Equipment downtime in the radiology departments of three teaching hospitals in Ghana.

INTRODUCTION: Radiology equipment requires routine maintenance to prevent equipment breakdown. Equipment breakdown can lead to adverse patient outcomes and lost revenue to hospitals. In Ghana, there is a mismatch between the available radiology equipment and requests which may result in frequent breakdown. Several studies have been conducted to investigate equipment downtime across radiology departments. However, there is none for Ghana. This study therefore investigated the downtimes of radiology equipment across three hospitals in Ghana. METHOD: The study covered the period January-December 2020. An inventory sheet was used to collect data on equipment specifications, frequency of breakdown, downtimes, average daily patient throughput, the average cost of common examinations, the availability of post-installation training and maintenance contracts/agreements. RESULTS: The study reviewed 32 items of radiology equipment. Radiology equipment across the hospitals broke down frequently and downtimes were very high. Radiographers/radiologists across the hospitals were provided with poor/inadequate post-installation training, and maintenance contracts/agreements were unavailable. The radiology equipment downtimes resulted in significant lost revenue of GH₵ 16,279,803 (US$ 1,968,537). CONCLUSION: Radiology equipment across the hospitals broke down frequently and downtimes were lengthy leading to significant lost revenue for the hospitals. Post-installation trainings were poor/inadequate, spanning a few hours. Also, maintenance contracts/agreements were non-existent across the three hospitals. A nationwide study is needed to determine equipment downtimes and lost revenue across all radiology departments in Ghanaian hospitals, to better inform policy-making. IMPLICATIONS FOR PRACTICE: This study may help hospital managers and other stakeholders involved in policy formulation and strategic planning, put measures in place to minimise radiology equipment breakdown in Ghana. The study may also help optimise radiology services and enable radiology departments to render uninterrupted clinical services to patients in Ghana.

Mammography Diagnostic Reference Levels (DRLs) in Ghana.

INTRODUCTION: Diagnostic Reference Levels (DRLs) are essential for optimisation in mammography. A local DRL for screen-film mammography has been established in Ghana but none exists for the digital mammography systems. Furthermore, technological advancement is phasing out the use of screen-film mammography and replacing it with digital mammography systems. This study aims to establish the local DRLs used in digital mammography across three institutions in Ghana to guide mammography practice. METHODS: Average glandular dose (AGD), compressed breast thickness (CBT), age of patients, entrance surface exposure (ESE), kVp, and mAs were retrospectively extracted from three digital mammography systems. The 75th and 95th percentile values were obtained for the AGD of each mammography projection and at CBT of 60 ± 5 mm. The correlation between the AGD and CBT, kVp, mAs, and ESE were investigated. RESULTS: The 75th percentile for the AGD at CBT of 60 ± 5 mm for Centres 1, 2, 3, and all centres were 2.3, 1.8, 2.1, and 2.0 mGy respectively. The DRLs obtained were comparably higher than international studies except those of the United Kingdom. The AGD showed a strong positive correlation with the CBT, kVp, mAs, and ESE. There was variability in the AGD applied across the three centres for the craniocaudal (CC) and mediolateral oblique (MLO) projections. The mean AGD, mAs, and ESE for all the three centres and per centre recorded were higher than previous studies, but the mean kVp and CBT were lower than previous studies. CONCLUSION: The higher DRLs estimated in this preliminary study indicates that there is a need for dose optimisation in digital mammography practice in Ghana to improve radiation protection. IMPLICATIONS FOR PRACTICE: The findings will guide the process of optimisation and limit the variations in the radiation dose during mammography practice.

An audit of MRI machines and services in Ghana.

INTRODUCTION: Magnetic resonance imaging (MRI) is a useful medical imaging modality for the diagnosis and management of patients. However, the huge costs associated with establishing and operating MRI means it may not be readily accessible and affordable for hospitals in developing countries. Little is currently known about the availability of MRI machines in Ghana. Such information may assist in informing future health service development within the country. This study reports on the findings and implications of an audit of MRI machines in Ghana. METHODS: A quantitative descriptive cross-sectional survey was conducted involving all MRI machines in Ghana. Data obtained was analyzed using the Statistical Package for Social Sciences (SPSS) version 23. Independent-samples t-test was conducted to compare the mean cost of MRI examinations between privately-owned and state-owned MRI machines in Ghana. RESULTS: 18 MRI machines, spread across five regions, are available in Ghana. 15 (83.3%) of the MRI machines are located in the Greater-Accra and Ashanti regions. MRI examinations are more expensive in privately-owned machines compared to state-owned machines (p < 0.05). Four state-owned machines have been non-operational for between three-six years resulting in a revenue loss of GHC 36 million (US$7.2 million). CONCLUSION: There are few MRI machines in Ghana and the majority are concentrated in the two largest regions. The increase in MRI machines over the past decade can be attributed to private investment in the sector. IMPLICATIONS FOR PRACTICE: This study will inform the Ghana Health Service and other healthcare policy makers in Ghana to increase investment in MRI machines to ensure equitable regional distribution of MRI machines so that patients across Ghana would have access to the diagnostic benefits associated with MRI machines.

Compression force variability in mammography in Ghana - A baseline study.

