Browsing by Author "Boima, V."

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The Association between Diabetes-Related Distress and Medication Adherence in Adult Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study
(Journal of Diabetes Research, 2020-03-02) Kretchy, I.A.; Koduah, A.; Ohene-Agyei, T.; Boima, V.; Appiah, B.
Background. Type 2 diabetes mellitus (T2DM) is a major public health problem associated with distress. T2DM can affect health outcomes and adherence to medications. Little is however known about the association between diabetes distress and medication adherence among patients with T2DM in Ghana. Objective. The objective of the present study is twofold: to estimate distress associated with T2DM and to examine its association with medication adherence. Methods. A hospital-based crosssectional study was conducted among 188 patients with T2DM recruited from a diabetes specialist outpatient clinic at the Pantang Hospital in Accra, Ghana. Data were obtained using the Problem Areas In Diabetes (PAID) scale and the Medication Adherence Report Scale. Results. The findings showed that about 44.7% of the patients showed high levels of diabetes-related distress. Poor adherence to medications was recorded in 66.5% of the patients. Patients who were highly distressed had 68% lower odds of adhering to their medications compared to those who were not (OR: 0.32, 95% CI: 0.15-0.65). A principal component analysis revealed four areas of T2DM distress which were conceptualized as negative emotions about diabetes, dietary concerns and diabetes care, dissatisfaction with external support, and diabetes management helplessness. Conclusion. Our findings suggest that diabetes distress is a significant determinant of medication adherence behaviour in patients with T2DM. Thus, incorporating routine screening for distress into the standard diabetes care within the Ghanaian health system and having health practitioners adopt holistic approaches to diabetes management will be important context-specific interventions to improve adherence and health outcomes of people living and coping with T2DM.
Catheter‑Related Bloodstream Infections among patients on maintenance haemodialysis: a cross‑sectional study at a tertiary hospital in Ghana
(BMC Infectious Diseases, 2023) Opoku‑Asare, B.; Boima, V.; Aboagye, E.; et al.
Background Catheter-Related Bloodstream Infections (CRBSIs) are notable complications among patients receiving maintenance haemodialysis. However, data on the prevalence of CRBSIs is lacking. This study was conducted to deter‑ mine the prevalence and factors associated with CRBSIs among patients receiving haemodialysis in the renal unit of the largest tertiary hospital in Ghana. Methods A hospital-based cross-sectional study was conducted on patients receiving maintenance haemodialy‑ sis via central venous catheters (CVC) between September 2021 and April 2022. Multivariate analysis using logistic regression was used to determine the risk factors that were predictive of CRBSI. Analysis was performed using SPSS version 23 and a p-value<0.05 was statistically signifcant. Results The prevalence of CRBSI was 34.2% (52/152). Of these, more than half of them (53.9%(28/52)) had Possible CRBSI while 11.5% (6/52) had Defnite CRBSI. Among the positive cultures, 62% (21/34) were from catheter sites whilst the rest were from peripheral blood. Gram-negative cultures made up 53% (18/34) of positive cultures with the rest being Gram positive cultures. Acinetobacter baumannii (33.3% (6/18)) was the commonest organism isolated among Gram-negative cultures whilst Coagulase negative Staphylococci (43.7% (7/16)) was the commonest organism isolated among Gram-positve cultures. Gram-negative bacilli were more predominant in this study making up 52.9% of the total bacteria cultured. Sex, duration of maintenance dialysis, underlying cause of End-stage kidney disease, mean corpuscular haemoglobin (MCH), neutrophil count and lymphocyte count were signifcantly predictive of CRBSI status (p<0.05). Conclusion There was a high prevalence of CRBSI among patients undergoing haemodialysis. The commonest causative agent was Coagulase negative Staphylococci, however there was a predominance of Gram-negative bacilli as compared to Gram positive cocci. There is a need to set up infection surveillance unit in the renal unit to track CRBSI and put in place measures to reduce these CRBSI.
Comparison of neurocognitive changes among newly diagnosed tuberculosis patients with and without dysglycaemia
(BMC Psychiatry, 2020-04-03) Yorke, E.; Boima, V.; Dey, I.D.; Ganu, D.; Nkornu, N.; Acquaye, K.S.; Mate-Kole, C.C.
