Browsing by Author "Doku, A."

Now showing 1 - 15 of 15

Association between eNOS Gene Polymorphism (T786C and VNTR) and Sickle Cell Disease Patients in Ghana
(Diseases, 2018) Antwi-Boasiako, C.; Dzudzor, B.; Doku, A.; et al.
Endothelial nitric oxide synthase (eNOS) variants have been found to be associated with several vascular disorders as well as the pathogenesis of sickle cell disease (SCD) complications such as vaso-occlusive crises (VOC). Studies on eNOS gene variants among SCD patients are rare in Ghana and several other African countries. The current study aimed to determine a possible association between variants of the eNOS gene (variable number of tandem repeats in intron 4 and T786C) in SCD complications among Ghanaian patients. This was a cross-sectional study involving 89 HbSS patients with complications and 46 HbSS patients without complications. Genomic DNA was extracted from leukocytes in the buffy coat and separated from collected whole blood samples of the study participants. PCR amplification, followed by restriction fragment length polymorphism (RFLP) was used to genotype T786C (rs2070744) variants. Variable number of tandem repeats (VNTR) in intron 4 was genotyped by PCR and direct electrophoresis. There was a significant difference in the genotype frequency of the T786C variant between HbSS patients with complications and those without complications (p = 0.0165). However, there was no significant difference in the VNTR intron 4 variant of the eNOS gene between patients with complications and those without complications (p > 0.05). The study shows an association between the eNOS gene variant (T786C) and complications in SCD.
Cardiovascular Care in Africa – Cost Crisis and the Urgent Need for Contextual Health Service Solutions
(Global Heart, 2023) Akumiah, F.K.; Yakubu, A-S; Doku, A.; etc.
The 20th century marked a shift in the global disease burden profile with an epidemiological transition from infectious diseases to noncommunicable and degenerative diseases [1]. The rates of transition differed between regions and economic status, with economically backwards nations being saddled with a double burden of infectious and non-communicable diseases. Cardiovascular diseases (CVDs) predominated [2]. Africa encounters such a similar double disease burden. The CVD burden is increasing in Africa, threatening to derail the fragile current health system. The recent global, regional and country-specific economic crises have reduced household incomes, thereby reducing the access to and affordability of guideline-directed care for hypertension, dyslipidemia, diabetes, heart failure, ischemic heart disease, strokes, and the like.
Changes in origin of acute chest pain in a sub-Saharan African setting
(SAGE, 2022) Tettey, M.; Edwin, F.; Doku, A.; Ndanu, T.; Entsua-Mensah, K.; Adzamli, I.
Our aim was to demonstrate a shifting epidemiology of acute chest pain in Ghana. Efforts to increase physician awareness and best practices are urgently required. Patients presenting with acute chest pain to the two leading tertiary care centres in Accra were investigated
Contemporary aetiology of acute heart failure in a teaching hospital in Ghana
(BMC Cardiovascular Disorders, 2023) Agyekum, F.; Folson, A.A.; Asare, B.Y-A.; Doku, A.; Kpodonu, J.; Okine, R.; Fokuoh, F.; Akamah, J.A.
Background Heart failure (HF) is recognized as a global public health disease associated with high morbidity and mortality. It is suggested that the main underlying causes of HF in developing countries difer from those identifed in well-resourced countries. This study therefore presents the cardiovascular risk factors and the underlying aetiology of HF among admitted patients in a teaching Hospital in Ghana. Method The study prospectively recruited 140 consecutive patients admitted for heart failure at the Medical depart‑ ment of the Korle-Bu Teaching Hospital from March to October, 2014. The study evaluated the cardiovascular risk fac‑ tors and the aetiologies of heart failure, and compared the risk factors and aetiologies with patient’s age and gender. Results The mean age of the study participants was 51.3±16.8 years. The commonest cardiovascular risk factors observed were hypertension (46.5%), history of previous HF (40.7%), excessive alcohol use (38.6%), and family history of heart disease (29.3%); predominantly hypertension (68.3%). The major underlying aetiology of HF were dilated car‑ diomyopathy (38.6%), hypertensive heart disease (21.4%), ischaemic heart disease (13.6%) and valvular heart disease (12.9%). These underlying aetiology of HF were more common in patients aged 40 years and above (p=0.004) and those presenting with multiple risk factors (p=0.001). Conclusion The major underlying aetiology of heart failure in adults were dilated cardiomyopathy, hypertensive heart disease, ischaemic heart disease and valvular heart disease, which were signifcantly high among patients aged 40 years and above and those presenting multiple risk factors. Hypertension, excessive alcohol use, family history of heart disease and personal history of previous heart failure diagnosis are noted as the main cardiovascular risk factors among heart failure patients
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.