INTRODUCTION: Breast compression during mammographic examinations improves image quality and patient management. Several studies have been conducted to assess compression force variability among practitioners in order to establish compression guidelines. However, no such study has been conducted in Ghana. This study aims to investigate the compression force variability in mammography in Ghana. METHODS: This retrospective study used data gathered from 1071 screening and diagnostic mammography patients from January, 2018-December, 2019. Data were gathered by seven radiographers at three centers. Compression force, breast thickness and practitioners' years of work experience were recorded. Compression force variability among practitioners and the correlation between compression force and breast thickness were investigated. RESULTS: Mean compression force values recorded for craniocaudal (CC) (17.2 daN) and mediolateral oblique (MLO) (18.2 daN), were within the recommended values used by western countries. Most of the mammograms performed - 80% - were within the National Health Service Breast Screening Programme (NHSBSP) range. However, 65% were above the Norwegian Breast Cancer Screening Programme (NBCSP) range. Compression forces varied significantly (p = 0.0001) among practitioners. Compression forces increased significantly (p = 0.0001) with the years of work experience. A weak negative correlation (r = -0.144) and a weak positive correlation (r = 0.142) were established between compression force and breast thickness for CC and MLO projections respectively. CONCLUSION: This initial study confirmed that although wide variations in compression force exist among practitioners in Ghana, most practitioners used compression forces broadly within the range set by the NHSBSP. As no national guidelines for compression force currently exist in Ghana, provision of these may help to reduce the range of variations recorded. IMPLICATIONS FOR PRACTICE: Confirmation of variations in compression will guide future practice to minimize image quality disparities and improve quality of care.

Possible healthcare-associated transmission as a cause of secondary infection and population structure of Staphylococcus aureus isolates from two wound treatment centres in Ghana.

We have previously shown that secondary infections of Buruli ulcer wounds were frequently caused by Staphylococcus aureus. To gain understanding into possible routes of secondary infection, we characterized S. aureus isolates from patient lesions and surrounding environments across two Ghanaian health centres. One hundred and one S. aureus isolates were isolated from wounds (n = 93, 92.1%) and the hospital environment (n = 8, 7.9%) and characterized by the spa gene, mecA and the Panton-Valentine leucocidin toxin followed by spa sequencing and whole genome sequencing of a subset of 49 isolates. Spa typing and sequencing of the spa gene from 91 isolates identified 29 different spa types with t355 (ST152), t186 (ST88), and t346 dominating. Although many distinct strains were isolated from both health centres, genotype clustering was identified within centres. In addition, we identified a cluster consisting of isolates from a healthcare worker, patients dressed that same day and forceps used for dressing, pointing to possible healthcare-associated transmission. These clusters were confirmed by phylogenomic analysis. Twenty-four (22.8%) isolates were identified as methicillin-resistant S. aureus and lukFS genes encoding Panton-Valentine leucocidin were identified in 67 (63.8%) of the isolates. Phenotype screening showed widespread resistance to tetracycline, erythromycin, rifampicin, amikacin and streptomycin. Genomics confirmed the widespread presence of antibiotic resistance genes to ß-lactams, chloramphenicol, trimethoprim, quinolone, streptomycin and tetracycline. Our findings indicate that the healthcare environment probably contributes to the superinfection of Buruli ulcer wounds and calls for improved training in wound management and infection control techniques.

Detection and characterization of drug-resistant conferring genes in Mycobacterium tuberculosis complex strains: A prospective study in two distant regions of Ghana.

We spoligotyped and screened 1490 clinical Mycobacterium tuberculosis complex strains from Northern and Greater Accra regions of Ghana against INH and RIF using the microplate alamar blue phenotypic assay. Specific drug resistance associated genetic elements of drug resistant strains were analyzed for mutations. A total of 111 (7.5%), 10 (0.7%) and 40 (2.6%) were mono-resistant to INH, RIF, and MDR, respectively. We found the Ghana spoligotype to be associated with drug resistance (INH: 22.1%; p = 0.0000, RIF: 6.2%; p = 0.0103, MDR: 4.6%; p = 0.0240) as compared to the Cameroon spoligotype (INH: 6.7%, RIF: 2.4%, MDR: 1.6%). The propensity for an isolate to harbour katG S315T mutation was higher in M. tuberculosis (75.8%) than Mycobacterium africanum (51.7%) (p = 0.0000) whereas the opposite was true for inhApro mutations; MAF (48.3%) compared to MTBSS (26.7%) (p = 0.0419). We identified possible novel compensatory INH resistance mutations in inhA (G204D) and ahpCpro (-88G/A and -142G/A) and a novel ndh mutation K32R. We detected two possible rpoC mutations (G332R and V483G), which occurred independently with rpoB S450L, respectively. The study provides the first evidence that associate the Ghana spoligotype with DR-TB and calls for further genome analyses for proper classification of this spoligotype and to explore for fitness implications and mechanisms underlying this observation.

Culture and sensitivity of mycobacterial isolates from cases of pulmonary tuberculosis classified as treatment failures in a teaching hospital.

BACKGROUND: The level of drug resistance in mycobacterial isolates from previously treated cases in Ghana is not known although drug resistant tuberculosis threatens efforts to control the disease. OBJECTIVE: To identify and determine the susceptibility of mycobacterial isolates from tuberculosis cases with clinical treatment failure. METHODS: This prospective survey was undertaken at the Chest Clinic of Korle Bu Teaching Hospital in Accra, Ghana. The participants were twenty-eight cases referred to the hospital with clinical treatment failure. Two sputum specimens from each case were stained by Ziehl-Neelsen method, cultured, identified and sensitivity tests performed by the proportion method. RESULTS: Eighteen isolates of mycobacteria were identified from 28 failed treatment cases. Five were atypical mycobacteria. Approximately fifty percent (13/28) of cases had Mycobacterium tuberculosis, 5(18%) had atypical mycobacteria, 7(25%) had pure fungal growth and 3(11% 8) had no growth. Fifteen isolates were resistant to two or more drugs, of which 6 were resistant to all four drugs tested. CONCLUSION: Continuous drug resistance monitoring must be instituted as part of the tuberculosis control programme.