Browsing by Author "Enweronu-Laryea, C."
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Item 3.6 Million Neonatal Deaths-What Is Progressing and What Is Not?(Seminars in Perinatology, 2010-12) Lawn, J.E.; Kerber, K.; Enweronu-Laryea, C.; Cousens, S.Each year 3.6 million infants are estimated to die in the first 4 weeks of life (neonatal period)-but the majority continue to die at home, uncounted. This article reviews progress for newborn health globally, with a focus on the countries in which most deaths occur-what data do we have to guide accelerated efforts? All regions are advancing, but the level of decrease in neonatal mortality differs by region, country, and within countries. Progress also differs by the main causes of neonatal death. Three major causes of neonatal deaths (infections, complications of preterm birth, and intrapartum-related neonatal deaths or "birth asphyxia") account for more than 80% of all neonatal deaths globally. The most rapid reductions have been made in reducing neonatal tetanus, and there has been apparent progress towards reducing neonatal infections. Limited, if any, reduction has been made in reducing global deaths from preterm birth and for intrapartum-related neonatal deaths. High-impact, feasible interventions to address these 3 causes are summarized in this article, along with estimates of potential for lives saved. A major gap is reaching mothers and babies at birth and in the early postnatal period. There are promising community-based service delivery models that have been tested mainly in research studies in Asia that are now being adapted and evaluated at scale and also being tested through a network of African implementation research trials. To meet Millennium Development Goal 4, more can and must be done to address neonatal deaths. A critical step is improving the quantity, quality and use of data to select and implement the most effective interventions and strengthen existing programs, especially at district level. © 2010 Elsevier Inc.Item Amikacin Treatment With or Without Aminophylline in Neonates with Suspected Sepsis at Korle-Bu Teaching Hospital: A Pharmacokinetic and Pharmacodynamic Study(University of Ghana, 2015-07) Amponsah, S. K.; Obeng Adjei, G.; Kurtzhals, J.; Enweronu-Laryea, C.; University of Ghana, College of Health Sciences, School of Pharmacy, Department of Pharmacology and ToxicologyBackground: Sepsis is a major cause of death among neonates. In neonates, symptoms of sepsis are often non-specific and diagnosis requires a high index of suspicion. Thus, the role of additional diagnostic markers is important. Amikacin is used as first-line treatment of neonatal sepsis and it is usually co-administered with aminophylline in preterm neonates in Ghana. Amikacin dosing is well established, however, optimal effect requires specific dose titration and maintenance therapy should be individualized. Aim: To describe the PK and evaluate selected aspects of the PD of amikacin in neonates with suspected sepsis. Methods: Neonates with suspected sepsis (n=322) and requiring amikacin or amikacin with aminophylline treatment were recruited at the Neonatal Intensive Care Unit, Korle-Bu Teaching Hospital, Ghana. Admission clinical and demographic information was collected, using case record forms. Blood culture and sensitivity, selected hematological (FBC), and biochemical [urea, creatinine, total bilirubin, C-reactive protein (CRP) and procalcitonin (PCT)] parameters were measured before treatment. A standard dose of amikacin was administered as per local guidelines. Brainstem auditory evoked potential was done before treatment commencement and seven days later in a randomly selected group of neonates. Serum amikacin concentration was measured at specified times after treatment initiation and amikacin concentration data was analyzed, using population PK modeling. Results: A total of 163 (50.6%) of admitted neonates were born preterm, of which 14 (4.3%) were extreme preterm. A total of 79 (24.5%) had signs/symptoms consistent with birth asphyxia. There was 13.6% (41/302) culture positivity. Among neonates categorized as having ―highly probable‖, ―probable‖ or ―less probable‖ sepsis, mean PCT was significantly different (P<0.001). The sensitivity, PPV, NPV and AUC was higher compared with CRP. The proportion of neonates with elevated PCT on admission was significantly higher in the ―highly probable‖ group compared with the ―probable group‖ [91% (20/22 versus 31.6% (6/19), p<0.001]. Overall mortality was 12%, with case fatality being highest among extreme preterms or those with birth weight less than 1 kg, or with elevated PCT. A total of 419 plasma concentration profile data was available for 247 neonates for population pharmacokinetic modeling. A one-compartment model best fitted amikacin disposition. The mean peak amikacin serum concentration was 20.56+8.7 μg/mL, and trough 6.68+3.86 μg/mL. Neonates administered amikacin with or without aminophylline showed varying CL and V, but with a high BSV, suggesting possible lack of effect of aminophylline co-administration on amikacin disposition. The population clearance (CL), and volume of distribution (V) of amikacin were related as: CL = 0.153 (birth weight/2.5)1.31, V = 