Electrical storm in a middle-aged man
(Ghana Medical Journal, 2023) Ahadzi, D.; Agyekum, F.; Doku, A.; et al.
Electrical storm (ES) refers to a life-threatening condition characterised by three or more episodes of ventricular tachycardia (VT), ventricular fibrillation (VF), or appropriate implantable cardioverter defibrillator (ICD) shocks in 24 hours. We report a case of a 58-year-old man who suffered recurrent episodes of sustained VT despite appropriate defibrillation and antiarrhythmic drug therapy. On stepwise evaluation, arrhythmogenic right ventricular cardiomyopathy (ARVC) was considered the most likely substrate for his dysrhythmia. He was managed conservatively on antiarrhythmic drugs with no further clinical episodes of VT, and ICD implantation for secondary prophylaxis was recommended.
Emerging trends of marketing surgical cases in Africa: Balancing health financing strategies exploitation and ethical concerns
(HSI Journal, 2024) Toboh, B.; Agyekum, F.; Doku, A.
The unmet health needs in African communities, especially for surgical interventions, have resulted in desperate attempts by families and groups to raise the necessary financial resources. Open marketing of illness and leveraging on empathy from communities deny the sufferers the dignity of humanity. This article delves into the evolving landscape of marketing surgical cases in Africa, examining its role as a health financing strategy and highlighting potential ethical concerns.
Hematological parameters in Ghanaian sickle cell disease patients
(Journal of Blood Medicine, 2018-10) Antwi-Boasiako, C.; Ekem, I.; Abdul-Rahman, M.; Sey, F.; Doku, A.; Dzudzor, B.; Dankwah, G.B.; Otu, K.H.; Ahenkorah, J.; Aryee, R.
Background: Effective treatment and management of sickle cell disease (SCD) has been a challenge in Africa over the years. Hematological parameters are very useful profiles in the effective management of the disease. However, there is scarcity of studies on the hematological parameters of SCD in Ghana. This study aimed at determining hematological parameters among SCD patients with vaso-occlusion, those in the steady state as well as healthy controls at a teaching hospital in Ghana. Methodology: This was a cross-sectional study involving a total of 628 subjects, including 148 HbAA controls, 208 HbSS patients in steady state, 82 HbSC patients in steady state, 156 HbSS patients in vaso-occlusive crises (VOC), and 34 HbSC patients in VOC. Venous blood sample was collected from all study participants. A full blood count was done within 2 hours of collection, and hemoglobin (Hb) concentration, packed cell volume, red blood cell (RBC) concentration, mean corpuscular Hb, mean cell volume, mean corpuscular Hb concentration, and white blood cells (WBC) and platelet (PLT) counts were recorded. Results: WBC and PLT counts were significantly higher in both female and male patients with SCD, compared with their healthy counterparts (P<0.05). The level of WBC was, however, significantly higher in patients with HbSS VOC among the SCD patients (P<0.001). Levels of Hb, RBC, and hematocrit were significantly higher in the controls (P<0.001). There was no significant difference in mean cell Hb among male patients with SCD (P=0.274) and female patients with SCD (P=0.5410). Conclusion: The SCD patients had lower Hb and RBC than the controls; however, higher PLT and WBC are noted in various status of SCD, possibly reflecting spleen effect in these patients. Further studies are needed to confirm these findings.
Indications for and the diagnostic yield of 24-hour Holter monitoring: a prospective study at the Korle Bu Teaching Hospital
(Ghana Medical Journal, 2018-12) Doku, A.; Ndanu, T.A.; Asare, B.Y.A.; Antwi-Boasiako, C.; Kpodonu, J.
