Browsing by Author "Asiamah, S."
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Item Effect of removing direct payment for health care on utilisation and health outcomes in Ghanaian children:(2009) Ansah, E.K.; Narh-Bana, S.; Asiamah, S.; Dzordzordzi, V.; Biantey, K.; Dickson, K.; Gyapong, J.O.; Koram, K.A.; Greenwood, B.M.; Mills, A.; Whitty, C.J.M.Background: Delays in accessing care for malaria and other diseases can lead to disease progression, and user fees are a known barrier to accessing health care. Governments are introducing free health care to improve health outcomes. Free health care affects treatment seeking, and it is therefore assumed to lead to improved health outcomes, but there is no direct trial evidence of the impact of removing out-of-pocket payments on health outcomes in developing countries. This trial was designed to test the impact of free health care on health outcomes directly. Methods and Findings: 2,194 households containing 2,592 Ghanaian children under 5 y old were randomised into a prepayment scheme allowing free primary care including drugs, or to a control group whose families paid user fees for health care (normal practice); 165 children whose families had previously paid to enrol in the prepayment scheme formed an observational arm. The primary outcome was moderate anaemia (haemoglobin [Hb] < 8 g/dl); major secondary outcomes were health care utilisation, severe anaemia, and mortality. At baseline the randomised groups were similar. Introducing free primary health care altered the health care seeking behaviour of households; those randomised to the intervention arm used formal health care more and nonformal care less than the control group. Introducing free primary health care did not lead to any measurable difference in any health outcome. The primary outcome of moderate anaemia was detected in 37 (3.1%) children in the control and 36 children (3.2%) in the intervention arm (adjusted odds ratio 1.05, 95% confidence interval 0.66-1.67). There were four deaths in the control and five in the intervention group. Mean Hb concentration, severe anaemia, parasite prevalence, and anthropometric measurements were similar in each group. Families who previously self-enrolled in the prepayment scheme were significantly less poor, had better health measures, and used services more frequently than those in the randomised group. Conclusions: In the study setting, removing out-of-pocket payments for health care had an impact on health care-seeking behaviour but not on the health outcomes measured. Trial registration: ClinicalTrials.gov (#NCT00146692). © 2009 Ansah et al.Item Effect of removing direct payment for health care on utilisation and health outcomes in Ghanaian children: a randomised controlled trial(PLoS Med., 2009) Ansah, E.K.; Narh-Bana, S.; Asiamah, S.; Dzordzordzi, V.; Biantey, K.; Dickson, K.; Gyapong, J.O.; Koram, K.A.; Greenwood, B.M.; Mills, A.; Whitty, C.J.Delays in accessing care for malaria and other diseases can lead to disease progression, and user fees are a known barrier to accessing health care. Governments are introducing free health care to improve health outcomes. Free health care affects treatment seeking, and it is therefore assumed to lead to improved health outcomes, but there is no direct trial evidence of the impact of removing out-of-pocket payments on health outcomes in developing countries. This trial was designed to test the impact of free health care on health outcomes directly. Methods and Findings: 2,194 households containing 2,592 Ghanaian children under 5 y old were randomised into a prepayment scheme allowing free primary care including drugs, or to a control group whose families paid user fees for health care (normal practice); 165 children whose families had previously paid to enrol in the prepayment scheme formed an observational arm. The primary outcome was moderate anaemia (haemoglobin [Hb] < 8 g/dl); major secondary outcomes were health care utilisation, severe anaemia, and mortality. At baseline the randomised groups were similar. Introducing free primary health care altered the health care seeking behaviour of households; those randomised to the intervention arm used formal health care more and nonformal care less than the control group. Introducing free primary health care did not lead to any measurable difference in any health outcome. The primary outcome of moderate anaemia was detected in 37 (3.1%) children in the control and 36 children (3.2%) in the intervention arm (adjusted odds ratio 1.05, 