Background: Diabetes often occurs together with tuberculosis (TB) and both may affect each other negatively. Diabetes may be associated with neurocognitive dysfunctioning in affected patients and may negatively impact treatment adherence and outcomes. This study compared the neurocognitive status between newly diagnosed smear positive tuberculosis patients with dysglycaemia and those with normoglycaemia. Methods: The current study was a cross-sectional study involving one hundred and forty-six (146) newly diagnosed smear positive TB patients. Oral glucose tolerance test (OGTT) was performed and the results were categorized as either normoglycaemia, impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or diabetes. Neurocognitive functioning among study participants was assessed at the time of TB diagnosis using Cognitive Failure Questionnaire (CFQ), Montreal Cognitive Assessment tool (MoCA), California Verbal Learning Test (CVLT), Brief Symptom Inventory (BSI) and the Spitzer Quality of Life Index (QLI). Results: The mean age of the participants (n = 146) was 38.7 years with 78.8% being males and 21.2% females. Using the fasting blood glucose test, the prevalence of impaired fasting glucose and diabetes were 5.5 and 3.4% respectively, both representing a total of 13 out of the 146 participants; whilst the prevalence of impaired glucose tolerance and diabetes using 2-h post-glucose values were 28.8 and 11.6% respectively, both representing a total of 59 out of the 146 participants. There were no significant differences in the mean scores on the neurocognitive measures between the dysglaycaemia and normoglycamic groups using fasting plasma glucose (FPG). However, there were significant differences in the mean scores between the dysglycaemia and normal groups using 2-h postprandial (2HPP) glucose values on Phobic Anxiety (Normal, Mean = 0.38 ± 0.603; dysglycaemia, Mean = 0.23 ± 0.356; p = 0.045), and Montreal Cognitive Assessment (MoCA) scores (17.26 ± 5.981 vs. 15.04 ± 5.834, p = 0.037). Conclusion: Newly diagnosed smear positive patients with dysglycaemia were associated with significantly lower mean cognitive scores and scores on phobic anxiety than those with normoglyacaemia. The latter finding must be further explored.
Coping strategies and resilience among patients with hypertension in Ghana
(Frontiers in Psychology, 2023) Boima, V.; Yorke, E.; Ganu, V.; Gyaban-Mensah, A.; Ekem-Ferguson, G.; Kretchy, I.A.; Mate-Kole, C.C.
Background: Hypertension is associated with high morbidity and mortality and this has been linked to poor treatment and control rates. To optimize drug treatment, patient-centered strategies such as coping, resilience, and adherence to medication may improve control rates and decrease the morbidity and mortality associated with hypertension. This study, therefore, assessed coping skills and resilience among patients with hypertension in Ghana. Methods: A cross-sectional study was conducted at Korle Bu Teaching Hospital. 224 consented patients with a diagnosis of hypertension were consecutively selected from the outpatient clinic. Questionnaires comprising socio-demographic characteristics, clinical parameters, Adult Resilience Measure, and the Africultural Coping Systems Inventory were administered. Data were analyzed using Stata version 16.1 and significance level was set at p-value of ≤ 0.05. Results: The mean age of participants was 62.03 ± 11.40 years and the majority were female (63%). The overall coping strategy mean score was 43.13 ± 13.57. For resilience, median relational and personal resilience (PR) scores were 32 (IQR-7) and 39 (IQR-9), respectively. Increased systolic BP significantly increases the overall coping strategy score. Collective coping strategy and systolic BP significantly increased coping scores (95%CI = 0.05–3.69 vs. 95%CI = 0.58–5.31). Overall coping strategy significantly increased personal and relational resilience (RR) domain scores by 0.004 (95%CI = 0.002–0.01) and 0.005 (95%CI = 0.003–0.006) units, respectively. This study demonstrated that Cognitive and emotional debriefing coping strategy was mostly used by patients with hypertension. Conclusion: Coping strategies had a positive and significant correlation with personal and RR, specifically collective and cognitive debriefing had a significant positive association with resilience among study participants. There is a need to actively put in measures that can improve the coping strategies and resilience among patients with hypertension to adjust to the long-term nature of the illness and treatment as this will promote better treatment outcomes.
Creatinine based equations and glomerular filtration rate: interpretation and clinical relevance
(Ghana Medical Journal, 2016-09) Boima, V.
Chronic Kidney Disease (CKD) is now a major public health problem globally, more so in developing countries with Sub-Saharan Africa (SSA) being the most affected sub-region.1 A systematic review and metaanalysis estimated CKD prevalence in SSA to be 13.9%.2 In Ghana the true prevalence still remains unknown. The growing burden of CKD in Africa can be largely attributed to the rising prevalence of hypertension, diabetes and chronic glomerulonephritis.1,3 CKD affects people who are economically productive in the African continent1. Aside the heightened cardiovascular morbidity and mortality, CKD imposes huge economic burden on affected individuals and their care takers.1,3 Additionally patients with CKD suffer from various psychological problems such as depression, anxiety, cognitive dysfunction amongst others.4,5 Thus the disease, cost of treatment and these psychological problems may lead to poor quality of life. It is therefore imperative to make accurate diagnosis. The diagnosis of CKD is usually made by estimating Glomerular Filtration Rate (GFR). Measuring GFR is relatively cumbersome therefore more simple endogenous variables have been used to estimate renal function. The most commonly used variable is serum creatinine
Depression and quality of life in patients on long term hemodialysis at a nationalhospital in Ghana: a cross-sectional study
(Ghana medical journal, 2018-03) Ganu, V.J.; Boima, V.; Adjei, D.N.; Yendork, J.S.; Dey, I.D.; Yorke, E.; Mate-Kole, C.C.; Mate-Kole, M.O.