Background: Holter monitoring (HM) is an important tool used to evaluate symptoms suspected to be caused by arrhythmias. This study was aimed at determining the diagnostic yield of Holter monitoring among symptomatic and asymptomatic patients undergoing HM at the Korle-Bu Teaching Hospital. Methods: This was a prospective study among 400 consecutive symptomatic and asymptomatic patients undergoing HM from August 2006 to December, 2009 at the Korle-Bu Teaching Hospital. Data from the Holter study were analyzed, and symptoms linked to arrhythmias were evaluated to determine the diagnostic yield of HM in symptomatic and asymptomatic patients. Results: The mean age of the patients was 51.81 ± 16 years. The most common indications (symptoms) for HM were palpitation (62.9%) and dizziness (34.0%); about half (53.3%) of the symptomatic patients had only one indication. Among the symptomatic group, 28 in 115 symptoms were linked to arrhythmias giving a diagnostic yield of 24.3% whereas in the asymptomatic group 1 in 33 of symptom was linked to arrhythmia giving a diagnostic yield of 3.0%. The study found an overall diagnostic yield of 19.6%. Conclusion: HM as a regular health check for the general population (asymptomatic cohorts) is not cost effective and does not provide significant data to influence care except when the subject is found to have symptoms.
A multilevel and multicenter assessment of health care system capacity to manage cardiovascular diseases in Africa: a baseline study of the Ghana Heart Initiative
(BMC Cardiovascular Disorders, 2023) Doku, A.; Tuglo, L.S.; Chilunga, F.; et al
Introduction Cardiovascular diseases (CVD) remain the leading cause of death worldwide, with over 70% of these deaths occurring in low- and middle-income regions such as Africa. However, most countries in Africa do not have the capacity to manage CVD. The Ghana Heart Initiative has been an ongoing national program since 2018, aimed at improving CVD care and thus reducing the death rates of these diseases in Ghana. This study therefore aimed at assessing the impact of this initiative by identifying, at baseline, the gaps in the management of CVDs within the health system to develop robust measures to bolster CVD management and care in Ghana. Methods This study employed a cross-sectional study design and was conducted from November 2019 to March 2020 in 44 health facilities in the Greater Accra region. The assessment covered CVD management, equipment availability, knowledge of health workers in CVD and others including the CVD management support system, availability of CVD management guidelines and CVD/NCD indicators in the District Health Information Management System (DHIMS2). Results The baseline data showed a total of 85,612 outpatient attendants over the period in the study facilities, 70% were women and 364(0.4%) were newly diagnosed with hypertension. A total of 83% of the newly diagnosed hypertensives were put on treatment, 56.3% (171) continued treatment during the study period and less than 10% (5%) had their blood pressure controlled at the end of the study (in March 2020). Other gaps identified included suboptimal health worker knowledge in CVD management (mean score of 69.0 ± 13.0, p < 0.05), lack of equipment for prompt CVD emergency diagnosis, poor management and monitoring of CVD care across all levels of health care, lack of standardized protocol on CVD management, and limited number of indicators on CVD in the National Database (i.e., DHIMS2) for CVD monitoring. Conclusion This study shows that there are gaps in CVD care and therefore, there is a need to address such gaps to improve the capacity of the health system to effectively manage CVDs in Ghana.
Outcome of life‑threatening arrhythmias among patients presenting in an emergency setting at a tertiary hospital in Accra‑Ghana
(Doku et al. BMC Cardiovascular Disorders, 2022) Doku, A.; Asare, B.Y.A.; Osei, R.; Owoo, C.; Aniteye, E.; et al.
