Paediatric resuscitation for nurses working in Ghana: an educational intervention.

BACKGROUND: Deficiencies in the paediatric emergency systems of developing countries may contribute to avoidable paediatric mortality. Studies suggest that nurses and doctors may not be educationally prepared to provide immediate paediatric resuscitative care to acutely ill children. The purpose of this study was to determine if a 1-day World Health Organization (WHO) Emergency Triage and Assessment Treatment (ETAT) Program in paediatric resuscitation would increase Ghanaian nurses' knowledge and self-efficacy of paediatric resuscitation. METHODS: A pre-experimental, one-group, pre-test, post-test design was used to assess differences in the nurses' knowledge of paediatric resuscitation, and their perceived self-efficacy of paediatric resuscitation after completing a 1-day educational intervention in paediatric resuscitation. Forty-one nurses from a public teaching hospital in Ghana were recruited and participated in the study. RESULTS: Using a paired samples t-test, there was a statistically significant increase in the nurses' perceived self-efficacy of paediatric resuscitation in general (P < 0.000), perceived self-efficacy of bag and mask ventilation (P < 0.000), and knowledge of paediatric resuscitation (P < 0.000). CONCLUSIONS: Findings from this study suggest that a 1-day WHO ETAT Program may increase self-efficacy of paediatric resuscitation and knowledge of paediatric resuscitation. CLINICAL RELEVANCE: Policy makers in Ghana need to consider implementing education programmes in paediatric resuscitation for nurses as part of a comprehensive strategy to improve emergency systems and address preventable and avoidable infant and child mortality.

Factors affecting the survival of the "at risk" newborn at Korle Bu Teaching Hospital, Accra, Ghana.

High risk pregnancies continue to be associated with high perinatal mortality and morbidity in developing countries. Korle Bu Teaching Hospital is no exception with a perinatal mortality rate of 98.7/1000 births. Multiple factors resulting in this include the high risk nature of the pregnancies resulting in increased incidence of premature deliveries and asphyxiated babies, the delay in transfer of the sick neonate as well as the inadequate mode of transfer. The type of delivery other than the spontaneous vaginal route also affects the outcome, though the relationship was not statistically significant. Logistic regression analysis showed that maturity, birthweight and time from birth to admission to NICU were the most significant factors associated with the survival of the neonate. Proper foetal surveillance both in the antenatal period and during labour cannot be over emphasized and the mere presence of a paediatrician at these high risk deliveries may make a difference. Also, increased vigilance in the special care offered will help reduce mortality.

Incidence and management of malaria in two communities of different socio-economic level, in Accra, Ghana.

Two adjacent communities of differing socio-economic levels were selected, in Accra, Ghana, for the study of the home management of malaria. The youngest child in each selected household, each of which had a child aged < 5 years, was recruited for weekly follow-up, following informed consent. Malaria was the most common condition reported by the 'caregivers' (mothers of the subjects and others caring for the subjects) in each community, with 2.0 episodes of clinical malaria/child during the 9-month study. Most (89%) of the caregivers in the better-off community had been educated beyond primary-school level, but 55% of the caregivers in the poorer community had either received no formal education or only primary-school education. This difference was also reflected by the educational facilities provided to the children studied: 52% of the those in the better-off community attended nurseries, kindergartens or creches, compared with 8% of the children investigated in the poorer community. The proportion of caregivers who purchased drugs without prescription or used left-over drugs to treat clinical malaria in the children was higher in the poorer community (82% v. 53%), and a child from the poorer community was less likely to have been taken to a clinic or hospital to be treated for malaria than a child from the better-off community (27% v. 42%). During the follow-up period two children died, one from each community. Treatment of malaria in young children is likely to be less effective in the poorer community, where a lack of economic access to health services was demonstrated.

Pattern of childhood malignancy in Korle Bu Teaching Hospital, Ghana.

Data from the cancer register in the Department of Child Health, Korle Bu Teaching Hospital Accra, Ghana was reviewed in order to document the pattern of malignancies seen in children. Out of a total of 15,200 admissions over a 40 month period there were 254 malignancies diagnosed constituting 1.67% of all admission. Lymphoma was the commonest tumour constituting 67% with Burkitt's Lymphoma being the commonest subtype. This was followed by Retinoblastoma (8.6%), Leukaemia (8.2%) and Wilms tumour (7.8%). This trend is similar to the picture seen in other developing countries in Africa where there is a high incidence of lymphoma and a low incidence of leukaemia, the converse being the case in Europe and North America.

Holt-Oram syndrome in a Ghanaian infant

A female infant with Holt-Oram syndrome of skeletal and cardiovascular anomalies is described

Nutritional rickets in Ghanaian children

Eighteen (18) Ghanaian children with nutritional rickets seen in the Department of Child Health; Korle-Bu Teaching Hospital (KBTH) from 1985-1994 are reported. Their ages ranged from 14 months to 44 months. Their mean age at presentation is 29.4 months. There were eight (8) boys and ten (10) girls. None of these 18 children was receiving the daily recommended allowance (DRA) of Vitamin D. They all had characteristic diagnostic X-ray findings in their wrist and ankle bones. The product of their serum calcium (Ca2+) and serum inorganic phosphate (Pi) that is (Ca2+ x Pi) was less than 30 in all of them and all had markedly raised serum alkaline phosphatase levels