The study examined quality of life and prevalence of depressive symptoms in patients on long term hemodialysis. Further, it explored the impact of socio-demographic characteristics on depression and quality of life. Design Study design was cross-sectional. Setting Study was conducted in the two renal dialysis units of the Korle-Bu Teaching hospital in Accra, Ghana. Participants and study tools One hundred and six participants on haemodialysis were recruited for the study. The Patient Health Questionnaire and the World Health Organization Quality of Life instrument were used to assess depression and quality of life. Results Forty five percent of participants screened positive for symptoms of depression. Approximately 19% obtained low scores on overall quality of life. There were significant negative correlations between the following: Depression and overall QoL, Depression and duration of dialysis treatment and Depression and income level. There was positive correlation between overall QoL and duration of dialysis, treatment and income. Conclusion Depressive symptoms were common amongst patients on long term hemodialysis. Haemodialysis patients who obtained low scores on quality of life measures were more likely to screen positive for depressive symptoms. Screening for depressive symptoms among these patients is critical as early treatment may improve their general wellbeing.
Determinants of Willingness To Accept Kidney Transplantation Among Chronic Kidney Disease Patients in Ghana
(BMC Nephrology, 2021) Boima, V.; Amissah-Arthur, M. B.; Yorke, E.; Dey, D.; Fiagbe, D.; Yawson, A.E.; Nonvignon, J.; Mate-Kole, C.C.;
Background: The burden of chronic kidney disease in Africa is three to four times higher compared to high- income countries and the cost of treatment is beyond the reach of most affected persons. The best treatment for end stage renal disease is kidney transplantation which is not available in most African countries. As kidney transplantation surgery is emerging in Ghana, this study assessed factors which could influence the willingness of patients with chronic kidney disease to accept it as a mode of treatment. Methods: This cross-sectional survey was carried out among patients with chronic kidney disease in Korle-Bu Teaching Hospital. A consecutive sampling method was used to recruit consenting patients. A structured questionnaire and standardized research instruments were used to obtain information on demographic, socio- economic characteristics, knowledge about transplantation, perception of transplantation, religiosity and spirituality. Logistic regression model was used to assess the determinants of willingness to accept a kidney transplant. Results: 342 CKD patients participated in the study of which 56.7% (n = 194) were male. The mean age of the participants was 50.24 ± 17.08 years. The proportion of participants who were willing to accept a kidney transplant was 67.3% (95%CI: 62.0–72.2%). The factors which influenced participants’ willingness to accept this treatment included; willingness to attend a class on kidney transplantation (p < 0.016), willingness to donate a kidney if they had the chance (p < 0.005), perception that a living person could donate a kidney (p < 0.001) and perceived improvement in quality of life after transplantation (p < 0.005). The barriers for accepting kidney transplantation were anticipated complications of transplant surgery and financial constraints. Conclusion: More than two-thirds of CKD patients were willing to accept a kidney transplant and this is influenced by multiple factors. Government health agencies must consider full or partial coverage of kidney transplantation through the existing national health insurance scheme. Further, efficient educational programmes are required to improve both patients’ and physicians’ knowledge on the importance of kidney transplantation in the management of end stage renal disease in Ghana.
Effectiveness of digital health interventions on blood pressure control, lifestyle behaviours and adherence to medication in patients with hypertension in low-income and middle-income countries: a systematic review and meta-analysis of randomised controlled trials
(Review, 2024) Boima, V.; Doku, A.; Agyekum, F.; et al
Background Digital health interventions can be effective for blood pressure (BP) control, but a comparison of the effectiveness and application of these types of interventions have not yet been systematically evaluated in low- and middle-income countries (LMICs). This study aimed to compare the effectiveness of digital health interventions according to the World Health Organization (WHO) classifications of patients in terms of BP control, lifestyle behaviour changes, and adherence to medication in patients with hypertension in LMICs. Methods: In this systematic review and meta-analysis, we searched PubMed, Scopus, Web of Science, Embase, CINAHL and Cochrane Library databases for randomised controlled trials (RCTs) published in English comprise of adults (≥18 years old) with hypertension and the intervention consisted of digital health interventions according to WHO’s classifications for patients in LMICs between January 1, 2009, and July 17, 2023. We excluded RCTs that considered patients with hypertension comorbidities such as diabetes and hypertension-mediated target organs damage (HMTOD). The references were downloaded into Mendeley Desktop and imported into the Rayyan web tool for deduplication and screening. The risk of bias was assessed using Cochrane Risk of Bias 2. Data extraction was done according to Cochrane’s guidelines. The main outcome measures were mean systolic blood pressure (SBP) and BP control, which were assessed using the random-effect DerSimonian-Laird and Mantel-Haenszel models. We presented the BP outcomes, lifestyle behaviour changes and medication adherence in forest plots, as well as summarized them in tables. This study is registered with PROSPERO, CRD42023424227. Findings We identified 9322 articles, of which 22 RCTs from 12 countries (n = 12,892 respondents) were included in the