Abstract Background: Management of life-threatening arrhythmia can be incredibly challenging in advanced health systems. In sub-Saharan Africa (SSA), this is likely more challenging because of weak pre-hospital and in-hospital critical care systems. Little is known about life-threatening arrhythmia and their outcomes in SSA. The aim of this study was to examine the types and outcomes of arrhythmias among haemodynamically unstable patients presenting at a tertiary hospital in Accra-Ghana. Method: This was a retrospective case series study conducted at the Korle-Bu Teaching Hospital (KBTH), Accra- Ghana. Medical records of patients who presented with or developed haemodynamically unstable arrhythmias within 24h of admission from January 2018 to December 2020 were reviewed. The demographic characteristics and clinical data including outcomes of patients were collected. Descriptive statistics were used and results presented in frequency tables. Results: A total of 42 patients with life-threatening arrhythmias were included. Haemodynamically unstable tachyarrhythmias were the most common arrhythmias found among the patients (66.7%). Approximately 52% of patients had structural heart diseases whereas 26.2% had no apparent underlying cause or predisposing factor. Cardioversion (52.4%), commonly electrical (63.6%), and transvenous pacemaker implantation (23.8%) were the common initial interventions. The majority of the patients (88.1%) survived and were discharged home. Conclusion: Tachyarrhythmias are the most common haemodynamically unstable arrhythmias seen among patients presenting emergently in a leading tertiary hospital in Ghana. A high survival rate was observed and cannot be extrapolated to other healthcare settings in sub-Saharan Africa with limited resources to manage these clinical entities.
Outcome of Thrombolysis for Massive Pulmonary Embolism
(Ghana Medical Journal, 2009-03) Aniteye, E; Tettey, M.; Sereboe, L.; Edwin, F.; Kotei, D.; Doku, A.; Tamatey, M.; Enstuah- Mensah, K.; Delia, I.; Frimpong-Boateng, K.
Background: Deep vein thrombosis is increasingly being diagnosed in Ghana. The commonest complication that leads to death is pulmonary embolism. The mortality rate from massive pulmonary embolism is high even with intervention. Thrombolysis is recommended in massive embolism. Objective: To determine the outcome of thrombolysis in the management of massive pulmonary embolism in patients admitted to the Cardiothoracic Intensive Care unit. Method: A retrospective audit of the patients who were admitted to the Intensive care unit of the National Cardiothoracic centre with a diagnosis of massive pulmonary embolism between 1st January 2003 and 31st September 2007. Results: Seventeen patients were admitted with the diagnosis of massive pulmonary embolism of which 14 were thrombolysed. Commonest clinical presentations were dyspnoea in 17(100.0%) and hypotension in 12(70.3%) of the patients. Streptokinase was used in 13(92.9%) and urokinase in 1(7.1%) of the patients. The main complications of thrombolysis were bleeding in 12(85.7%), hypotension in 10(71.4%) and nausea and vomiting in 7(50.0%) of the patients. Postthrombolysis, the respiratory function deteriorated in 12 (85.7%) of the patients which required mechanical ventilation. The overall mortality rate was 35.3%. Three patients died before thrombolysis. Of the 14 (82.4%) who were thrombolysed 3(21.4%) died within 8 hours. Conclusion: The mortality rate of patients with massive pulmonary embolism is high even after thrombolysis. The commonest complication of thrombolysis was bleeding.
Prevalence of Cardiovascular Disease and Risk Factors in Ghana: A Systematic Review and Meta-analysis
(Global Heart., 2024) Doku, A.; Tuglo, L.S.; Boima, V.; et al.
Background: The increasing cardiovascular disease (CVD) burden threatens the global population as the major cause of disability and premature death. Data are scarce on the magnitude of CVD among the population in West Africa, particularly in Ghana. This study examined the available scientific evidence to determine the pooled prevalence (PP) of CVD and risk factors in Ghana. Methods: We searched electronic databases such as PubMed, Google Scholar, the Cochrane Library, Science Direct and Africa Journal Online databases to identify literature published from the start of the indexing of the database to 10th February 2023. All articles published in the English language that assessed the prevalence of CVD or reported on CVD in Ghana were included. Two authors independently performed the study selection, assessed the risk of bias, extracted the data and checked by the third author. The effect sizes and pooled odds ratio (POR) were determined using the random-effects DerSimonian-Laird (DL) model. Result: Sixteen studies with 58912 participants from 1954 to 2022 were included in the meta-analysis. Six studies out of 16 reported more than one prevalence of CVD, giving a total of 59 estimates for PP. The PP of CVD in the general population in Ghana was 10.34% (95% Cl: [8.48, 12.20]; l2 99.54%, p < 0.001). Based on the subgroup analysis, the prevalence of CVD was higher in hospital-based settings at 10.74% (95%, confidence interval [Cl]: 8.69, 12.79) than in community-based settings at 5.04% (95% Cl: 2.54, 7.53). The risk factors were male gender (pooled odds ratio [POR]: 1.66; 95% CI: 1.02, 2.70), old age (POR: 1.32; 95% CI: 1.21, 1.45), unemployment (POR: 2.62; 95% CI: 1.33, 5.16), diabetes (POR: 2.79; 95% CI: 1.62, 4.81) and hypertension (POR: 3.41; 95% CI: 1.75, 6.66). Conclusion: The prevalence of CVD was high in Ghana. Urgent interventions are needed for the prevention and management of the high burden of CVD and its risk factors
Serum iron levels and copper-to-zinc ratio in sickle cell disease
(Medicina (Lithuania), 2019-05-16) Antwi-Boasiako, C.; Dankwah, G.B.; Aryee, R.; Hayfron-Benjamin, C.; Doku, A.; N’guessan, B.B.; Asiedu-Gyekye, I.J.; Campbell, A.D.