2.94 (birth weight/2.5)1.18, with 58.9 and 50.7% between-subject variability in clearance and volume, respectively. Mean half-life (t1/2) of amikacin was 13.6 hours. There was no difference in the baseline and follow-up BAEP of neonates who received amikacin and those who did not. Conclusion: Birth weight was an important predictor of amikacin CL and V. Co-administration of aminophylline with amikacin did not influence the pharmacokinetics of amikacin. There was a relatively large V and long t1/2 of amikacin in recruited neonates. No difference existed in baseline and follow-up BAEP results of neonates treated with amikacin, although one subject showed a high BAEP threshold post-amikacin dose. PCT was a more sensitive marker than CRP in the diagnosis of early onset neonatal sepsis.Item Antibiotic prescribing in paediatric inpatients in Ghana: a multi-centre point prevalence survey(BMC Pediatrics, 2018-12) Labi, A.K.; Obeng-Nkrumah, N.; Sunkwa-Mills, G.; Bediako-Bowan, A.; Akufo, C.; Bjerrum, S.; Owusu, E.; Enweronu-Laryea, C.; Opintan, J.A.; Kurtzhals, J.A.L.; Newman, M.J.Background Excessive and inappropriate use of antibiotics in hospitalised patients contributes to the development and spread of antibiotic resistance. Implementing a stewardship programme to curb the problem requires information on antibiotic use. This study describes a multicentre point prevalence of antibiotic use among paediatric inpatients in Ghana. Methods Data were extracted from a multicentre point prevalence survey of hospital acquired infections in Ghana. Data were collected between September 2016 and December 2016 from ten hospitals through inpatient folder and chart reviews using European Centre for Disease Control (ECDC) adapted data collection instrument. From each site, data were collected within a 12-h period (8 am to 8 pm) by a primary team of research investigators and a select group of health professionals from each participating hospital. Results Among 716 paediatric inpatients, 506 (70.6%; 95% confidence interval (CI): 67.2 to 74.0%) were on antibiotics. A significant proportion of antibiotics (82.9%) was prescribed for infants compared to neonates (63.9%) and adolescents (60.0%). The majority of patients (n = 251, 49.6%) were prescribed two antibiotics at the time of the survey. The top five classes of antibiotics prescribed were third generation cephalosporins (n = 154, 18.5%) aminoglycosides (n = 149, 17.9%), second generation cephalosporins (n = 103,12.4%), beta lactam resistant penicillins (n = 83, 10.0%) and nitroimidazoles (n = 82, 9.9%). The majority of antibiotics (n = 508, 61.0%) were prescribed for community acquired infections. The top three agents for managing community acquired infections were ceftriaxone (n = 97, 19.1%), gentamicin (n = 85, 16.7%) and cefuroxime (n = 73, 14.4%). Conclusion This study points to high use of antibiotics among paediatric inpatients in Ghana. Cephalosporin use may offer an important target for reduction through antibiotic stewardship programmes.Item Basic newborn care and neonatal resuscitation: a multi-country analysis of health system bottlenecks and potential solution(BMC Pregnancy and Childbirth, 2015-09) Enweronu-Laryea, C.; Dickson, K.E.; Moxon, S.G.; Simen-Kapeu, A.; Nyange, C.; Niermeyer, S.; Bégin, F.; Sobel, H.L.; Lee, A.C.C.; von Xylander, S.R.; Lawn, J.E.Background: An estimated two-thirds of the world's 2.7 million newborn deaths could be prevented with quality care at birth and during the postnatal period. Basic Newborn Care (BNC) is part of the solution and includes hygienic birth and newborn care practices including cord care, thermal care, and early and exclusive breastfeeding. Timely provision of resuscitation if needed is also critical to newborn survival. This paper describes health system barriers to BNC and neonatal resuscitation and proposes solutions to scale up evidence-based strategies. Methods: The maternal and newborn bottleneck analysis tool was applied by 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" that hinder the scale up of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for BNC and neonatal resuscitation. Results: Eleven of the 12 countries provided grading data. Overall, bottlenecks were graded more severely for resuscitation. The most severely graded bottlenecks for BNC were health workforce (8 of 11 countries), health financing (9 out of 11) and service delivery (7 out of 9); and for neonatal resuscitation, workforce (9 out of 10), essential commodities (9 out of 10) and service delivery (8 out of 10). Country teams from Africa graded bottlenecks overall more severely. Improving workforce performance, availability of essential commodities, and well-integrated health service delivery were the key solutions proposed. Conclusions: BNC was perceived to have the least health system challenges among the seven maternal and newborn intervention packages assessed. Although neonatal resuscitation bottlenecks were graded more severe than for BNC, similarities particularly in the workforce and service delivery building blocks highlight the inextricable link between the two interventions and the need to equip birth attendants with requisite skills and commodities to assess and care for every newborn. Solutions