Pharmacotherapy for Infertility in Ghana: A Prospective Study on Prescription Patterns and Treatment Outcomes among Women undergoing Fertility Treatment.

Background: Pharmacotherapy remains a first-line and major treatment option for couples struggling with infertility, especially in sub-Saharan Africa, where other expensive alternatives are rarely available. Despite the reliance on pharmacotherapy for treating infertility in the subregion, especially for those diagnosed with unexplained infertility, little is known about the actual influence of drug therapies on conception. Objectives: The study aimed to prospectively assess the prescription patterns and outcomes of pharmacotherapy for women undergoing fertility treatment in Ghana. Methods: This prospective cohort study involved 482 infertile women presenting for fertility treatment in 4 fertility clinics in the Cape Coast Metropolis of Ghana between March 2019 and February 2021. A simple random sampling technique was used to recruit subjects for the study. The women were followed up for 12 months to assess the outcome of drug therapy on conception. Data analysis was done using Stata version 14. Logistic regression was used to assess the association between trends with dichotomous outcomes. Results: The study identified that approximately 45.2% of the patients received monotherapy, whereas 24.1% received a combination of 2 drugs. Patients treated with a combination of 3 drugs were more likely to conceive (adjusted odds ratio = 4.10; 95% CI, 1.29-13.02; P = 0.02) than those without treatment. Conclusions: Patients treated with combination therapies had higher chances of conception than those without medications. However, a combination of nutritional and herbal therapies were associated with improved outcomes compared with conventional and nutritional supplements. The study's outcome could provide fertility specialists and stakeholders insight into choosing appropriate treatment options for prospective couples seeking fertility care. Consequently, fertility patients can access specific treatment options to meet their desired needs.

A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country.

INTRODUCTION: Obstetric intensive care unit admission (ICU) suggests severe morbidity. However, there is no available data on the subject in Ghana. This retrospective review was conducted to determine the indications for obstetric ICU admission, their outcomes and factors influencing these outcomes to aid continuous quality improvement in obstetric care. METHODS: This was a retrospective review conducted in a tertiary hospital in Ghana. Data on participant characteristics including age and whether participant was intubated were collected from patient records for all obstetric ICU admissions from 1st January 2010 to 31st December 2019. Descriptive statistics were presented as frequencies, proportions and charts. Hazard ratios were generated for relations between obstetric ICU admission outcome and participant characteristics. A p-value <0.05 was deemed statistically significant. RESULTS: There were 443 obstetric ICU admissions over the review period making up 25.7% of all ICU admissions. The commonest indications for obstetric ICU admissions were hypertensive disorders of pregnancy (70.4%, n = 312/443), hemorrhage (14.4%, n = 64/443) and sepsis (9.3%, n = 41/443). The case fatality rates for hypertension, hemorrhage, and sepsis were 17.6%, 37.5%, and 63.4% respectively. The obstetric ICU mortality rate was 26% (115/443) over the review period. Age ≥25 years and a need for mechanical ventilation carried increased mortality risks following ICU admission while surgery in the index pregnancy was associated with a reduced risk of death. CONCLUSION: Hypertension, haemorrhage and sepsis are the leading indications for obstetric ICU admissions. Thus, preeclampsia screening and prevention, as well as intensifying antenatal education on the danger signs of pregnancy can minimize obstetric complications. The establishment of an obstetric HDU in CCTH and the strengthening of communication between specialists and the healthcare providers in the lower facilities, are also essential for improved pregnancy outcomes. Further studies are needed to better appreciate the wider issues underlying obstetric ICU admission outcomes. PLAIN LANGUAGE SUMMARY: This was a review of the reasons for admitting severely-ill pregnant women and women who had delivered within the past 42 days to the intensive care unit (ICU), the admission outcomes and risk factors associated with ICU mortality in a tertiary hospital in a low-resource country. High blood pressure and its complications, bleeding and severe infections were observed as the three most significant reasons for ICU admissions in decreasing order of significance. Pre-existing medical conditions and those arising as a result of, or aggravated by pregnancy; obstructed labour and post-operative monitoring were the other reasons for ICU admission over the study period. Overall, 26% of the admitted patients died at the ICU and maternal age of at least 25 years and the need for intubation were identified as risk factors for ICU deaths. Attention must be paid to high blood pressure during pregnancy.

Ellucidating the incidence and the prevalence of Schistosomiasis spp infection in riparian communities of the Bui dam.

The flow rate of rivers are affected when modifications are made for the benefit of mankind. Some man-made alterations carried out include dam construction. The aim of this study was to investigate the health impact of the Bui dam with respect to the prevalence and awareness level of schistosomiasis in a typical damming environment. The study was conducted in 4 riparian communities within the dam catchment area. A cross-sectional study design was employed to interview 350 individuals. Urine and stool samples were also collected from 386 participants. Results of the study showed that, knowledge of schistosomiasis was significantly greater in close communities (99.47%) than their far counterparts (50.29%) (p > 0.001; OR = 172). Schistosomiasis infection rate in the close communities (32.57%) were significantly greater in far communities (7.23%; p ≤ 0.0001). The overall prevalence of 82 (21.1%) was recorded for Schistosoma haematobium and 64 (16.1%) for Schistosoma mansoni. A significantly high prevalence of S. haematobium (43.3%) was found in the age group 15-24 with no prevalence reported for age group 5-9 (Close communities) (p = 0.012). When the same age group was further examined for S. mansonii, group 5-9 recorded a prevalence of 0% with age group 10-14 showing a high prevalence of 26.1% (p = 0.047). From the study, it was concluded that, though awareness level of Schistosomiasis knowledge on the cause, mode of transmission and symptoms were high, they were ignorant on personal preventive strategies. In addition, the study also revealed that, S. haematobium was more prevalent among inhabitants living closer to the Bui dam with children less than 14 years of age being the worst affected.