95% confidence interval 0.66-1.67). There were four deaths in the control and five in the intervention group. Mean Hb concentration, severe anaemia, parasite prevalence, and anthropometric measurements were similar in each group. Families who previously self-enrolled in the prepayment scheme were significantly less poor, had better health measures, and used services more frequently than those in the randomized group. Conclusions: In the study setting, removing out-of-pocket payments for health care had an impact on health care-seeking behaviour but not on the health outcomes measured.Item Erratum: Effect of removing direct payment for health care on utilisation and health outcomes in Ghanaian children: A randomised controlled trial (PLoS medicine (2009) 6:2 (e1000033)DOI:10.1371/journal.pmed.1000007)).(2009-02) Ansah, E.K.; Narh-Bana, S.; Asiamah, S.; Dzordzordzi, V.; Biantey, K.; Dickson, K.; Gyapong, J.O.; Greenwood, B.M.; Mills, A.; Whitty, C.J.M.Item Establishing the Cardiothoracic Ratio Using Chest Radiographs in an Indigenous Ghanaian Population: A Simple Tool For Cardiomegaly Screening(Ghana Medical Journal, 2015-09) Mensah, Y.B.; Mensah, K.; Asiamah, S.; Gbadamosi, H.; Idun, E.A.; Brakohiapa, W.; Oddoye, A.Background: Cardiothoracic ratio is a simple and cheap tool in the estimation of heart size. It is a useful index of cardiac size evaluation, and a value of 50% is generally considered to indicate the upper limit of normal. Study Objective: This study is to ascertain the normal mean value in cardiothoracic ratio of Ghanaians using chest radiography to serve as baseline for screening for cardiomegaly. Methodology: Standard postero-anterior radiographs of the -clients/patients were used in the study. The cardiothoracic ratio (CTR) was obtained by dividing the transverse cardiac diameter [sum of the horizontal distances from the right and left lateral-most margins of the heart to the midline (spinous processes of the vertebral bodies)] by the maximum internal thoracic diameter. Systematic sampling with appropriate inclusion and exclusion criteria were used to obtain a sample size of 1989. Results: The mean transverse cardiac diameter and cardiothoracic ratio increased with age. The transverse thoracic diameter increased with age until the sixth decade when it reduced with age. The mean CTR increased gradually with age with females having greater values than males. The mean CTR of the study population were 0.459, 0.467 and 0.452 for the general population, females and males respectively. Conclusion: This study has been able to establish 0.459 as the mean CTR values for Ghanaians. It has also shown the relationship between age and clients /patient’s cardiothoracic ratio which compares favourably with findings of a similar study in Nigeria, a neighbouring country in the West African sub region with similar ethnic and social structure.Item MRI features in the non-traumatic spinal cord injury patients presenting at the Korle Bu Teaching Hospital, Accra(Ghana medical journal, 2018-09) Gbadamosi, H.; Mensah, Y.B.; Asiamah, S.Background: Neurological limb deficit due to non-traumatic myelopathy is a disabling and distressing neurological condition. In recent time Magnetic Resonance Imaging (MRI) has proven to be the ultimate imaging modality for evaluating pathologies of the spinal cord. Objective: To describe the Magnetic Resonance Imaging (MRI) features of patients with Non-Traumatic Spinal Cord Injury evaluated at the Korle Bu Teaching Hospital. Methods: A descriptive cross-sectional study was carried out at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Results: Out of a total of 141 MRI’s evaluated 60.3% were males and 39.7% female. The majority of the respondents 85.1% had paraparesis/paraplegia,13.5% had quadriparesis/quadriplegia, 1.4% had weakness in one upper limb and both lower limbs. The commonest MRI features of NTSCI recorded was due to degenerative disease of the spine 75.9%, spinal metastases 5.7%, Pott's/pyogenic spondylitis 3.5%, demyelinating disease 2.8% and primary spinal tumours 2.8%. Conclusion: The commonest MRI findings in the study population were due to degenerative disease of the spine, followed by spinal metastases and infective spondylitis.Item Outcome of barium enema in patients with colorectal symptoms(Ghana Medical Journal, 2008) Mensah, Y.; Dakubo, J.; Asiamah, S.; Naaeder, S.Background For many years, double contrast barium enema has been an effective way to evaluate the large bowel. With the development of the colonoscope, the role of