Browsing by Author "Ahmed, K."
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Item Client Perception of Quality of Health Care in Bawku West District of the Upper East Region of the Republic of Ghana(University of Ghana, 2009-08) Doe, F.; Esena, R.; Ahmed, K.; University of Ghana, College of Health Sciences, School of Public HealthAs calls are made by health professional groups and clients for a more client-centered health care system, it becomes essential to define and measure patient perceptions of health care quality and to understand more fully what drives those perceptions. The aim of this study is to describe client perceived quality of health care and satisfaction with care in selected public health facilities in Bawku West District. The study was a cross-sectional survey conducted in three health facilities in Bawku West District to describe the quality of health care from the clients‘ perspective. It was undertaken over a period of three months, from June to August 2009. Exit interviews were carried out for 265 clients aged15 years and above who reported to the general OPD, antenatal clinic and post natal clinics. The caretakers of clients who were less than 15 years were also interviewed. Both quantitative and qualitative methods of data collection were employed. Descriptive analysis and logistic regression were done using Epi Info 6 Version 3.4.1. The results indicate that perception of quality of care and client satisfaction were high in all the three facilities. Mean score for quality of care was highest for the health centre (3.24) followed by the clinic (3.20) and then the hospital (3.15). Mean satisfaction score also follows the same trend with the health centre recording 3.16, the clinic 3.15 and the hospital 3.08. Quality of care in the hospital was positively associated with adequacy medicines prescribed (p < 0.05) and the most significant predictors of client satisfaction are examining the client (p < 0.05), adequacy of medicines prescribed (p < 0.005), cleanliness of the facility (p < 0.05), privacy during consultation (p < 0.05) and quality of care (p < 0.0001). Most significant predictor of client satisfaction in the health centre is respect for clients (p < 0.05). It is concluded that perception of quality of care and satisfaction are very high in all the facilities. Nonetheless there are gaps in communication with the client, provider/client relationship and availability of medicines that need to be addressed. It is recommended that the facilities improve on communication with clients, provider/client relationship and availability of medicines.Item Influence of in-vivo endotoxin liberation on anti-anaerobic antimicrobial efficacy(Journal of Chemotherapy, 2001) Rotimi, V.O.; Al-Sweih, N.N.; Anim, J.T.; Ahmed, K.; Verghese, T.L.; Khodakhast, F.B.The ability of cefoxitin, clindamycin, imipenem, meropenem, metronidazole and piperacillin-tazobactam to cause Gram-negative anaerobic bacteria to release endotoxin and the influence of such liberated endotoxin on antibiotic efficacy were investigated in in-vivo experiments in animal models. Experimental infections in various animal models (mice, hamster and infant rats) with cultures of wild and reference strains of Bacteroides fragilis group and Fusobacterium spp. were carried out by injecting these animals with different inocula (10 6, 10 7 and 10 8 cfu/ml) of the bacterial suspension. Appropriate doses of the test antibiotics were then injected and the plasma lipopolysaccharide (endotoxin) release measured by the Limulus Amoebocyte Lysate (LAL) Assay. Evidence of worsening of the outcome of the infections post-therapy was assessed, including histopathological changes in the internal organs. Infection with generalized septicemia was established with F. nucleatum in the mice and hamster models while with the B. fragilis group, infections only led to intra-abdominal abscess formation. Plasma endotoxin release was higher in animals infected with F. nucleatum than B. fragilis and was unrelated to the bacterial inoculum. Imipenem, meropenem and cefoxitin, in that order, induced the highest levels of endotoxin activities in the animal model, particularly following F. nucleatum infection. Histological examination of the internal organs of various animals showed variation in the pattern of histopathological changes; grades 3-4 inflammatory changes in the liver were observed in the Fusobacterium-infected animals that were treated with the carbapenems and cefoxitin. Therapy with the other antibiotics did not exacerbate anaerobic sepsis. In this study, bacteremia did not lead to massive endotoxin release and antibiotic therapy appeared not to have negatively influenced the outcome of most of the Gram-negative anaerobic infections, except for infections caused by Fusobacterium spp. However, it is conceivable that if the gastrointestinal tract is the source of the endotoxin in patients with systemic inflammatory response syndrome, then the obligate anaerobes like Bacteroides and Fusobacterium species, which are members of the gut flora, may play a major role in the unfavorable outcome of antibiotic therapy in some of these infections.Item Molecular diagnosis of Schistosoma infections in urine samples of school children in Ghana(American Journal of Tropical Medicine and Hygiene, 2013-06) Aryeetey, Y.A.; Essien-Baidoo, S.; Larbi, I.A.; Ahmed, K.; Amoah, A.S.; Obeng, B.B.; Van Lieshout, L.; Yazdanbakhsh, M.; Boakye, D.A.; Verweij, J.J.Recent studies using an internal transcribed spacer (ITS)-based real-time polymerase chain reaction (PCR) for the detection of Schistosoma DNA in urine samples has shown high sensitivity and specificity when performed on controls and known microscopy-positive samples. In this study, using 730 urine samples collected from children in five primary schools from different communities in the Greater Accra region of Ghana, specific detection of Schistosoma DNA showed excellent sensitivity of 100% and 85.2% in urines with > 50 eggs/10 mL urine and ≤ 50 eggs/10 mL of urine, respectively. Additionally, Schistosoma-specific DNA was amplified in 102 of 673 samples in which Schistosoma eggs could not be detected with microscopy. Taking microscopy and/or PCR-positive samples as true positives, the negative predictive value calculated was 94.6-100% for each school sampled as compared with 54.3-95.7% using microscopy. This ITS-based real-time PCR proves to be a powerful tool in epidemiological surveys of schistosomiasis providing more precise and sensitive results than microscopy. Copyright © 2013 by The American Society of Tropical Medicine and Hygiene.Item Thirty-month follow-up of sub-optimal responders to multiple treatments with ivermectin, in two onchocerciasis-endemic foci in Ghana(Annals of Tropical Medicine and Parasitology, 2004) Awadzi, K.; Attah, S.K.; Addy, E.T.; Opoku, N.O.; Quartey, B.T.; Lazdins-Helds, J.K.; Ahmed, K.; Boatin, B.A.; Boakye, D.A.; Edwards, G.The pathogenesis of the sub-optimal response of Onchocerca volvulus to ivermectin was investigated in a 30-month follow-up of 28 individuals who, in a previous study, had been found to show a sub-optimal (N = 15) or adequate response (N = 13) to multiple treatments with the drug. Verbal informed consent was obtained before each subject was given a general clinical and ocular examination. Skin snips were taken from both iliac crests and both calves. Seventeen nodule carriers were hospitalized for nodulectomy. Adult worms were harvested, embryogrammes were constructed and all developmental stages were counted; degenerate, stretched microfilariae were noted separately. All the subjects were in good general health and all except one had received at least one additional treatment with ivermectin since the earlier study. A large proportion of the adult female worms in 10 out of the 11 sub-optimal responders who were nodule carriers were in full embryonic production but most of the stretched microfilariae they carried were degenerate. This picture is similar to that found in adult worms exposed to the first dose of ivermectin. In one subject who had no viable worms in his nodules, the existence of occult but actively reproductive worms was inferred from the high level of microfilaridermia observed less than 12 months after treatment. These observations confirm the existence of populations of adult female O. volvulus that respond poorly to repeated doses of ivermectin. The use of suramin in the treatment of the sub-optimal responders is discussed.