highlighted by country teams include ensuring more investment to improve workforce performance and distribution, especially numbers of skilled birth attendants, incentives for placement in challenging settings, and skills-based training particularly for neonatal resuscitation. (PDF) Basic newborn care and neonatal resuscitation: A multi-country analysis of health system bottlenecks and potential solutions. Available from: https://www.researchgate.net/publication/281749399_Basic_newborn_care_and_neonatal_resuscitation_A_multi-country_analysis_of_health_system_bottlenecks_and_potential_solutions [accessed Sep 14 2018].Item Basic newborn care and neonatal resuscitation: A multi-country analysis of health system bottlenecks and potential solutions(BioMed Central Ltd., 2015) Enweronu-Laryea, C.; Dickson, K.E.; Moxon, S.G.; Simen-Kapeu, A.; Nyange, C.; Niermeyer, S.; Bégin, F.; Sobel, H.L.; Lee, A.C.C.; von Xylander, S.R.; Lawn, J.E.Item Core temperature after birth in babies with neonatal encephalopathy in a sub-Saharan African hospital setting(Journal of Physiology, 2019-06-15) Enweronu-Laryea, C.; Martinello, K.A.; Rose, M.; Manu, S.; Tann, C.J.; Meek, J.; Ahor-Essel, K.; Boylan, G.B.; Robertson, N.J.Neonatal encephalopathy (NE) is a significant worldwide problem with the greatest burden in sub‐Saharan Africa. Therapeutic hypothermia (HT), comprising the standard of care for infants with moderate‐to‐severe NE in settings with sophisticated intensive care, is not available to infants in many sub‐Saharan African countries, including Ghana. We prospectively assessed the temperature response in relation to outcome in the 80 h after birth in a cohort of babies with NE undergoing ‘facilitated passive cooling’ at Korle Bu Teaching Hospital, Accra, Ghana. We hypothesized that NE infants demonstrate passive cooling. Thirteen infants (69% male) ≥36 weeks with moderate‐to‐severe NE were enrolled. Ambient mean ± SD temperature was 28.3 ± 0.7°C. Infant core temperature was 34.2 ± 1.2°C over the first 24 h and 35.0 ± 1.0°C over 80 h. Nadir mean temperature occurred at 15 h. Temperatures were within target range for HT with respect to 18 ± 14% of measurements within the first 72 h. Axillary temperature was 0.5 ± 0.2°C below core. Three infants died before discharge. Core temperature over 80 h for surviving infants was 35.3 ± 0.9°C and 33.96 ± 0.7°C for those that died (P = 0.043). Temperature profile negatively correlated with Thompson NE score on day 4 (r 2 = 0.66): infants with a Thompson score of 0–6 had higher temperatures than those with a score of 7–15 (P = 0.021) and a score of 16+/deceased (P = 0.007). More severe NE was associated with lower core temperatures. Passive cooling is a physiological response after hypoxia–ischaemia; however, the potential neuroprotective effect of facilitated passive cooling is unknown. An awareness of facilitated passive cooling in babies with NE is important for the design of clinical trials of neuroprotection in low and mid resource settings.Item Count every newborn; A measurement improvement roadmap for coverage data(BioMed Central Ltd., 2015) Moxon, S.G.; Ruysen, H.; Kerber, K.J.; Amouzou, A.; Fournier, S.; Grove, J.; Moran, A.C.; Vaz, L.M.E.; Blencowe, H.; Conroy, N.; Gülmezoglu, A.M.; Vogel, J.P.; Rawlins, B.; Sayed, R.; Hill, K.; Vivio, D.; Qazi, S.A.; Sitrin, D.; Seale, A.C.; Wall, S.; Wall, S.; Jacobs, T.; Ruiz Peláez, J.G.; Guenther, T.; Coffey, P.S.; Dawson, P.; Marchant, T.; Waiswa, P.; Deorari, A.; Enweronu-Laryea, C.; Arifeen, S.E.; Lee, A.C.C.; Mathai, M.; Lawn, J.E.Background: The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. Methods: In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. Results: ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. Conclusions: The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.Item Count every newborn; a measurement improvement roadmap for coverage data(BMC Pregnancy and Childbirth, 2015-09) Moxon, S.G.; Ruysen, H.; Kerber, K.J.; Amouzou, A.; Fournier, S.; Grove, J.; Moran, A.C.; Vaz, L.M.E.; Blencowe, H.; Conroy, N.; Gülmezoglu, A.M.; Vogel, J.P.; Rawlins, B.; Sayed, R.; Hill, K.; Vivio, D.; Qazi, S.A.; Sitrin, D.; Seale, A.C.; Wall, S.; Jacobs, T.; Ruiz Peláez, J.G.; Guenther, T.; Coffey, P.S.; Dawson, P.; Marchant, T.; Waiswa, P.; Deorari, A.; Enweronu-Laryea, C.; Arifeen, S.E.; Lee, A.C.C.; Mathai, M.; Lawn, J.E.BACKGROUND: The Every Newborn Action Plan (ENAP), launched in 2014, aims to end preventable newborn deaths and stillbirths, with national targets of ≤12 neonatal deaths per 1000 live births and ≤12 stillbirths per 1000 total births by 2030. This requires ambitious improvement of the data on care at birth and of small and sick newborns, particularly to track coverage, quality and equity. METHODS: In a multistage process, a matrix of 70 indicators were assessed by the Every Newborn steering group. Indicators were graded based on their availability and importance to ENAP, resulting in 10 core and 10 additional indicators. A consultation process was undertaken to assess the status of each ENAP core indicator definition, data availability and measurement feasibility. Coverage indicators for the specific ENAP treatment interventions were assigned task teams and