systematic review. The quality of the 22 studies was graded as high risk (n = 7), had some concerns (n = 3) and low risk of bias (n = 12). A total of 19 RCTs (n = 12,418 respondents) were included in the meta-analysis. Overall, digital health intervention had significant reductions in SBP [mean difference (MD) = −4.43 mmHg (95% CI −6.19 to −2.67)], I 2 = 92%] and BP control [odds ratio (OR) = 2.20 (95% CI 1.64–2.94), I2 = 78%], respectively, compared with usual care. A subgroup analysis revealed that short message service (SMS) interventions had the greatest statistical significant reduction of SBP [MD = −5.75 mm Hg (95% Cl −7.77 to −3.73), I2 = 86%] compared to mobile phone calls [MD = 3.08 mm Hg (−6.16 to 12.32), I2 = 87%] or smartphone apps interventions [MD = −4.06 mm Hg] (−6.56 to −1.55), I2 = 79%], but the difference between groups was not statistically significant (p = 0.14). The meta-analysis showed that the interventions had a significant effect in supporting changes in lifestyle behaviours related to a low salt diet [standardised mean difference (SMD) = 1.25; (95% CI 0.64–1.87), I2 = 89%], physical activity [SMD = 1.30 (95% CI 0.23–2.37), I2 = 94%] and smoking reduction [risk difference (RR) = 0.03; (95% CI 0.01–0.05), I2 = 0%] compared to the control group. In addition, improvements in medication adherence was statistically significant and higher in the intervention group than in the control group [SMD]. = 1.59 (95% CI 0.51–2.67), I2 = 97% Interpretation Our findings suggest that digital health interventions may be effective for BP control, Changes in lifestyle behaviours, and improvements in medication adherence in LMICs. However, we observed high heterogeneity between included studies, and only two studies from Africa were included. The combination of digital health interventions with clinical management is crucial to achieving optimal clinical effectiveness in BP control, Changes in lifestyle behaviours and improvements in medication adherence. Funding None.
Factors Associated with Medication Nonadherence among Hypertensives in Ghana and Nigeria
(International Journal of Hypertension, 2015-10) Boima, V.; Ademola, A.D.; Odusola, A.O.; Agyekum, F.; Nwafor, C.E.; Cole, H.; Salako, B.L.; Ogedegbe, G.; Tayo, B.O.
Background. Blood pressure (BP) control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication nonadherence (MNA); our study therefore aimed to determine factors associated with MNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (n=120), Ghana; and University of Port Harcourt Teaching Hospital, (n=73) Apapa General Hospital Lagos (n=79) and University College Hospital Ibadan (n=85), Nigeria. Results. 357 hypertensive patients (42.6% males) participated. MNA was found in 66.7%. Adherence showed correlation with depression (r=-0.208, P<0.001), concern about medications (r=-0.0347, P=0.002), and knowledge of hypertension (r=0.14, P=0.006). MNA was associated with formal education (P=0.001) and use of herbal preparation (P=0.014). MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (P=0.032). Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (P=0.006). Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation. © 2015 Vincent Boima et al.
Health-seeking behaviour, referral patterns and associated factors among patients with autoimmune rheumatic diseases in Ghana: A cross-sectional mixed method study
(PLOS ONE, 2022) Amissah-Arthur, M-B.; Gyaban-Mensah, A.; Boima, V.; Yorke, E.; Dey, D.; Ganu, V.; Mate-Kole, C.
Background Challenges exist in the diagnosis and management of autoimmune rheumatic diseases in low and middle income countries due to factors, such as poverty and under-resourced healthcare infrastructure. Furthermore, other contributory factors such as societal, cultural and religious practices influence health seeking behaviour which has a bearing on access and delivery of healthcare. Objectives To examine the health seeking behaviour and referral patterns of Ghanaian patients with autoimmune rheumatic diseases and assess the associated factors that influence these. Method A cross-sectional study using an explanatory sequential mixed method design was carried out in a Rheumatology clinic at a national referral centre. 110 participants were purposively recruited for the quantitative phase. The qualitative phase comprised 10 participants for indepth interviews and 10 participants for a focus group discussion. Analysis using descriptive statistics, t-tests and logistic regression models were performed. Transcripts generated from the interviews and focused group discussion were analysed using thematic analysis. Results Median duration from onset of symptoms until seeking help was 1 week (IQR = 12); from seeking help until obtaining a final diagnosis was 12 months (IQR = 33). Multiple factors determined the choice of first facility visited, X2 (12, N = 107) = 32.29, p = .001. Only twenty-one participants (19.6%) had knowledge of their disease prior to diagnosis. Education predicted prior knowledge [OR = 2.6 (95% CI = .66–10.12), p < .021]. Unemployed participants had increased odds of seeking help after a month compared to those who were employed [Odds ratio = 2.60 (95% CI = 1.14–5.90), p = .02]. Knowledge of autoimmune rheumatic diseases was low with multiple causative factors such as biomedical, environmental and spiritual causes determining where patients accessed care. Forty (36.4%) participants utilised complementary and alternative treatment options. Conclusion We observed that knowledge about autoimmune rheumatic diseases among Ghanaian patients was low. Patients sought help from numerous medical facilities, traditional healers and prayer camps often contributing to a delay in diagnosis for most patients. This was influenced by individual perceptions, cultural beliefs and socioeconomic status. Active awareness and educational programmes for the public and healthcare workers are required, as well as strategic planning to integrate the biomedical and traditional care services to enable earlier presentation, accurate diagnosis and better clinical outcomes for the patients.