barium enema has been questioned. However it is still useful in investigating patients with colorectal symptoms especially in the developing world where colonoscopy is widely unavailable and fraught with challenges in completely evaluating the colon. Objective This study aimed at reviewing double contrast barium enema investigations in our centre. Methods This was a retrospective study on patients who underwent double contrast barium enema at the Korle Bu Teaching Hospital from May 2003 to April 2007 on account of symptoms referable to the large bowel. Results A total of 362 investigation reports were studied, of which 205 were for males Ghana Medical Journal Ghana Medical Association Outcome of Barium Enema in Patients with Colorectal Symptoms YB Mensah, JCB Dakubo, [...], and SB Naaeder Additional article information Summary Background For many years, double contrast barium enema has been an effective way to evaluate the large bowel. With the development of the colonoscope, the role of barium enema has been questioned. However it is still useful in investigating patients with colorectal symptoms especially in the developing world where colonoscopy is widely unavailable and fraught with challenges in completely evaluating the colon. Objective This study aimed at reviewing double contrast barium enema investigations in our centre. Methods This was a retrospective study on patients who underwent double contrast barium enema at the Korle Bu Teaching Hospital from May 2003 to April 2007 on account of symptoms referable to the large bowel. Results A total of 362 investigation reports were studied, of which 205 were for males and 154 for females, the mean age of the patients was 55.3 years (S.D 15.3 years). Majority of the investigations, 228 (61.96%), were normal. Diverticular disease diagnosed in 88 (23.91%) cases was the commonest finding, followed by neoplasm 27 (7.34%) cases and Ulcerative colitis 6 (1.63%) cases, non-specific narrowing of the bowel in 4 (1.09%) and in 5 (1.36%) cases their investigations were inconclusive due to poor bowel preparation. Rectal bleeding was the most frequent symptom prompting barium enema studies. Conclusion Double contrast barium enema study of the large bowel is an important evaluation of patients with colorectal symptoms. .Item Pneumatic reduction of intussusception in children at Korle Bu Teaching Hospital: An initial experience(African Journal of Paediatric Surgery, 2011-05) Mensah, Y.; Glover-Addy, H.; Etwire, V.; Twum, M.; Asiamah, S.; Appeadu-Mensah, W.; Hesse, A.Background: Intussusception is a common abdominal emergency in children which necessitates prompt diagnosis and management. Nonsurgical methods of managing this condition are rapidly gaining popularity with fluoroscopic-guided pneumatic reduction being one of such methods that has been used with great success in many countries. We present our initial experience with fluoroscopic-guided pneumatic reduction of intussusception at Korle Bu Teaching Hospital which is also the first time the technique has been used in Ghana. Materials and Methods: A total of 18 children were enrolled in the study between August 2007 and February 2008 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were given air enema under fluoroscopic-guidance using locally assembled equipment. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 120 mmHg. A total of three attempts of 3 min each were allowed. Results: There were 12 males and 6 females. The average age of the patients was 8.3 months (SD= 3 months). Twelve (67%) of the cases were reduced successfully while 6 (33%) failed to reduce. A majority of those that did not reduced had symptoms for at least 2 days. Bowel perforation occurred in three (16.7%) cases. Conclusion: Pneumatic reduction of intussusception is a cost-effective and rapid method of management of intussusception. It however has limitations like high reported rate of bowel perforation and limited ability to identify lead points. The benefits however seem to outweigh these challenges, such as fluoroscopic-guided pneumatic reduction has a very high success rate. Fluoroscopic guided pneumatic reduction should be considered as one of the primary modes of reduction in Ghana and other neighbouring countries that are yet to practice it.Item Pneumatic reduction of intussuseception in children at the Korle-Bu Teaching Hospital- an initial experience(African Journal of Paediatric Surgery, 2011) Mensah, Y.B.; Glover-Addy, H.; Etwire, V.; Twum, M.B.; Asiamah, S.; Appeadu-Mensah, W.; Hesse, A.A.J.