given priority as they were identified as requiring the most technical work. Consultations were held throughout. RESULTS: ENAP published 10 core indicators plus 10 additional indicators. Three core impact indicators (neonatal mortality rate, maternal mortality ratio, stillbirth rate) are well defined, with future efforts needed to focus on improving data quantity and quality. Three core indicators on coverage of care for all mothers and newborns (intrapartum/skilled birth attendance, early postnatal care, essential newborn care) have defined contact points, but gaps exist in measuring content and quality of the interventions. Four core (antenatal corticosteroids, neonatal resuscitation, treatment of serious neonatal infections, kangaroo mother care) and one additional coverage indicator for newborns at risk or with complications (chlorhexidine cord cleansing) lack indicator definitions or data, especially for denominators (population in need). To address these gaps, feasible coverage indicator definitions are presented for validity testing. Measurable process indicators to help monitor health service readiness are also presented. A major measurement gap exists to monitor care of small and sick babies, yet signal functions could be tracked similarly to emergency obstetric care. CONCLUSIONS: The ENAP Measurement Improvement Roadmap (2015-2020) outlines tools to be developed (e.g., improved birth and death registration, audit, and minimum perinatal dataset) and actions to test, validate and institutionalise proposed coverage indicators. The roadmap presents a unique opportunity to strengthen routine health information systems, crosslinking these data with civil registration and vital statistics and population-based surveys. Real measurement change requires intentional transfer of leadership to countries with the greatest disease burden and will be achieved by working with centres of excellence and existing networks.Item Etiology of severe acute watery diarrhea in children in the global rotavirus surveillance network using quantitative polymerase chain reaction(Journal of Infectious Diseases, 2017) Operario, D.J.; Platts-Mills, J.A.; Nadan, S.; Page, N.; Seheri, M.; Mphahlele, J.; Praharaj, I.; Kang, G.; Araujo, I.T.; Leite, J.P.G.; Cowley, D.; Thomas, S.; Kirkwood, C.D.; Dennis, F.; Armah, G.; Mwenda, J.M.; Wijesinghe, P.R.; Rey, G.; Grabovac, V.; Berejena, C.; Simwaka, C.J.; Uwimana, J.; Sherchand, J.B.; Thu, H.M.; Galagoda, G.; Bonkoungou, I.J.O.; Jagne, S.; Tsolenyanu, E.; Enweronu-Laryea, C.; Borbor, S.A.; Liu, J.; McMurry, T.; Lopman, B.; Parashar, U.; Gentsch, J.; Steele, A.D.; Cohen, A.; Serhan, F.; Houpt, E.R.Background. The etiology of acute watery diarrhea remains poorly characterized, particularly after rotavirus vaccine introduction. Methods. We performed quantitative polymerase chain reaction for multiple enteropathogens on 878 acute watery diarrheal stools sampled from 14 643 episodes captured by surveillance of children <5 years of age during 2013-2014 from 16 countries. We used previously developed models of the association between pathogen quantity and diarrhea to calculate pathogen-specific weighted attributable fractions (AFs). Results. Rotavirus remained the leading etiology (overall weighted AF, 40.3% [95% confidence interval {CI}, 37.6%-44.3%]), though the AF was substantially lower in the Americas (AF, 12.2 [95% CI, 8.9-15.6]), based on samples from a country with universal rotavirus vaccination. Norovirus GII (AF, 6.2 [95% CI, 2.8-9.2]), Cryptosporidium (AF, 5.8 [95% CI, 4.0-7.6]), Shigella (AF, 4.7 [95% CI, 2.8-6.9]), heat-stable enterotoxin-producing Escherichia coli (ST-ETEC) (AF, 4.2 [95% CI, 2.0-6.1]), and adenovirus 40/41 (AF, 4.2 [95% CI, 2.9-5.5]) were also important. In the Africa Region, the rotavirus AF declined from 54.8% (95% CI, 48.3%-61.5%) in rotavirus vaccine age-ineligible children to 20.0% (95% CI, 12.4%-30.4%) in age-eligible children. Conclusions. Rotavirus remained the leading etiology of acute watery diarrhea despite a clear impact of rotavirus vaccine introduction. Norovirus GII, Cryptosporidium, Shigella, ST-ETEC, and adenovirus 40/41 were also important. Prospective surveillance can help identify priorities for further reducing the burden of diarrhea. © The Author 2017.Item Evaluating the effectiveness of a strategy for teaching neonatal resuscitation in West Africa(Resuscitation, 2009-08) Enweronu-Laryea, C.; Engmann, C.; Osafo, A.; Bose, C.Aim: To evaluate the effectiveness of a strategy for teaching neonatal resuscitation on the cognitive knowledge of health professionals who attend deliveries in Ghana, West Africa. Methods: Train-the-trainer model was used to train health professionals at 2-3 day workshops from 2003 to 2007. Obstetric Anticipatory Care and Basic Neonatal Care modules were taught as part of Neonatal Resuscitation Training package. American Neonatal Resuscitation Program was adapted to the clinical role of participants and local resources. Cognitive knowledge was evaluated by written pre- and post-training tests. Results: The median pre-training and post-training scores were 38% and 71% for midwives, 43% and 81% for nurses, 52% and 90% for nurse anaesthetists, and 62% and 98% for physicians. All groups of