to evaluate low-fidelity simulation as a feasible and effective method of improving resident knowledge and confidence in a low-resource setting. Knowledge and confidence in PPH management were measured before and after using 5-point Likert scales and multiple-choice questions. A feedback survey was administered. Descriptive statistics were calculated to summarize demographics, confidence, and knowledge, with frequencies, means and standard deviations reported. Statistical significance of the change in scores was assessed using paired t tests. Statistically significant improvements in knowledge and confidence in managing PPH were evident following the simulation exercise. All participants agreed the simulation was educational, relevant and realistic, and 94% felt it could be incorporated into their training. (Afr J Reprod Health 2022; 26[4]: 57-64)

Herbalists' explanations of infertility: The case of Northern and Southern Ghana

In sub-Saharan Africa, traditional medical practitioners also referred to as herbalists, offer diagnostics and therapeutics for diverse medical conditions irrespective of the cause. Given their traditional role as healers and repository of knowledge about medicinal plants, spirituality, customs and religion, people use their services regardless of their location, education, or socio-economic backgrounds. The aim of the study is to explore herbalists´ views and explanations on infertility and women with infertility. Using an exploratory qualitative design, semi-structured interviews were conducted with 10 herbalists, 5 from the North-East region, 2 from Ashanti region and 3 from the Greater Accra region. Following thematic analysis, findings show that infertility has multiple causes - medical, natural, spiritual and lifestyle. Some herbalists stated that everyone was created to bear children while others refuted this notion. They shared the common consensus that not everyone can have children even though they may be medically and spiritually fit. The public should be advised on the need for periodic reproductive health checks. Also, there should be a conscious, concerted efforts to gradually dissociate unhealthy explanations of infertility from the actual empirically proven realities.This would empower society to rise above those entrenched beliefs, thereby reducing the stigma associated with infertility and women with infertility. (Afr J Reprod Health 2022; 26[5]: 96-106).

Parenting practices and family relationships during the COVID-19 lockdown in Ghana

The effects of the COVID-19 pandemic have been far reaching across almost every sphere of life. Families, which are the basic units of society, have not been spared the ravages of the pandemic. Changes in family daily routines as a result of COVID-19 can affect spousal relationships, parenting and childcare practices. However, the extent to which the pandemic has affected parenting practices and family relationships in Ghana is not known. The goal of this study was to assess how parenting practices and family relationships have been influenced during the COVID-19 pandemic in Ghana. Data for this paper was drawn from an online questionnaire response from 463 participants in Ghana as a subset analysis from a multi-country study on personal and family coping system with COVID-19 pandemic in the global south. The mean score for pre-COVID-19 relationship with partner (36.86) was higher (p<0.0001) than the mean score for during COVID-19 relationship with partner (35.32) indicating that COVID-19 has had negative influence on relationships. The mean score for pre-COVID-19 parenting (32.78) was higher (p<0.0001) compared to the mean score for during COVID-19 parenting (31.40) indicating negative influence on parenting. We have predicted that participants whose coping levels were "Well" on the average, are likely to be doing well in relationship with partners and parenting practices during the COVID-19 period The challenging public health containment measures of the COVID-19 pandemic have negatively influenced the relationship between partners and parenting practices in Ghana.

Application of the hub and spokes model in improving access to cervical cancer screening in Ghana

Objective: To examine the contribution of lower-level health facilities in increasing access to cervical cancer screening in the North Tongu District. Design: A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cervical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing. Participants: A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes. Main outcome measure: The detection of screen positives Results: The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes. Conclusion: We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of 'spokes' could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed

Patient treatment cost of oral diseases in Ghana

Objectives: To estimate patient treatment cost of oral diseases in Ghana Design: A cross-sectional study design using cost-of-illness analysis was employed Setting: The study was conducted at the dental unit of the University of Ghana Hospital, Legon Participants: About185 patients attending the dental unit of the hospital were selected Interventions: None Main outcome measures: Direct medical and non-medical costs, indirect costs, and intangible costs of treatment of oral conditions Results: The estimated average cost of treatment for oral diseases was US$ 35.75. The total cost was US$ 6,614.11, with the direct and indirect costs constituting 94.5% and 5.5%, respectively of the total cost. Direct medical costs constituted 86.9%, while direct non-medical costs constituted 13.1% of the total direct cost. The richer socio-economic group had the highest cost per quintile, with a mean of US$ 46.69. The intangible cost described was highest for pain (47.1%), followed by difficulty in eating (40.8%) and sleeping (34.6%) for both men and women. Conclusion: The costs of oral diseases are huge and cannot be overlooked. Oral diseases also pose significant productivity losses to patients