High BMI: an important health risk factor among older adults in Ghana
(Public Health Nutrition, 2021) Yorke, E.; Tetteh, J.; Boima, V.; Yawson, AE.
Objective: We examined BMI as a health risk factor for self-reported diabetes mellitus, angina, strokes and arthritis among older Ghanaians aged 50 years and above. Design: We analysed the individual-level data from the World Health Organization Study on global AGEing and adult health Ghana Wave 2 (2014/2015). The influence of BMI on self-reported chronic conditions including diabetes, angina, stroke and arthritis was examined. Setting: Households from all the administrative regions of Ghana. Participants: Included 3350 adults aged 50 years and older. Results: The prevalence of overweight and obesity among participants was 22·8 % (95 % CI 20·6, 25·2) and 13·2 %, respectively (95 % CI 11·5, 15·1). With respect to individual chronic conditions, arthritis emerged with the highest prevalence rate of 7·3 (95 % CI 5·3, 9·9), while the prevalence rate of diabetes, angina and stroke was 2·8 % (95 % CI 2·0, 3·9), 1·7 % (95 % CI 1·1, 2·6) and 1·3 % (95 % CI 1·0, 1·8), respectively. The risk of diabetes among overweight and obesity was over three and two times, respectively, higher compared with participants with normal weights. Overweight and obesity were significantly more than two and three times likely to experience angina, respectively, compared with participants with normal weight. Obesity significantly influences arthritis with approximately two times increased odds compared with normal weight participants. Conclusion: Prevalence of obesity and overweight in Ghana is high and increasing, which poses a health risk at the individual and population levels. Inter-sectorial and multidisciplinary measures in line with the national non-communicable disease policies aimed at curbing this trend are imperative.
HIV Viremia Is Associated With APOL1 Variants and Reduced JC-Viruria
(FRONTIERS IN MEDICINE, 2021) Kruzel-Davila, E.; Sankofi, B.M.; Amos-Abanyie, E.K.; Ghansah, A.; Nyarko, A.; Agyemang, S.; Awandare, G.A.; Ghansah, A.; Szwarcwort-Cohen, M.; Reiner-Benaim, A.; Hijazi, B.; Ulasi, I.; Raji, Y.R.; Boima, V.; Osafo, C.; Adabayeri, V.M.; Matekole, M.; Olanrewaju, T.O.; Ajayi, S.; Mamven, M.; Antwi, S.; Ademola, A.D.; Plange-Rhule, J.; Arogundade, F.; Akyaw, P.A.; . Winkler, C.A.; Salako, B.L.; Ojo, A.; Skorecki, K.; Adu, D.; H3Africa Kidney Disease Research Network Investigators
Variants in the Apolipoprotein L1 (APOL1) gene (G1-rs60910145, rs73885319, G2-rs71785313) are common in Africans and in individuals of recent African ancestry and are associated with an increased risk of non-diabetic chronic kidney disease (CKD) and in particular of HIV associated nephropathy (HIVAN). In light of the significantly increased risk of HIVAN in carriers of two APOL1 risk alleles, a role in HIV infectivity has been postulated in the mechanism of APOL1 associated kidney disease. Herein, we aim to explore the association between HIV viremia and APOL1 genotype. In addition, we investigated interaction between BK and JC viruria, CKD and HIV viremia. A total of 199 persons living with HIV/AIDS (comprising 82 CKD cases and 117 controls) from among the participants in the ongoing Human Heredity and Health in Africa (H3Africa) Kidney Disease Research Network case control study have been recruited. The two APOL1 renal risk alleles (RRA) genotypes were associated with a higher risk of CKD (OR 12.6, 95% CI 3.89–40.8, p < 0.0001). Even a single APOL1 RRA was associated with CKD risk (OR 4.42, 95% CI 1.49–13.15, p = 0.007). The 2 APOL1 RRA genotypes were associated with an increased probability of having HIV viremia (OR 2.37 95% CI 1.0–5.63, p = 0.05). HIV viremia was associated with increased CKD risk (OR 7.45, 95% CI 1.66–33.35, P = 0.009) and with a significant reduction of JC virus urine shedding (OR 0.35, 95% CI 0.12–0.98, p = 0.046). In contrast to prior studies, JC viruria was not associated with CKD but was restricted in patients with HIV viremia, regardless of CKD status. These findings suggest a role of APOL1 variants in HIV infectivity and emphasize that JC viruria can serve as biomarker for innate immune system activation.
