Experiences of Multidisciplinary Working: Perspectives from the Wessex Ghana Stroke Partnership.

INTRODUCTION: Substantial gaps remain in our understanding of stroke in Africa as well as in stroke care, practice and policy on the continent. The effective organization of preventative, therapeutic and rehabilitative stroke services continue to be challenging in many African countries. METHODOLOGY: In this article we define the nature, function and benefits of effective multidisciplinary team (MDT) working. The experiences and perspectives of members of the MDT were collated by focus group discussions as well as individual and country specific contributions. RESULTS: The experiences and perspectives of multidisciplinary team members from the United Kingdom and Ghana implementing these practices at the first stroke unit in Korle Bu Teaching Hospital, Accra, with a transparent discussion of successes and challenges faced throughout development of the service, is presented. MDT working has improved outcomes for patients and families who use the services, including encouraging better shared treatment planning and compliance. More stroke rehabilitation services are provided than previously, including greater self-management education and better secondary prevention care. CONCLUSION: It is hoped that this article will provide an inspirational model for others working to provide stroke care in low-resource settings in Africa and worldwide.

INTRODUCTION: Des lacunes substantielles subsistent dans notre compréhension de l'accident vasculaire cérébral en Afrique ainsi que dans les pratiques et politiques sur le continent. L'organisation efficace des services de prévention, de traitement et de réadaptation des AVC reste un défi dans de nombreux pays africains. MÉTHODOLOGIE: Dans cet article, nous définissons la nature, la fonction et les avantages d'une équipe multidisciplinaire efficace (PCT).Les expériences et les points de vue des membres de la PCT ont été recueillis par des discussions de groupes de réflexion ainsi que contributions individuelles et spécifiques à chaque pays. RÉSULTATS: Les expériences et les perspectives des membres d'équipes multidisciplinaires du Royaume-Uni et du Ghana, qui ont mis en œuvre ces pratiques dans la première unité d'AVC du de l'hôpital universitaire Korle Bu, à Accra, avec une discussion transparente des succès et des défis rencontrés tout au long du développement du service, sont présentées. Le travail de la PCT a amélioré les résultats pour les patients et les familles qui utilisent les services, notamment en encourageant un meilleur partage du traitement, l'organisation et la complaisance. Davantage de services de réadaptation après un AVC sont fournis plus qu'auparavant, y compris une meilleure éducation à l'autogestion et de meilleurs soins de prévention secondaire. CONCLUSION: Nous espérons que cet article constituera un modèle inspirant pour d'autres personnes travaillant à la prise en charge d'AVC dans des contextes à faibles ressources en Afrique et dans le monde. Mots clés: Unité de expériences, multidisciplinaire, Ghana, partenariat.

Renal status of children with sickle cell disease in Accra, Ghana.

INTRODUCTION: In West Africa, the prevalence of sickle cell disease (SCD) is 2%. The disease adversely affects growth, development and organ function including the kidneys. There is however a dearth of information about the renal status of SCD children in Ghana. OBJECTIVES: To assess the renal status of children with SCD in steady state. DESIGN: A cross-sectional case-control study. SETTING: Paediatric Sickle Cell Clinic, Korle Bu Teaching Hospital, Accra. PARTICIPANTS: Cases-357 SCD cases and 70 of their HbAA siblings as controls. METHODS: Documentation of their socio-demographic data, clinical data and dipstick urinalysis findings, and renal ultrasonography on selected participants. RESULTS: The mean [SD] age was 7.18 [3.15]yrs for cases and 5.16[3.28]yrs for controls. The genotypes were Hb SS (76.7%), Hb SC (21.8 %), and Hb Sßthal (1.4%). Urinalysis showed leucocyturia in 12.6% versus 5.7% (χ2=62.5 and the p=0.000)), isolated proteinuria in 2.8% versus 1.43% (χ2=10.01 and p=0.001) haematuria in 2.6% versus 0% (χ2=9.233, p=0.002) and nitrites in 2.2% versus 1.4% (χ2=16.3,p=0.02) of cases and controls respectively. The youngest SCD case with proteinuria was 2 yrs. old. Proteinuria prevalence increased with age, , occurring in 5.7% of cases aged 9-11yrs. and 20.6% of cases aged 12 yrs. Two-thirds of the proteinuria cases were aged 9-12 yrs., of whom 50% were aged 12 yrs. Renal ultrasound findings were normal in all those examined. CONCLUSION: Urinary abnormalities suggesting nephropathy occur early in SCD patients in Ghana. Routine dipstick screening at clinic visits countrywide would help early detection and prompt intervention to limit renal impairment.

Nutritional status of children with sickle cell disease at Korle Bu Teaching Hospital, Accra, Ghana.

BACKGROUND: Sickle cell disease (SCD) with its attendant increased energy requirements has an adverse effect on growth. Good nutrition is essential for normal childhood growth and development. Differences in growth between children living within the same SEC's are likely to be due to the effects of the sickle cell disease. OBJECTIVE: To determine the relationship between SCD and nutritional status in children. METHODS: This cross-sectional study, conducted at the Paediatric Sickle Cell Clinic of the Korle Bu Teaching Hospital, recruited 427 children aged 1-12 years: 357 SCD patients (cases) and 70 of their siblings with Hb AA (controls), over a four-month period. Their socio-demographic data, weight and height/length were documented, and the weight-for-age (WAZ) and height/length-for-age (HAZ), weight-for-height/length (WHZ) scores calculated as indices of nutritional status. RESULTS: The mean (SD) age of SCD participants was 7.18 (3.15) years and of controls was 5.13 (3.28) years, (p=0.8). The prevalence of malnutrition was 61.3% among SCD subjects and 28.6% among controls, (p<0.001). The WAZ (underweight) and HAZ (stunting) scores were significantly more common among SCD children than controls, but the difference in the rates of wasting (WHZ) was not significant (p=0.3). CONCLUSION: Ghanaian SCD children are more underweight and stunted than their Hb AA counterparts living under similar socio-economic conditions. Better education of families about the nutritional needs of SCD children in our community is needed.