Seroprevalence of Hepatitis B virus infection and associated factors among pregnant women at Korle-Bu Teaching Hospital, Ghana.

INTRODUCTION: Hepatitis B virus infection is a global public health problem. Though, the disease is endemic in sub-Saharan Africa, little is known about its epidemiology among pregnant women in Ghana. This study sought to determine the seroprevalence of Hepatitis B virus infection and associated factors among pregnant women attending antenatal care at Korle-Bu Teaching Hospital; Ghana's largest hospital. METHODS: We conducted a facility-based cross-sectional survey among 232 antenatal attendants. Participants were recruited using systematic random sampling technique and screened with HBsAg Rapid Test. Data was analyzed with the aid of Statistical Package for Social Sciences (SPSS), version 23.0. Results were presented using descriptive statistics, Fisher's Exact test and Logistic Regression analysis. RESULTS: Two hundred and twenty-one (221) of the total sample (n = 232) agreed to participate in this study; representing a response rate of 95%. The mean age of the participants was 31 years and standard deviation of 5.3. The mean gestational period at recruitment was 28 weeks and standard deviation of 6.8. Majority of the participants were married (83.3%), parous (69.6%), educated (91.4%) and employed (90.5%). The prevalence of HBsAg was 7.7%. We found no significant association between socio-demographic characteristics of the participants and HBV infection. CONCLUSION: Seroprevalence of 7.7% indicates moderate endemicity. Socio-demographic characteristics did not influence HBV infection among pregnant women attending antenatal care at Korle-Bu Teaching Hospital. The findings provide empirical evidence that will contribute to knowledge of HBV epidemiology in Ghana.

Feasibility and acceptability of the menstrual cup for non-surgical management of vesicovaginal fistula among women at a health facility in Ghana.

OBJECTIVE: To assess the feasibility of the menstrual cup for short-term management of urinary leakage among women with vesicovaginal fistula (VVF). METHODS: A repeated measures design compared volume of leakage with and without the cup via a 2-hr pad test among women with VVF seeking surgical repair at a health facility in Ghana. Subsequently a gynecological exam was administered to assess safety outcomes, followed by a questionnaire to assess acceptability and perceived efficacy. A paired t-test was used to analyze reduction of leakage in ml, and percent reduction was reported. Study limitations include observer bias while evaluating adverse outcomes and the possibility of social desirability bias during questionnaire administration that might overestimate the effect of the cup and women's acceptability. RESULTS: Of the 32 patients screened, 11 were eligible (100% consent rate). At baseline, mean (±SD) leakage in ml was 63.2 (±49.2) (95% CI: 30.2-96.3) over two hours, while the mean leakage over two hours of use of the cup was 16.8 (±16.5) (95% CI: 5.7-27.9). The mean difference of 46.4 (±52.1) ml with use of the cup (95% CI: 11.4-81.4) was statistically significant (p = 0.02). With the cup, women experienced an average 61.0% (±37.4) (95% CI: 35.9-86.2) leakage reduction, a difference 10/11 users (91.0%) perceived in reduced leakage. One participant, reporting four previous surgical attempts, experienced a 78.7% leakage reduction. Acceptability was high-women could easily insert (8/11), remove (8/11), and comfortably wear (11/11) the cup and most (10/11) would recommend it. No adverse effects attributable to the intervention were observed on exam, although some women perceived difficulties with insertion and removal. Data collection tools were appropriate with slight modification advised. CONCLUSION: A larger trial is warranted for a more robust evaluation of the menstrual cup for management of urinary leakage due to VVF among women who have not yet accessed surgery or for whom surgery was not successful.

Career destinations of University of Ghana Medical School graduates of various year groups.

BACKGROUND: To report on the current career destination of the University of Ghana Medical School (UGMS) qualified doctors in the year groups, 1998, 2000, 2003, 2005 and 2008. DESIGN: Interview of doctors from each year group currently working at the Korle-Bu Teaching Hospital corroborated by phone calls to the doctors. SUBJECTS: All Ghanaian doctors from each graduating year group. MAIN OUTCOME MEASURES: 1. Current location of employment in Ghana or abroad, 2. Gender ratios of the doctors retained in Ghana. RESULTS: Three hundred and seventy-two (372) UGMS doctors consisting of 353 Ghanaians and 19 foreign students graduated over the five year groups. Of the 353 Ghanaians, 113 emigrated, while all but one of the 240 living in Ghana, practice medicine. The retention rate improved from 54.2% in 1998 to 86.3% in 2008. The overall retention rate however is 68.0% while the retention rates for the male and female doctors were 69.3% and 64.6% respectively. Of the 177 doctors practicing in Ghana from the first 4 year-groups (i.e. 1998, 2000, 2003 and 2005,) 139 (i.e. 31, 31, 34 and 43 from the respective year groups) have either completed postgraduate training or are in the residency training programme. Thus 78.5% of these doctors working in Ghana have opted for postgraduate training. CONCLUSION: The establishment of the GCPS and to a lesser extent the introduction of the ADHA before it appear to have slowed down the medical brain drain as more and more doctors avail themselves of the local opportunities. The GCPS therefore needs supporting effectively in order to continue to be a strong incentive for the retention of doctors in Ghana, apart from helping to staff district general hospitals with specialists.