Knowledge and Willingness to Donate Kidneys for Transplantation in Ghana: A Cross-Sectional Survey
(Transplantation Proceedings, 2020-05-10) Boima, V.; Ganu, V.; Yorke, E.; Dey, D.; Amissah-Arthur, M.B.; Agyabeng, K.; Yawson, A.; Lartey, M.; Mate-Kole, C.C.
Background. The main treatment modalities for chronic kidney disease (CKD) are dialysis and kidney transplantation. While kidney transplantation provides better survival and quality of life outcomes, it is a new treatment option in Ghana. Finding kidney donors for transplant may be a major challenge due to varied views of the public. Methods. This cross-sectional study was carried out in 5 purposively selected communities in the Greater Accra region in Ghana. Structured questionnaires and standardized instruments were used to assess sociodemographic characteristics, spirituality, and perception of kidney transplantation. Results. The mean age of the 480 participants was 29.60 10.65 years. The proportion of men was 51%. The average score for knowledge of participants on kidney donation was 4.8 2.6. The level of spirituality score was 25.4 3.89. Approximately 48%(231/480) of participants were willing to donate a kidney while still alive. Willingness to donate when dead was 72% (344/480). Willingness to donate a kidney when deadwas significantly lower among the participants in the older age groups.High level of knowledge about kidney transplantation, being employed, basic formal education, and never married were associated with willingness to donate kidney (P < .05). Conclusion. Our results suggest that participants have a low level of knowledge regarding kidney transplantation, while about two-thirds are willing to donate only after death. Continuous public education is key to raise public awareness of the need for kidney transplants. This will support the Ministry of Health in their efforts to institute a kidney transplant program in Ghana.
The mediating role of quality of life on depression and medication adherence among patients with type 2 diabetes mellitus: A cross‐sectional study
(Health Sci. Rep., 2023) Yorke, E.; Boima, V.; Ganu, V.; et al.
Background and Aim: Patients living with diabetes mellitus have a high burden of psychological distress such as depression and anxiety as well as impaired quality of life, which may negatively impact their adherence to medications, glucose control, and health‐related costs. This study assessed the impact of quality of life and depression on medication adherence among patients with type 2 diabetes (type 2 diabetes mellitus [T2DM]) in a tertiary care setting in Ghana Methods: The study was a cross‐sectional study involving 238 patients with diabetes aged 18 years and above. Validated tools were used to assess medication adherence, depressive symptoms, and quality of life. Structural Equation Modeling was adopted to examine the mediation effect of quality of life on the relationship between depression and medication adherence among participants. Results: The mean age of the participants was 58.82 ± 13.49, and 169 (71.0%) out of a total of 238 respondents were females. Depression had a significant direct relationship with the quality of life of respondents [aβ (95% confidence interval, CI) = −0.20 (−0.03, −0.00), p < 0.05; −0.21 (−0.41, −0.01) p < 0.05, respectively] and indirect relationship with quality of life [aβ (95% CI) = −0.01 (−0.02, −0.004) p < 0.001]. Educational status and religion both showed a significant indirect relationship with quality of life [aβ (95% CI) = 0.06 (0.07, 0.12), p < 0.05; 0.18 (0.01, 0.35) p < 0.05, respectively]. The mediating effect of quality of life on the relationship between depression and medication adherence was significant (Sobel = −3.19, p < 0.001). Conclusion: Depression, medication adherence, and quality of life were higher among older adults with T2DM. Depression was also found to have a strong negative association with both medication adherence and quality of life. Interventions to screen for depression and to improve the quality of life in patients living with diabetes are also recommended and this should go beyond the provision of standard treatments to explore further the mechanisms of this relationships.
Older adults with hypertension have increased risk of depression compared to their younger counterparts: Evidence from the World Health Organization study of Global Ageing and Adult Health Wave 2 in Ghana
(Journal of Affective Disorders, 2020) Boima, V.; Yorke, E.; Archampong, T.; et al.