the 271 professionals (18 nurse anaesthetists, 55 nurses, 68 physicians, and 130 midwives) who completed the course showed significant improvement (p < 0.001) in median post-training test scores. Midwives at primary health care facilities were less likely to achieve passing post-test scores than midwives at secondary and tertiary facilities [35/53 vs. 24/26 vs. 45/51 (p = 0.004)] respectively. Conclusion: Evidence-based neonatal resuscitation training adapted to local resources significantly improved cognitive knowledge of all groups of health professionals. Further modification of training for midwives working at primary level health facilities and incorporation of neonatal resuscitation in continuing education and professional training programs are recommended. © 2009 Elsevier Ireland Ltd.Item Hand hygiene practices in a neonatal intensive care unit in Ghana(Journal Infect. Dev. Ctries, 2009) Newman, M.J.; Asare; Enweronu-Laryea, C.Item Incidence and risk factors of retinopathy of prematurity in Korle-Bu Teaching Hospital a baseline prospective study(BMJ, 2020-08) Braimah, I.Z.; Enweronu-Laryea, C.; Sackey, A.Objective To determine the incidence of retinopathy of prematurity (ROP) and any associated risk factors among preterm infants at the Neonatal Intensive Care Unit (NICU) of Korle-Bu Teaching Hospital (KBTH). Design Prospective study. Setting Level 3 NICU of KBTH from June 2018 to February 2019. Participants Eligible infants with birth weight (BW) less than 2 kg or gestational age (GA) less than 37 weeks were examined at scheduled intervals until full maturity of their retina. Outcome measures The primary outcome measure was cumulative incidence of ROP and secondary outcome measure was risk factors associated with ROP. Results Of the 401 infants, 222 were females (55.4%), mean±SD GA was 32.3±2.4 weeks (median 32, IQR 31 to 34) and mean BW 1.6±0.4 kg (median 1.5, IQR 1.3 to 1.9). The cumulative incidence of ROP was 13.7% (95% CI: 10.5 to 17.5%), with 1.8% (seven infants) having type 1 ROP. Increased risk of ROP was observed in babies with supplemental oxygen exposure (p<0.001), BW less than 1.5 kg (p=0.019), confirmed neonatal sepsis (p=0.001), nasogastric tube feeding (p=0.03) and poor pupillary dilation (0.032). A reduced risk of ROP was observed in boys (p=0.004) and after delivery by caesarean section (p=0.019). Conclusion The rates of ROP at KBTH are comparable to other NICUs in sub-Saharan Africa. Birth weight less than 1.5 kg, confirmed neonatal sepsis, nasogastric tube feeding and poor pupil dilation were independently associated with increased incidence of ROP. ROP screening should be a part of the routine service for premature infants in Ghana.Item Neonatal bloodstream infections in a Ghanaian Tertiary Hospital: Are the current antibiotic recommendations adequate?(BioMed Central Ltd., 2016) Labi, A.-K.; Obeng-Nkrumah, N.; Bjerrum, S.; Enweronu-Laryea, C.; Newman, M.J.Background: Diagnosis of bloodstream infections (BSI) in neonates is usually difficult due to minimal symptoms at presentation; thus early empirical therapy guided by local antibiotic susceptibility profile is necessary to improve therapeutic outcomes. Methods: A review of neonatal blood cultures submitted to the microbiology department of the Korle-Bu Teaching Hospital was conducted from January 2010 through December 2013. We assessed the prevalence of bacteria and fungi involved in BSI and the susceptibility coverage of recommended empiric antibiotics by Ghana Standard Treatment guidelines and the WHO recommendations for managing neonatal sepsis. The national and WHO treatment guidelines recommend either ampicillin plus gentamicin or ampicillin plus cefotaxime for empiric treatment of neonatal BSI. The WHO recommendations also include cloxacillin plus gentamicin. We described the resistance profile over a 28-day neonatal period using multivariable logistic regression analysis with linear or restricted cubic splines. Results: A total of 8,025 neonatal blood culture reports were reviewed over the four-year period. Total blood culture positivity was 21.9 %. Gram positive organisms accounted for most positive cultures, with coagulase negative staphylococci (CoNS) being the most frequently isolated pathogen in early onset infections (EOS) (59.1 %) and late onset infections (LOS) (52.8 %). Susceptibility coverage of early onset bacterial isolates were 20.7 % to ampicillin plus cefotaxime, 32.2 % to the combination of ampicillin and gentamicin, and 71.7 % to cloxacillin plus gentamicin. For LOS, coverage was 24.6 % to ampicillin plus cefotaxime, 36.2 % to the combination ampicillin and gentamicin and 63.6 % to cloxacillin plus gentamicin. Cloxacillin plus gentamicin remained the most active regimen for EOS and LOS after exclusion of BSI caused by CoNS. For this regimen, the adjusted odds of resistance decreased between 12-34 % per day from birth to day 3 followed by the slowest rate of resistance increase, compared to the other antibiotic regimen, thereafter until day 28. The trend in resistance remained generally unchanged after excluding data from CoNS. Multidrug resistant isolates were significantly (p-value <0.001) higher in LOS (62.4 %, n = 555/886) than in EOS (37.3 %, n = 331/886). Conclusions: