Deciphering the contextual barriers to mainstreaming the implementation of stroke thrombolysis in a Ghanaian hospital: Findings from the activate mixed-methods study.

BACKGROUND: Each year, stroke-related death and disability claim over 143 million years of healthy life globally. Despite accounting for much of the global stroke burden, acute stroke care in Low-and-Middle-Income Countries remains suboptimal. Thrombolysis, an effective treatment option for stroke, is only received by a minority of stroke patients in these settings. AIM: To determine the context-specific barriers and facilitators for the implementation of mainstream stroke thrombolysis in a Ghanaian hospital. METHODS: We employed a mixed-methods approach involving key stakeholders (recipients, providers, and leaders) in the acute stroke care continuum. Surveys were administered to acute stroke patients, and in-depth key informant interviews were conducted with experts in stroke care, including a neurologist, medical director, neurology residents, a stroke nurse, emergency physicians, a radiologist, and a pharmacist. The data collected from these interviews were transcribed and analysed using content analysis with the CFIR (Consolidated Framework for Implementation Research) model as a guiding template. Two independent coders were involved in the analysis process to ensure reliability and accuracy. RESULTS: The stroke thrombolysis rate over a 6-month period was 0.83% (2 out of 242), with an average door-to-needle time among thrombolyzed patients being 2 hours, 37 minutes. Only 12.8% of patients (31 out of 242) presented within 4.5 hours of stroke symptom onset. The most significant obstacle to the implementation of acute stroke thrombolysis was related to the characteristics of the individuals involved, notably delays in presenting to the hospital among stroke patients due to a lack of knowledge about stroke symptoms and cultural beliefs. Additionally, a significant bottleneck that contributed to the discrepancy between the number of patients who presented within the 4.5-6 hour window and the number of patients who actually received thrombolysis was the inability to pay for the cost of thrombolytic agents. This was followed by challenges in the implementation processes. CONCLUSIONS: Addressing challenges related to stroke awareness, and financial constraints via multi-level stakeholder engagement, and enactment of stroke protocols are crucial steps in ensuring a successful implementation of a stroke thrombolysis program in a resource-limited setting.

Prevalence of Typhoid and Paratyphoid Fever in the Hohoe Municipality of the Volta Region, Ghana: A Five-Year Retrospective Trend Analysis.

Background: Typhoid and paratyphoid fever remain a global public health burden, yet annual estimates of prevalence vary. Estimates have ranged between 9.9 and 24.2 million cases annually. Similar differences in estimates are seen within countries but point to a serious health challenge. In Ghana, for instance, typhoid fever has been ranked among the top twenty causes of outpatient morbidity and constituted 1.2%, 1.7% and 1.3% of hospital admissions in 2017, 2016 and 2015 respectively. Objective: The objective of the study was to determine the prevalence of Salmonella Typhi and Salmonella Paratyphi in the Hohoe Municipality. Methods: Data on all reported cases of typhoid fever in the Hohoe municipality as entered into the District Health Information Management System 2 (DHIMS 2) database between January 2012 and December 2016 were extracted. A time-trend analysis was conducted to establish the relationship between typhoid fever prevalence and factors such as age, gender, and season. Stata was used to analyse data and to measure rates, associations, and their significance. Findings: The results showed that a total of 6282 individuals suffered from typhoid fever during the five-year period. Of these numbers, 2080 (33.1%) were males, and 4202 (66.9%) were females, representing a P-value 0.0222, and 95% CI. The 25-29 age group were the most affected. High prevalence was observed during the wet months, although cases occurred throughout the year. Trend analysis showed growing cases of typhoid over the period. Prevalence for the various years were found as follows: 2012 - 148 per 100,000, 2013 - 135 per 100,000, 2014 - 396 per 100,000 and in 2015 - 943 per 100,000. Conclusions: Typhoid fever remains and continues to be a major public health challenge in the municipality. This calls for health authorities and service providers to educate the public about the disease if the challenge is to be addressed.