The effects of Ghana's capitation policy on hospital Under-5 mortality in the Ashanti Region

Objective: The study estimated the capitation policy's effect on the under-5 mortality (U5MR) rate in hospitals in Ashanti Region. Design: We used an interrupted time series design to estimate the impact from secondary data obtained from the DHIMS-2 database. Monthly under-5 deaths and the number of live births per month were extracted and entered into Stata 15.0 for analyses. The U5MR was calculated by dividing the number of live deaths by the number of live births for each of the 60 months of the study. Setting: Health facilities of the Ashanti Region with Data in the DHIMS 2. Intervention: the level and trend of U5MR for 31 months during the Capitation Policy implementation (January 2015 to July 2017) were compared with the level and trend 29 months after the withdrawal of the capitation policy (August 2017 to December 2019). Outcome measures: changes in trend or level of U5MR after the withdrawal of capitation. Main Results: During the capitation policy, monthly U5MR averaged 10.71 +/-2.71 per 1000 live births. It declined to 0.03 deaths per 1000 live births (p=0.65). After the policy withdrawal, the immediate (increase of 0.01 per 1000live births) and the trend (decline of 0.13 deaths per 1000 live births per month) were still not statistically significant. Conclusion: We conclude that the capitation policy did not appear to have influenced under-5 mortality in the Ashanti Region. The design of future healthcare payment models should target quality improvement to reduce under-5 mortalities

Strengths, disconnects and lessons in local and central governance of the response to the first wave of COVID-19 in Ghana

Objectives: To explore governance, coordination and implementation actors, structures and processes, facilitators, and barriers within local government and between central and local government in Ghana's COVID-19 response during the first wave of the outbreak. Design: Cross-sectional single case study. Data collection involved a desk review of media, policy and administrative documents and key informant in-depth interviews. Setting: Two municipalities in the Greater Accra region of Ghana Participants: Local government decentralised decision makers and officials of decentralised departments. Interventions: None. Main Outcome Measures: None Results: Coordination between the national and local government involved the provision of directives, guidelines, training, and resources. Most of the emergency response structures at the municipal level were functional except for some Public Health Emergency Management Committees. Inadequate resources challenged all aspects of the response. Coordination between local government and district health directorates in risk communication was poor. During the distribution of relief items, a biased selection process and a lack of a bottom-up approach in planning and implementation were common and undermined the ability to target the most vulnerable beneficiaries. Conclusions: Adequate financing and equipping of frontline health facilities and workers for surveillance, laboratory and case management activities, transparent criteria to ensure effective targeting and monitoring of the distribution of relief items, and a stronger bottom-up approach to the planning and implementation of interventions need to be given high priority in any response to health security threats such as COVID-19.

Pattern of chest computerized tomography scan findings in symptomatic RT-PCR positive COVID-19 patients at the Korle Bu Teaching Hospital, Ghana

Background: Chest Computerized Tomography (CT) features of Corona Virus Disease 2019 (COVID-19) pneumonia are nonspecific, variable and sensitive in detecting early lung disease. Hence its usefulness in triaging in resource-limited regions. Objectives: To assess the pattern of chest CT scan findings of symptomatic COVID-19 patients confirmed by a positive RTPCR in Ghana. Methods: This study retrospectively reviewed chest CT images of 145 symptomatic RT-PCR positive COVID-19 patients examined at the Radiology Department of the Korle Bu Teaching Hospital (KBTH) from 8th April to 30th November 2020. Chi-Squared test was used to determine associations among variables. Statistical significance was specified at p≤0.05. Results: Males represent 73(50.3%). The mean age was 54.15±18.09 years. The age range was 5 months-90 years. Consolidation 88(60.7%), ground glass opacities (GGO) 78(53.8%) and crazy paving 43(29.7%) were the most predominant features. These features were most frequent in the elderly (≥65years). Posterobasal, peripheral and multilobe disease were found bilaterally. The most common comorbidities were hypertension 72(49.7%) and diabetes mellitus 42(29.2%) which had significant association with lobar involvement above 50%. Conclusion: The most predominant Chest CT scan features of COVID-19 pneumonia were GGO, consolidation with air bronchograms, crazy paving, and bilateral multilobe lung disease in peripheral and posterior basal distribution

Comorbid anxiety and depression among women receiving care for breast cancer: analysis of prevalence and associated factors