Simple fistulas: diagnosis and management in low-resource settings--a descriptive report.

Obstetric fistulas occur in developing countries because of the scarcity or complete absence of obstetric services. The magnitude of the problem is unknown but thought to be sizeable. This article describes a basic approach to the care of women with fistulas in a low-resource rural hospital in northern Ghana, where the results were similar to those obtained at better-equipped centers. The facility includes an outpatient clinic for history taking and clinical examinations, and a laboratory for hemoglobin concentration assessment, sickling test, blood grouping, and cross-matching when necessary. Anesthesia consists of a spinal anesthesia given by the surgeon and monitored by a nurse while the surgeon scrubs up before repairing the fistula. Surgery is performed with the patient in exaggerated lithotomy position, and a bed sheet used as a sling prevents her from falling backwards. The patients are kept at the hospital for 14 days postoperatively for continuous bladder drainage.

Vaginal flora of first time urban family planning attendants in Accra, Ghana.

OBJECTIVE: To determine the vaginal flora of first time urban Family Planning clients at Korle-Bu Teaching Hospital and to assess its implications for the contraceptive choices made. DESIGN: A cross sectional study. METHODS: A standardized questionnaire surveying the sociodemographic characteristics and the choice of Family Planning method was administered to 100 clients at the Korle Bu Teaching Hospital between March and September 2001. High vaginal and endocervical swabs were also taken during the inspection of the vagina and cervix using a sterile bivalve speculum. The specimens were transported in Amies transport medium to the Microbiology laboratory for processing. RESULTS: The age range of the clients was 19-48 years with a modal age of 28 years. Ninety-six percent of them were married while 86% lived in urban slums. Sixty-three percent were sure of their last menstrual period. Potential pathogens were isolated from culture in 56% of the clients. Organisms causing bacterial vaginosis were the most prevalent in their genital tract. The intrauterine contraceptive device (IUCD) was the most common Family Planning method chosen, followed by the Norplant and the Depo-Provera injections. Potential pathogens were isolated from culture in 50% of those who chose the IUCD. CONCLUSION: Potential pathogens were isolated from culture in 56% of these first-time clients and organisms causing bacterial vaginosis were the most prevalent in the genital tract. It is suggested that Family Planning clients who screened positive for potential pathogens and opt for the IUCD should be considered for prophylactic antibiotics at insertion.

Potential pathogens in the lower genital tract at manual vacuum aspiration for incomplete abortion in Korle Bu Teaching Hospital, Ghana.

OBJECTIVES: To determine the carriage rates of potential pathogens in the lower genital tract and factors associated with colonization among women with incomplete abortion. DESIGN: A cross-sectional study. SETTING: The Manual Vacuum Aspiration room of the Korle-Bu Teaching Hospital, Accra, Ghana. SUBJECTS: Two hundred women undergoing Manual Vacuum Aspiration at the Korle-Bu Teaching Hospital. METHODS: Eligible patients were screened for the presence of organisms in the lower genital tract by microscopy and culture of high vaginal and endocervical swabs. RESULTS: Nearly two-thirds of the patients (64.2%) had potential pathogens in the lower genital tract. Bacterial vaginosis alone was present in 47% and a combination of bacterial vaginosis and Candida albicans was present in 17.2%. Residence in an urban slum showed a significant association with the presence of potential pathogens (Odds ratio 2.6; p-value 0.04). CONCLUSION: Organisms responsible for bacterial vaginosis were the most frequently isolated potential pathogens in the cervical canal of patients with incomplete abortion at the Korle-Bu Teaching Hospital. Management of these patients should therefore include antibiotic prophylaxis against bacterial vaginosis.

Hepatitis C virus seroprevalence among mothers delivering at the Korle-Bu Teaching Hospital, Ghana.