Background: Depression and hypertension interact through a complex interplay of social, behavioral and bio logical factors. Despite the huge burden of hypertension in the African sub-region, very little information exists on depression among hypertensive patients. This study assessed the prevalence and factors associated with depression among young and older adult hypertensive patients in Ghana. Method: Data from the World Health Organization Study on Global AGEing and Adult Health wave 2 (2014/ 2015) for Ghana was used. Depression was estimated among participants with blood pressure 140/90mmHg and above. Weighted descriptive statistics and logistic regression with adjusted predictions were carried out. The analysis was performed using Stata 15. Result: The overall prevalence of depression was 6.3%. Older hypertensive patients had almost twice the pre valence of depression compared with younger patients (8.4% vs 4.5%). The factors which predicted depression among hypertensive patients were educational level, marital status, religion, region of residence, work status, self-rated health (SRH), and unhealthy lifestyle. Participants with no religion were more than 7 times likely to be depressed compared with Christians [aOR(95%CI)=7.52(2.11-26.8)]. Those in the Volta region were more than 8 times likely to be depressed compared to those in the Greater Accra region [aOR(95%CI)=8.58(2.51-29.3)]. Conclusion: Older adult hypertensive patients were more likely to experience depressive symptoms. Multiple factors predicted depression in both young and old hypertensive patients; thus a comprehensive care package including psychological support for patients with hypertension is essential for optimum clinical management.
Overt and occult hepatitis B virus infection detected among chronic kidney disease patients on haemodialysis at a Tertiary Hospital in Ghana
(PLOS ONE, 2024) Dzudzor, B.; Nsowah, K.K.; Agyemang, S.; Vento, S.; Amarh, V.; Boima, V.; Tachi, K.
Hepatitis B virus (HBV) infection is endemic in Ghana and chronic kidney disease patients on haemodialysis are a high-risk group for HBV infection. We determined the prevalence of overt and occult HBV infection among haemodialysis patients at the Korle Bu Teaching Hos pital in Ghana. 104 consenting End Stage Renal Disease patients on long-term haemodialy sis were recruited for the study and their socio-demographic, clinical and laboratory information were obtained using structured questionnaire. All the participants were tested for the hepatitis B surface antigen (HBsAg). The HBsAg-negative participants were re tested for hepatitis B surface antibody (HBsAb), hepatitis B core antibody (HBcAb) and HBV DNA using chemiluminescence and Roche COBAS Ampli-Prep/TaqMan analyser and real time polymerase chain reaction. Eight (7.7%) of the total participants were positive for HBsAg. Among the 96 HBsAg-negative participants, 12.5% (12) were HBcAb-positive, 7.3% (7) had detectable HBV DNA (mean = 98.7±53.5 IU/mL) and 40.6% (39) were positive for HBsAb. Five out of the 7 HBV DNA-positive participants were males and only one partici pant was negative for HBcAb. Seventy-three out of the 96 HBsAg-negative participants were vaccinated and 37 of these vaccinated individuals had significant HBsAb titres (mean = 423.21± 380.72 IU/mL). Our data demonstrated that the prevalence of overt and occult HBV infection among the haemodialysis (HD) patients was 7.7% and 7.3%, respectively, and only 50.7% of those who showed proof of vaccination were protected from HBV infection
Peripheral sensory neuropathy in type 2 diabetes patients: A case control study in Accra, Ghana
(Journal of Clinical and Translational Endocrinology, 2016-09) Yeboah, K.; Puplampu, P.; Boima, V.; Antwi, D.A.; Gyan, B.; Amoah, A.G.B.
Objective Peripheral sensory neuropathy (PSN) is a common cause of ulceration and amputation in diabetes (DM) patients. The prevalence of PSN in DM patients is largely undetermined in sub-Saharan African population. We studied the burden of PSN in DM patients using a validated questionnaire and quantitative sensory test. Methods In a case-control design, PSN was measured in 491 DM patients and 330 non-DM controls using Michigan neuropathy screening instrument (MNSI) and vibration perception threshold (VPT). PSN was defined as MNSI symptom score ≥7, MNSI examination score ≥2 or VPT ≥25V. Results The prevalence of PSN screened by MNSI symptom score, MNSI examination score and VPT was 7.1%, 51.5% and 24.5% in DM patients; and 1.5%, 24.5% and 8.5% in non-DM participants respectively. The major determinants of PSN screened by MNSI examination score were diabetes status [OR (95% CI): 4.31 (2.94–6.31), p < 0.001], age [1.03 (1.01–1.05), p < 0.001], previous [4.55 (2.11–9.82), p < 0.001] and current [8.16 (3.77–17.68), p < 0.001] smoking status. The major determinants of PSN screened by VPT were diabetes status [1.04 (1.02–1.06), p < 0.001], age [1.02 (1.01–1.03), p = 0.047], heart rate [1.78 (1.08–2.92), p = 0.023], second-hand smoking [3.66 (2.26–5.95), p < 0.001] and body height [3.28 (1.65–8.42), p = 0.015]. Conclusion Our study has shown high burden of PSN in DM patients in Ghana using simple, accurate, and non-invasive screening tools like MNSI and neurothesiometer. © 2016
Pharmacokinetics of efavirenz when co-administered with rifampin in TB/HIV co-infected patients: Pharmacogenetic effect of CYP2B6 variation
(Journal of Clinical Pharmacology, 2008-09) Kwara, A.; Lartey, M.; Sagoe, K.W.; Xexemeku, F.; Kenu, E.; Oliver-Commey, J.; Boima, V.; Sagoe, A.; Boamah, I.; Greenblatt, D.J.; Court, M.H.