Background: Living with breast cancer has been associated with increased risk for common mental health problems including depression and anxiety. However, the prevalence of comorbid anxiety and depression (CAD) and their associated factors have received little attention especially in low- and middle-income countries (LMICs) including Ghana. Objectives: This study examined the prevalence of CAD and its correlates in the context of breast cancer. Methods: Participants were 205 women receiving care for breast cancer at a Tertiary Hospital in Ghana. The Hospital Anxiety and Depression Scale (HADS) and socio-demographic questionnaires were administered to the participants. Results: Findings from the study showed that the prevalence of CAD, anxiety and depression was 29.4%, 48.5% and 37.3% respectively. CAD was significantly predicted by patients' English language reading ability, shared decision making and good doctor-patient relationship. Anxiety was significantly predicted by shared decision making and good doctor-patient relationship whereas depression was significantly predicted educational status, patients' English language reading ability, shared decision making and good doctor-patient relationship. Conclusion: The findings suggest relatively high prevalence of comorbid anxiety and depression which could negatively impact breast cancer treatment outcomes and therefore, improved interpersonal relationships between doctors and their patients as well as literacy skills are warranted

COVID-19 vaccine acceptance and its determinants in the Bono Region of Ghana

Objective: The study assessed willingness to accept the COVID-19 vaccine among out-patient department (OPD) attendants in the Bono Region in Ghana. Design: This was an analytical cross-sectional study Setting: The study was conducted at the Wenchi Methodist Hospital (WMH) OPD, Bono Region, Ghana. The region had not yet been earmarked for vaccination at the time of the study. Participants: Three hundred and twenty-five (325) participants aged ≥18 years, accessing care at the OPD of WMH and willing to give informed consent, were interviewed.Main outcome measures: The proportion of participants willing to accept the COVID-19 vaccine and its determinants. Results: Of 325 participants interviewed, 32 (9.8%) had been vaccinated already. 82.6% (242/293) indicated COVID19 vaccine acceptance among the unvaccinated. The major reason for vaccine acceptance was "it could protect against COVID-19" (96.7%, 234/242). "Fear of vaccine side effects and "perception of not being susceptible to COVID-19" were among the reasons for vaccine refusal. Perceived susceptibility to COVID-19 (AOR 4.09, 95% CI 1.79, 9.34), knowledge of COVID-19 and COVID-19 vaccine (AOR 3.62, 95% CI 1.14, 11.46) and willingness to pay for the vaccine (AOR 5.20, 95% CI 2.49, 10.43) were associated with vaccine acceptance. Conclusions: Adequate knowledge of COVID-19 and the vaccine may drive vaccine acceptance in the study area and possibly other areas in Ghana. Campaign messages aimed at increasing COVID-19 vaccine coverage must emphasise its safety, likely side effects and management in order to help rid the population of misconceptions

Sociodemographic and medical characteristics of liver cirrhosis deaths in a Ghanaian tertiary hospita

Objective: Cirrhosis is common in Ghana because of its high risk factors prevalence. However, information on cirrhosis in Ghana is lacking. This study aimed to study the clinical, and laboratory characteristics of cirrhotic patients in a tertiary hospital in Ghana. Design: This was a retrospective study of sociodemographic characteristics, symptoms and signs, biochemical and fibrotic indices, treatments, and complications data of 247 patients with cirrhosis who died on admission. Setting: This study was carried out at the Gastroenterology Unit of the Korle-Bu Teaching Hospital, Ghana, Results: Two-thirds (68.0%) of the patients were within 30 to 60 years, with more than half (73.7%) being males. The most common aetiological factors among the patients were Hepatitis B virus infection (53.8%), alcohol use (31.6%) and Hepatitis C virus infection (4.9%). More than half (55.0%) of the patients reported late for admission, and 67.2% died within the first two weeks of admission. The most common clinical feature was abdominal distension (61.1% of patients), and the least was upper-abdominal mass (14.2%). The levels of most liver test parameters were elevated, fibrotic indices were high, and haemoglobin and albumin levels were reduced. More than half (53.8%) of the patients were in Child Pugh class B. The most common complication was hepatic encephalopathy; the least was hepato-renal syndrome. Definite treatment for complications of cirrhosis was lacking. Conclusion: Deaths from cirrhosis at the hospital were mostly of young males with chronic hepatitis B infection. Implementation of hepatitis B prevention and treatment guidelines can help reduce cirrhosis deaths.