OBJECTIVES: To determine the Hepatitis C virus (HCV) carrier rate among mothers, and to determine if selected sociodemographic characteristics are associated with HCV seropositivity. DESIGN: Maternity Unit of the Korle-Bu Teaching Hospital (KBTH). SETTING: A cross-sectional serological survey of mothers delivering at the KBTH. METHODS: Women who had singleton live births and fresh stillbirths in the two labour wards of the KBTH were randomly selected for screening from 1st March to 30th September, 2001. A structured pre-tested questionnaire was used by trained research assistants to collect and record data on medical and sociodemographic characteristics of the subjects. Maternal blood samples were taken and stored at the Public Health Reference Laboratory. The second generation Murex diagnostics ELISA kit was used to test the maternal sera for HCV antibodies. RESULTS: Sixteen (2.5%, 95% CI, 1.5-4.1%) of the 638 subjects were HCV seropositive. None of the medical and sociodemographic characteristics examined showed any association with HCV seropositivity. No subject or her sexual partner was a drug injector. CONCLUSION: The carrier rate of 2.5% of HCV infection found in this study is near the top end of the range found in unselected pregnant populations from other parts of the world. Knowing the prevalence rate of HCV infection in our pregnant population will help policy-makers on the cost effectiveness of available intervention measures.

Socio-demographic and reproductive characteristics of mothers delivered at the Korle-Bu Teaching Hospital, Ghana.

OBJECTIVES: To measure selected socio-demographic and reproductive history characteristics of parturients at the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana, and to compute the risk load. DESIGN: A non-randomised cross-sectional survey. SETTING: Korle-Bu Teaching Hospital, Accra, Ghana. SUBJECTS: Korle-Bu Teaching Hospital, a tertiary institution delivers about 11,000 women annually. From 1st November to 12th December 1994, 961 parturients were studied out of 978 delivered during the study period. Seventeen questionnaires were excluded from analysis because of errors and omissions that could not be corrected before the parturients' discharge from hospital. METHODS: The data sources were the patients' antenatal and delivery records, and a structured interviewer-administered questionnaire. RESULTS: More than three percent of the subjects were less than 18 years, and 10.8% were over 35 years of age. Before the index delivery, 5.8% were grand multiparae. Eighteen per cent had never been to school. Seventeen per cent of parous subjects had experienced a perinatal death. The non-educated had significantly more births. The mean birth interval was less than two years in 26.4%. Fifty percent of those who had been previously pregnant had a history of at least one induced-abortion. Only 21.0% of the 961 subjects had ever used a family planning method. The risk load was 53.0%. CONCLUSION: Analysis of the historical factors of parturients surveyed at the KBTH showed a high risk load related mainly to lack of education. Formal education of the female child and family health education of our women are recommended to reduce the high past abortion rate and risk load. Additionally, postpartum tubal ligation for those who have completed their families will further reduce the risk load.

Birthweight distribution at Korle-Bu Teaching Hospital, Ghana.

OBJECTIVES: To determine the birthweight distribution of singleton births at the Korle-Bu Teaching Hospital and to determine if selected socio-demographic and reproductive characteristics that are known to be associated with birthweight would show the association in our setting. DESIGN: A non-randomised cross-sectional survey of all deliveries within the study period. SETTING: Korle-Bu Teaching Hospital, a tertiary institution, delivering about 11,000 women a year. STUDY POPULATION: From 1st November to 12th December 1994, 866 singleton normally formed livebirths and fresh stillbirths were sequentially enrolled. DATA SOURCES: Data sources were the antenatal and delivery records of the subjects and an interviewer-administered questionnaire. RESULTS: The mean birthweight for the total sample was 3070 g +/- 616 g. One hundred and fifteen (13.3%) babies were low birthweight. The mean birthweight for those with reliable dates and born at term was 3262 g +/- 488.8 g. Multiple logistic regression analysis showed lack of antenatal malaria chemoprophylaxis and a history of previous low birthweight to be significantly associated with low birthweight. CONCLUSION: Although the mean birthweight of Korle-Bu babies was lower than those of USA and UK babies, it was comparable with those from other developing countries. Antenatal malaria chemoprophylaxis is a practical intervention that can produce an increase in mean birthweight and reduce the risk of low birthweight in our population.

Antenatal haemoglobin profile at Korle-Bu Teaching Hospital.

OBJECTIVE: To determine the frequency of haemoglobin (Hb) measurement and some socio-demographic characteristics in women attending antenatal clinic. DESIGN: Prospective cross-sectional study. SETTING: Antenatal clinic, Korle-Bu Teaching Hospital. SUBJECTS: Nine hundred and thirty two pregnant mothers attending antenatal clinic at the hospital. Patients with sickle cell disease, thalassaemia, sickling test positive or unknown sickling status were excluded. MAIN OUTCOME MEASURES: Proportion of patients whose records showed various frequencies of Hb determinations and the proportion of those with anaemia at 26 weeks and 34 weeks gestations. RESULTS: One hundred and seventy five (18.8%) patients did not have antenatal Hb measurement; 248 (26.6%) had two, and 251 (26.9%) had more than two measurements. The mean of booking Hb was 10.6 + 1.53 gm/dl. Of the 458 subjects with reliable dates, 293 had their booking Hb measurement at < 26 weeks. For this sub-group the mean was 10.8 +/- 1.43 gm/dl. (22.5% were < 10 gm/dl). For 272 subjects with reliable dates whose last Hb measurement was at > 34 weeks, the mean last Hb was 11.0 +/- 1.37 gm/dl. (last Hb was < 10 gm/dl in 19.1%). Nulliparity and booking antenatal weight < 64.0 kg were significantly associated with Hb < 10 gm/dl at some time during pregnancy. CONCLUSION: Anaemia in pregnancy is common in this urban population. Combined effects of iron-folate supplementation, malaria chemoprophylaxis as well as early booking and a waiver of antenatal care user fees for needy patients are suggested as remedial measures.