Background and Objectives: Altered copper and zinc homeostasis may influence the antioxidant defense system and consequently lead to oxidative stress and associated complications in sickle cell disease (SCD) patients. Iron levels have been reported to increase in sickle cell patients due to frequent blood transfusion, chronic intravenous haemolysis and increased absorption of iron from the gastrointestinal tract. These elevated levels of iron may also lead to extensive oxidative damage. The current study evaluated serum levels of iron, copper and zinc in SCD patients and "healthy" controls. Materials and Methods: The study was a cross-sectional one, comprising 90 SCD patients with Haemoglobin SS and Haemoglobin SC genotypes and 50 HbAA "healthy" controls. Serum levels of iron, copper and zinc were measured using a Flame Atomic Absorption Spectrometer (Variant 240FS manufactured by VARIAN Australia Pty Ltd, VIC, Australia). Copper and zinc ratios were calculated and analyzed. Results: Serum levels of iron and copper were significantly elevated in the SCD patients, compared to their "healthy" counterparts (p < 0.001). These levels were further increased in patients with haemoglobin SS in vaso-occlusive crises (HbSS VOCs). Serum zinc levels were, however, significantly lower in the SCD patients, particularly during vaso-occlusion. The copper-to-zinc ratio was also found to be significantly higher in the SCD patients. Conclusion: Elevated copper-to-zinc ratio may be a biomarker of sickle cell oxidative stress and associated complications. The ratio may also be informative for the management of sickle cell oxidative burden. The significantly lower levels of zinc in the SCD patients may warrant zinc supplementation.
Synchronised Cardioversion for Chronic Atrail Fibrillation
(Ghana Medical Journal, 2008-03) Aniteye, E.; Kotei, D.; Tettey, M.; Sereboe, L.; Edwin, F.; Doku, A.; Tamatey, M.; Entsuah- Mensah, K.; Batista, S.; Frimpong-Boateng, K.
Objective: To determine whether elective cardioversion was successful in establishing sinus rhythm in patients with chronic atrial fibrillation and the energy used for the cardioversion using a monophasic defibrillator. Design: This is a retrospective descriptive study. Setting: Intensive care unit of the National Cardiothoracic Centre, Korle-bu Teaching Hospital. Subjects: Twelve consecutive patients referred by physicians with chronic atrial fibrillation which had not responded appropriately to pharmacological agents. Method: Using the intensive care admissions and discharge register and report book, the patients case notes were retrieved. The pre-cardioversion echocardiography diagnosis and drugs were noted. The results of cardioversion, and the current rhythm status were also reviewed. Results: There were twelve elective cardioversions for chronic atrial fibrillation during the period under investigation. All the patients were on warfarin with INR- 2.2-2.8. Eight of the patients had initial echocardiographic evidence of thrombi in the left atrium. Sinus rhythm was established in 9(75%) of the patients. The mean energy used for the cardioversion was 384.4+167.7J. Of the 3 with failed cardioversion, one was later successfully cardioverted to sinus rhythm. On review, 9(75%) of the patients are still in sinus rhythm 6 months to 15 months after cardioversion. Six of these patients continue with oral amiodarone however. Conclusion: Synchronized cardioversion for chronic atrial fibrillation is safe and may be successful after failure of pharmacologic cardioversion in patients where sinus rhythm is desirable.