There is low antibiotic susceptibility coverage for organisms causing neonatal bloodstream infections in Korle-Bu Teaching Hospital when the current national and WHO recommended empiric antibiotics were assessed. A continuous surveillance of neonatal BSI is required to guide hospital and national antibiotic treatment guidelines for neonatal sepsis.Item Neonatal jaundice in Ghanaian children: Assessing maternal knowledge, attitude, and perceptions(PLOS ONE, 2022) Seneadza, N.A.H.; Insaidoo, G.; Boye, H.; Ani- Amponsah, M.; Leung, T.; Meek, J.; Enweronu-Laryea, C.Background Neonatal jaundice (NNJ) is a major cause of preventable childhood mortality and long-term impairment especially in countries with significant prevalence of the inherited condition, glucose- 6-phosphate dehydrogenase (G6PD) defect. In Ghana, routine screening of pregnant women for G6PD defect is standard care. Prevention of poor health outcomes from NNJ is contingent on population health literacy and early diagnosis. As part of a project to evaluate a screening tool for NNJ, we assessed the knowledge, attitude, and perceptions of Ghanaian mothers on NNJ at baseline. Methods Using a cross-sectional design, mothers attending antenatal and postnatal clinics at 3 selected health facilities in 2 geographical regions of Ghana were interviewed. Data on mothers’ understanding, perceptions, beliefs, and actions towards NNJ were evaluated. Chi-square test was used to determine the association between selected maternal characteristics and knowledge, attitude, and perception to NNJ. Results Of the 504 mothers interviewed, 428(85.4%) had heard about NNJ, 346 (68.7%) said the earliest signs are seen in the eyes, 384(76.2%) knew NNJ may be harmful and 467(92.7%) recommended seeking healthcare for the jaundiced newborn. None of the women knew about G6PD or their G6PD status following antenatal screening. Most did not know the signs/symptoms of severe NNJ. Of the 15 mothers who had had a jaundiced neonate, cost was the most perceived (8 out of 15) barrier to accessing health care. There were significant associations (p-value 0.05) between maternal age, educational level, and knowledge of NNJ. Conclusion Despite the high level of awareness of NNJ, gaps still exit in the knowledge, attitudes and perceptions of mothers concerning NNJ. Improving education of women about the causes, symptoms/signs, and the role of G6PD in severe NNJ is recommended. Addressing barriers to accessing healthcare for the jaundiced infant may enhance timely management of NNJ and reduce the associated complications and mortality.Item Newborn survival in low resource settings - Are we delivering?(BJOG: An International Journal of Obstetrics and Gynaecology, 2009-10) Lawn, J.E.; Kerber, K.; Enweronu-Laryea, C.; Bateman, O.M.The annual toll of losses resulting from poor pregnancy outcomes include half a million maternal deaths, more than three million stillbirths, of whom at least one million die during labour and 3.8 million neonatal deaths - up to half on the first day of life. Neonatal deaths account for an increasing proportion of child deaths (now 41%) and must be reduced to achieve Millennium Development Goal (MDG) 4 for child survival. Newborn survival is also related to MDG 5 for maternal health as the interventions are closely linked. This article reviews current progress for newborn health globally, with a focus on the countries where most deaths occur. Three major causes of neonatal deaths (infections, complications of preterm birth, intrapartum-related neonatal deaths) account for almost 90% of all neonatal deaths. The highest impact interventions to address these causes of neonatal death are summarised with estimates of potential for lives saved. Two priority opportunities to address newborn deaths through existing maternal health programmes are highlighted. First, antenatal steroids are high impact, feasible and yet under-used in low resource settings. Second, with increasing investment to scale up skilled attendance and emergency obstetric care, it is important to include skills and equipment for simple immediate newborn care and neonatal resuscitation. A major gap is care during the early postnatal period for mothers and babies. There are promising models that have been tested mainly in research studies in Asia that are now being adapted and evaluated at scale including through a network of African implementation research trials. © 2009 RCOG.Item Ocular manifestations of sickle cell disease at the Korle-Bu hospital, Accra, Ghana.