Complications of induced abortions and their preventions in Ghana.

Two hundred and twelve patients were admitted because of complications of induced abortions. 58% of those abortions had been performed outside designated health institutions despite the liberalisation of the abortion law in Ghana about ten years ago. Ghanaian society still seems to perceive abortions as illegal or unethical and hence to be procured clandestinely. The overall mortality rate was 2.4% whilst the case fatality rate for septic abortions was over three times this rate. The surgical intervention rate was high at about 94%. Over 50% of laparotomies were for ectopic pregnancy. Suspicion of ectopic pregnancy must always be borne in mind if undue delay in their management is to be avoided in all cases of complicated induced abortions especially when the patients have risk factors. None of the patients used a modern contraceptive method over the three months preceding the index pregnancy and post-arbortal contraceptive counselling was infrequent. Effective and widespread contraceptive use and continuing education of doctors remain pivotal if the incidence of abortions and their complications are to be reduced.

PIP: Although Ghana's abortion law was liberalized 10 years ago, widespread cultural and religious disapproval of pregnancy termination persists and unhygienic, clandestine induced abortions are common. The records were reviewed of 212 women admitted to Korle-Bu Hospital in a 12-month period during 1993-94 with complications from induced abortion. 85 (40.5%) of these women were 15-20 years of age and none had used a modern contraceptive method in the 3 months preceding the pregnancy. Over 95% of women were self-referred to the hospital at a time interval ranging from the day of the procedure to 2 months after abortion. 58% of pregnancy terminations were performed outside legally designated health institutions and 30% were self-induced. Sepsis was present in 15.7% of cases from health institutions and 21.5% of those from unregistered premises or self-induced. Of the 5 deaths in this series (2.4% mortality rate), 2 involved self-induction. The case fatality rate for septic abortion was 7.5%. 85.7% of the patients required surgical intervention and 17.6% received blood transfusions. Over 10% of the women required laparotomy, generally for ectopic pregnancies mistaken for intrauterine pregnancies. 56% of the women spent 1-3 days in the hospital, while 24.3% required 7 or more days. Postabortal counseling and contraception had been provided in only 13.5% of non-self-induced abortions. Recommended are educational campaigns on pregnancy prevention, easy access to reliable contraception, training and continuing education on abortion and its complications for physicians, regular inspection and monitoring of registered clinics to ensure hygienic conditions, and public debate on the amended abortion law.

Management of difficult intra operative bleeding by abdominal packing: report of four cases.

Difficult perioperative bleeding in four obstetric and gynaecology patients was managed with temporising abdominal packs left in place with abdominal closure for 48-72 hours in order to avoid deaths on the operating table when blood loss could not be adequately replaced and hemostasis could not be secured. Abdominal re-opening to remove the packs was undertaken. Three of the patients were eventually discharged home after satisfactory recovery. The fourth died of sepsis three weeks after the fourth re-operation and bilateral internal iliac artery ligation. Abdominal packing thus has a place in the management and salvage of patients with difficult obstetric and gynaecologic perioperative bleeding.

Perinatal and maternal mortality associated with retained second twins.

OBJECTIVES: The aim of this study of retained second twins admitted to Korle-Bu Hospital between 1988 and 1993 was to identify the factors contributing to the mode of delivery, perinatal and maternal mortalities, and draw up recommendations to improve outcome. METHODS: The study consisted of a review of record cards, outpatient admission and discharge books, delivery books, and inpatient case notes of women admitted with retained second twins of 28 weeks' or more gestation during the study period. RESULTS: Of the 65 cases fully reviewed, 33 (approximately 50%) were delivered by cesarean section due mainly to abnormal lie with or without shoulder impaction. The rest were assisted deliveries, mainly vertex deliveries or breech extractions. The perinatal mortality of the retained second twins was 38.5% compared with 12.3% for the first twins. Although in general the longer the interdelivery interval, the greater the second twin perinatal mortality risk, no clear direct correlation could be established. There was one perioperative maternal mortality due to anaphylactic reaction to intramuscular morphine injection. CONCLUSION: Irrespective of the antenatal course and early labor findings, twin delivery should be undertaken in a unit equipped for cesarean section and assisted delivery. The unacceptably high perinatal mortality of retained second twins could thus be significantly reduced.