The goal of this study was to determine the effect of CYP2B6 genetic variation on the steady-state pharmacokinetics of efavirenz (600 mg/d) in TB/HIV co-infected patients receiving concomitant rifampin, a potent CYP inducer. In the 26 patients studied, CYP2B6 c.516GG, GT, and TT genotype frequencies were 0.27, 0.50, and 0.23, respectively. Mean plasma efavirenz area under the curve was significantly higher in patients with CYP2B6 c.516TT than in those with GT (107 vs 27.6 μg·h/mL, P <.0001) or GG genotype (107 vs 23.0 μg· h/mL, P <.0001). Apparent oral clearance (CL/F) was significantly lower in patients with CYP2B6 c.516TT than in those with GT genotype (2.1 vs 8.4 mL/min/kg, P < 0.0001) and GG genotype (2.1 vs 9.9 mL/min/kg, P <.0001). No differences in efavirenz exposure or CL/F existed between patients with CYP2B6 c.516GT and GG genotypes. Our results indicate that CYP2B6 c.516TT genotype can be used to identify efavirenz poor metabolizers in patients co-treated with rifampin. © 2008 the American College of Clinical Pharmacology.
Predictors and outcome of systemic lupus erythematosus (SLE) admission rates in a large teaching hospital in sub-Saharan Africa
(Lupus, 2018-02) Dzifa, D.; Boima, V.; Yorke, E.; Yawson, A.; Ganu, V.; Mate-Kole, C.
Although it was previously believed that systemic lupus erythematosus was uncommon among Africans, it has become increasingly apparent that the incidence is higher, and socioeconomic challenges such as physician shortages, poor medical facility access, and poor health literacy may worsen prognosis. This retrospective study examines characteristics and outcomes of hospitalized systemic lupus erythematosus patients over a two-year period and serves as a baseline for comparison for future studies to examine the outcomes with the provision of more dedicated care. There were 51 patient admissions over a two-year period, with a mean duration from start of illness to admission of approximately two years. Duration of admission ranged from one to 140 days with a mean period of 26.12 days (SD ± 26.6). There were 22 deaths (43.1% of admissions), which were mainly due to infections and renal complications. Factors associated with risk of death in regression analysis were: infections, fever, disease flare, musculoskeletal involvement, amenorrhea, depression, a clinical finding of hepatomegaly, and chest infection. Understanding the effect and outcome of systemic lupus erythematosus across different countries can elucidate the role of genetic, environmental, and other causative factors in the progression of the disease.
Prevalence and determinants of depression among patients with hypertension: A cross-sectional comparison study in Ghana and Nigeria
(Nigerian Journal of Clinical Practice, 2019-04) Ademola, A.; Boima, V.; Odusola, A.; Agyekum, F.; Nwafor, C.; Salako, B.
Background: Despite evidence linking depression to poor blood pressure (BP) control and increased hypertension-related morbidity and mortality, there is paucity of data about depression among patients with hypertension in sub-Saharan Africa. We assessed factors associated with depression among patients with hypertension in Ghana and Nigeria. Subjects and Methods: Patients with hypertension were recruited from four hospitals: In Ghana, Korle Bu Teaching Hospital (n = 120), and in Nigeria, the University of Port Harcourt Teaching Hospital, the Lagos State General Hospital, and the University College Hospital Ibadan (n = 237). Demographic, socioeconomic, psychosocial, and clinical factors which predicted depression among the study cohort were assessed by logistic regression. Depression and beliefs about medications were assessed with the Patient Health Questionnaire (PHQ-9) and the Beliefs about Medication Questionnaire, respectively. Depression was regarded as PHQ-9 score >4. Results: The mean ages of the Ghanaian and Nigerian cohort were 57.0 ± 13.7 years (58.3% female) and 56.4 ± 12.9 years (57.0% female), respectively. Prevalence of depression was 41.7% and 26.6% among the Ghanaian and Nigerian cohorts, respectively. Significant predictors of depression in the Nigerian cohort were age in years [OR 0.97 (0.95-0.99)], concern about medications [OR 1.15 (1.03-1.30)], and poor BP control [OR 2.06 (1.09-3.88)]. Young age was the only independent predictor of depression in the Nigerian cohort. In the Ghanaian cohort, none of the factors significantly predicted depression. Conclusion: Prevalence of depression is high among patients with hypertension in Ghana and Nigeria. Screening and treatment of depression among patients with hypertension in Ghana and Nigeria may have important implications for improving outcomes.