(European Journal of Ophthalmology, 2011) Osafo-Kwaako, A.; Kimani, K.; Ilako, D.; Akafo, S.; Ekem, I.; Rodrigues, O.; Enweronu-Laryea, C.; Nentwich, M.M.PURPOSE: To determine the magnitude and pattern of ocular manifestations in sickle cell disease at Korle-bu Hospital, Accra, Ghana. METHODS:Hospital-based cross-sectional study including all patients with sickle cell disease reporting for routine follow-up at the Sickle Cell Clinic at Korle-bu Hospital, Accra, Ghana. RESULTS: A total of 201 patients with sickle cell disease (67 male and 134 female) were enrolled, comprising 114 subjects with genotype HbSS, aged 6-58 years, mean 19.26 (SD 11.70), and 87 with genotype HbSC, aged 6-65 years, mean 31.4 (SD 16.76). Visual impairment was found in 5.6% of eyes examined. Causes were cataract, proliferative sickle retinopathy (PSR), optic atrophy, phthisis bulbi, and central retinal artery occlusion. Common anterior segment signs of sickle cell disease, which were more common in HbSC patients, were tortuous corkscrew conjunctival vessels, iris atrophy, and cataract. Eyes with iris atrophy or depigmentation were 1.8 times more at risk of PSR than eyes without. Overall, PSR was found in 12.9% of subjects examined (3.5% of HbSS, 25.3% of HbSC; 15.9% of males and 11.2% of females). The prevalence of proliferative sickle retinopathy increased with age and increased systemic severity of sickle cell disease; sex did not have an influence. CONCLUSIONS: There is a high prevalence of ocular morbidity in sickle cell disease patients at Korle-bu Hospital. Prevalence increased with age, systemic severity of sickle cell disease, and HbSC genotype.Item Population Pharmacokinetic Characteristics of Amikacinin Suspected Cases of Neonatal Sepsisina Low-Resource African Setting: A Prospective Nonrandomized Single-SiteStudy(Elsevier Inc., 2017-01-03) Amponsah, S.K.; Adjei, G.O.; Enweronu-Laryea, C.; Bugyei, K.A.; Hadji-Popovski, K.; Kurtzhals, J.A.L.; Kristensen, K.Background: Amikacin exhibits marked pharmacokinetic (PK) variability and is commonly used in Combination with other drugs in the treatment of neonatal sepsis. There is a paucity of amikacin PK Information in neonates from low-resource settings. Objectives: To determine the PK parameters of amikacin, and explore the influence of selected covariates, including coadministration with aminophylline, on amikacin disposition in neonates of African origin. Methods: Neonates with suspected sepsis admitted to an intensive care unit in Accra, Ghana, and treated with amikacin (15mg/kg loading followed by 7.5mg/kg every 12 hours), were recruited. Serum amikacin Concentration was measured at specified times after treatment initiation and analysed using a population PK modelling approach. Results: A total of 419 serum concentrations were available for 247 neonates. Mean (SD) trough amikacin concentration (from samples collected 30 minutes before the fourth dose) among term (n ¼ 25), and preterm (< 37weeks’ gestation n ¼ 36) neonates were 6.2 (3.4) and 9.2 (5.7) mg/mL, respectively (P ¼ 0.02). A 1-compartment model best fitted amikacin disposition, and birth weight was the most important predictor of amikacin clearance (CL) and distribution (V). The population CL and V of amikacin were related as CL (L/h) ¼ 0.153 (birthweight/2.5) 1.31, V(L) ¼ 2.94 (birthweight/2.5)1.18. There was a high between-subject variability (58.9% and 50.7% ) in CL and V, respectively. CL and V were 0.058L/h/kg and 1.15L/kg, respectively, for a mean birth weight of 2.1kg, and the mean half-life (based on 1-compartmentmodel), was 13.7hours. Conclusions: The V and half-life of amikacin in this cohort varied from that reported in non-African populations, and the high trough and low peak amikacin concentrations in both term and preterm neonates suggest strategies to optimize amikacin dosing are required in this population.Item Population Pharmacokinetic Estimates Suggest Elevated Clearance and Distribution Volume of Desethylamodiaquine in Paediatric Sickle Cell Disease Patients Treated with Artesunate-Amodiaquine(Current Therapeutic Research - Clinical and Experimental, 2019-01) Adjei, G.O.; Amponsah, S.K.; Goka, B.Q.; Enweronu-Laryea, C.; Renner, L.; Sulley, A.M.; Alifrangis, M.; Kurtzhals, J.A.L.Background There is limited information on the safety or efficacy of currently recommended antimalarial drugs in patients with sickle cell disease (SCD), a population predisposed to worse outcomes if affected by acute malaria. Artesunate-amodiaquine (ASAQ) is the first-line treatment for uncomplicated malaria (UM) in many malaria-endemic countries and is also used for treatment of UM in SCD patients. There is, however, no information to date, on the pharmacokinetics (PK) of amodiaquine or artesunate or the metabolites of these drugs in SCD patients. Objectives This study sought to determine the PK of desethylamodiaquine (DEAQ), the main active metabolite of amodiaquine, among paediatric SCD patients with UM treated with artesunate-amodiaquine (ASAQ). Methods Plasma concentration-time data (median DEAQ levels) of SCD children (n = 16) was initially compared with those of concurrently recruited non-SCD paediatric patients with acute UM (n = 13). A population PK modelling approach was then used to analyze plasma DEAQ concentrations obtained between 64 and 169 hours after oral administration of ASAQ in paediatric SCD patients with acute UM (n = 16). To improve PK modeling, DEAQ concentration-time data (n = 21) from SCD was merged with DEAQ concentration-time data (n = 169) of a historical paediatric population treated with ASAQ (n = 103) from the same study setting. Results The median DEAQ concentrations on days 3 and 7 were comparatively lower in the SCD patients compared to the non-SCD patients. A two-compartment model best described the plasma DEAQ concentration-time data of the merged data (current SCD data and historical data). The estimated population clearance of DEAQ was higher in the SCD patients (67 L/h, 21% relative standard error (RSE) compared with the non-SCD population (15.5 L/h, 32% RSE). The central volume of distribution was larger in the SCD patients compared with the non-SCD patients (4400 L, 43% RSE vs. 368 L, 34% RSE). Conclusions The data shows a tendency towards lower DEAQ concentration in SCD patients and the exploratory population PK estimates suggest altered DEAQ disposition in SCD patients with acute UM. These findings, which if confirmed, may reflect pathophysiological changes associated with SCD on DEAQ disposition, have implications for therapeutic response to amodiaquine in SCD patients. The limited number of recruited SCD patients and sparse sampling approach however, limits extrapolation of the data, and calls for further studies in a larger population.Item Service Readiness for Inpatient Care of Small and Sick Newborns: What Do We Need and What Can We Measure Now?(Journal of Global Health, 2018-06) Moxon, S.G.; Guenther, T.; Gabrysch, S.; Enweronu-Laryea, C.; Ram, P.K.; Niermeyer, S.; Kerber, K.; Tann, C.J.; Russel, N.l; Kak, L.; Bailey, P.; Wilson, S.; Wang, W.; Winter, R.; Carvajal-Aguirre, L.; Blencowe, H.; Campbell, O.; Lawn, J.Background: Each year an estimated 2.6 million newborns die, mainly from complications of prematurity, neonatal infections, and intrapartum events. Reducing these deaths requires high coverage of good quality care at birth, and inpatient care for small and sick newborns. In low- and middle-income countries, standardised measurement of the readiness of facilities to provide emergency obstetric care has improved tracking of readiness to provide care at birth in recent years. However, the focus has been mainly on obstetric care; service readiness for providing inpatient care of small and sick newborns is still not consistently measured or tracked. Methods: We reviewed existing international guidelines and resources to create a matrix of the structural characteristics (infrastructure, equipment, drugs, providers and guidelines) for service readiness to deliver a package of inpatient care interventions for small and sick newborns. To identify gaps in existing measurement systems, we reviewed three multi-country health facility survey tools (the Service Availability and Readiness Assessment, the Service Provision Assessment and the Emergency Obstetric and Newborn Care Assessment) against our service readiness matrix. Findings: For service readiness to provide inpatient care for small and sick newborns, our matrix detailed over 600 structural characteristics. Our review of the SPA, the SARA and the EmONC assessment tools identified several measurement omissions to capture information on key intervention areas, such as thermoregulation, feeding and respiratory support, treatment of specific complications (seizures, jaundice), and screening and follow up services, as well as specialised staff and service infrastructure. Conclusions: Our review delineates the required inputs to ensure readiness to provide inpatient care for small and sick newborns. Based on these findings, we detail where questions need to be added to existing tools and describe how measurement systems can be adapted to reflect small and sick newborns interventions. Such work can inform investments in health systems to end preventable newborn death and disability as part of the Every Newborn Action Plan.Item Singleton Preterm Births in Korle Bu Teaching Hospital, Accra, Ghana - Origins and Outcomes K Nkyekyer(Ghana Medical Journal, 2006-09) Nkyekyer, K.; Enweronu-Laryea, C.; Boafor, T.Objective: To determine the singleton preterm birth rate, the relative proportions of the clinical categories of preterm births and to compare the outcomes in these categories. Setting: Department of Obstetrics & Gynaecol-ogy, Korle Bu Teaching Hospital. Participants: Preterm births from 1st July to 31st December 2003. Results: Out of a total of 4731 singleton births 440 were preterm, giving a preterm birth rate of 9.3%. One hundred and eighty-five (42%, [95% Confidence Interval (CI) 37.4%, 46.8%]) preterm births followed spontaneous onset of preterm la-bour (group A), 82 (18.6%, [95% CI 15.2%, 22.7%]) followed preterm premature rupture of membranes, PPROM (group B) and 173 (39.3%, [95% CI 34.8%, 44.1%]) were medically indicated (group C). The commonest indication for delivery in group C was severe pre-eclampsia/eclampsia. Although there was no significant difference in the mean gestational ages at delivery between the groups, babies in group C had significantly lower birth weights. No differences in sex ratios, still-birth rates, or incidence of low Apgar scores were found. Babies in group C were significantly more likely to be admitted to the neonatal intensive care unit (NICU) and had a significantly higher perina-tal death rate. Survivors of NICU admission among group C babies spent significantly longer periods in hospital before discharge. Conclusion: Outcomes of preterm births in Korle Bu Teaching Hospital are less favourable among indicated preterm births than among spontaneous or PPROM-related preterm births. A detailed study of the causes of neonatal morbidity and mortality is suggested to determine any differences between the three groups.