Browsing by Author "Nuamah, M.A."
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Item Associations between malaria in pregnancy and neonatal neurological outcomes(International Journal of Infectious Diseases, 2021) Lawford, H.L.S.; Nuamah, M.A.; Liley, H.G.; Griffin, A.; Lekpor, C.E.; Botchway, F.; Oppong, S.A.; Samba, A.; Badoe, E.V.; Kumar, S.; Lee, A.CC.; Gyasi, R.K.; Adjei, A.A.; Bora, S.Objective: To compare neurological functioning of neonates born to mothers with and without malaria in pregnancy. Methods: Pregnant women presenting at Korle Bu Teaching Hospital, Ghana were recruited into this prospective observational study. Malaria exposure was determined by clinically documented antenatal malaria infection; parasitemia in maternal, placental, or umbilical cord blood; or placental histology. Neu- rological functioning was assessed using the Hammersmith Neonatal Neurological Examination within 48 hours of birth. Performance was classified as "optimal" or "suboptimal" by subdomain and overall. Results: Between November 21, 2018 and February 10, 2019, a total of 211 term-born neonates, of whom 27 (13%) were exposed to malaria in pregnancy, were included. In the reflexes subdomain, exposed neonates tended to score lower (adjusted mean difference -0.34, 95% confidence interval -0.70 to 0.03), with an increased risk (adjusted risk ratio 1.63, 95% confidence interval 1.09 to 2.44) of suboptimal per- formance compared with unexposed neonates. There were no significant between-group differences in scores or optimality classification for the remaining subdomains and overall. Conclusions: Malaria-exposed neonates had similar neurological functioning relative to unexposed neonates, with differences confined to the reflexes subdomain, suggesting potential underlying neuro- logical immaturity or injury. Further studies are needed to confirm these findings and determine the significance of malaria in pregnancy on long-term neurological outcomes.Item Factors Associated with Ruptured Ectopic Pregnancy: A 10-Year Review at a District Hospital in Ghana(Hindawi, 2022) Sefogah, P.E.; Oduro, N.E.; Swarray-Deen, A.; Nuamah, H.G.; Takyi, R.B.; Nuamah, M.A.; Oppong, S.A.Background. Approximately 1–2% of all pregnancies are ectopic. Despite a decline in ectopic pregnancy-related mortality, there is still a paucity of information on the factors associated with clinical presentation and outcomes in Sub-Saharan Africa which is essential in determining the most appropriate treatment modalities. Methods. We performed a ten-year retrospective chart review of cases of ectopic pregnancies managed at the Lekma hospital and assessed them for peculiar risk factors, clinical presentation, and outcomes. Associations between patients’ sociodemographic characteristics, clinical presentation, and treatment outcome were evaluated using multiple logistic regression and reported as adjusted odds ratios (AOR). ,e confidence interval (CI) was set at 95%, and a p value <0.05 were considered significant. Results. Over the ten-year period, there were 115 ectopic pregnancies and 14,450 deliveries (7.9/1,000).,e mean age ± standard deviation of the 115 patients was 27.61 ± 5.56. More than half of the patients were single (59/115, 51.3%). ,e majority (71.3%) of the patients presented with a ruptured ectopic pregnancy. After adjusting for covariates, the odds of an ectopic pregnancy presenting as ruptured among single patients was 2.63 times higher than that of married patients (AOR =3.63, 95% CI: 1.33–9.93, p = 0.01). Ectopic pregnancies located in the isthmic region of the tube had a 77% lower odds of presenting as ruptured than those located in the ampullary region (AOR = 0.23, 95% CI: 0.07–0.74, p = 0.01). ,e odds of rupturing were 1.69 times increased for every additional week after the missed period (AOR = 2.69, 95% CI: 1.56–4.64, p < 0.01). No mortalities were reported as a result of an ectopic pregnancy. Conclusion. Most of the cases of ectopic pregnancy presented ruptured. Marital status and period of amenorrhoea were significantly associated with rupture.Item Gestational Age-Specific Distribution of the Hammersmith Neonatal Neurological Examination Scores Among Low-Risk Neonates in Ghana(Early Human Development, 2021) Lawford, H.L.S.; Nuamah, M.A.; Liley, H.G.; Lee, A.CC.; Botchway, F.; Kumar, S.; Group, I.S.; Adjei, A.A.; Boraa, S.Objective: To describe gestational age-specific distribution of scores for the Hammersmith Neonatal Neurological Examination (HNNE) up to 48 h after birth in a low-risk, term-born, single-center sample in Ghana. Study design: This is a nested substudy of a larger prospective study (IMPRINT: Impact of Malaria in Pregnancy on Infant Neurodevelopment) comprising 140 low-risk, term-born neonates at Korle Bu Teaching Hospital in Accra, Ghana, between November 2018 and February 2019. The sample was stratified into three gestational age groups: early-term (37 + 0–38 + 6, weeks + days; n = 61), full-term (39 + 0–40 + 6, weeks + days; n = 52), and late/post-term (41 + 0–42 + 6, weeks + days; n = 27). Neonates were administered the 34-item HNNE by trained physicians. As per the original British scoring system, raw scores for the Ghanaian sample were plotted and scores > 10th centile were assigned a score of 1, 5th–10th centile 0.5, and < 5th centile 0. Results: The range of raw scores for 16/34 HNNE items varied with gestational age. Specifically, 100% (7/7), 50% (5/10), 33% (1/3), 33% (1/3), 20% (1/5), and 14% (1/7) of items within the orientation and behavior, tone, abnormal signs/patterns, movements, tone patterns, and reflexes subdomain, respectively showed a different distribution of scores above the 10th centile across the three gestational age groups. Conclusion: Differences in gestational age-specific results within our sample in comparison to the original British sample could be, albeit unlikely, due to misclassification of gestational age, unmeasured maternal or fetal morbidity, or perhaps more likely, variation in testing or test conditions, or some combination of these. Genetic variation in neurological development is also a possibility. Further research is warranted to determine the reasons for differences. Our findings highlight the need to determine the accuracy and reliability of standardized neurologic assessments in predicting neurodevelopmental risk for infants in low- and middle-income countries.Item The Impact of Plasmodium Infection on Placental Histomorphology: A Stereological Preliminary Study(Infectious Diseases in Obstetrics and Gynecology, 2019-03) Ahenkorah, J.; Tetteh-Quarcoo, P.B.; Nuamah, M.A.; Kwansa-Bentum, B.; Nuamah, H.G.; Hottor, B.; Korankye, E.; Torto, M.; Ntumy, M.; Addai, F.K.Background: Malaria during pregnancy may threaten the mother's health and cause serious structural damage to the internal architecture of the placenta, which subsequently affects the pregnancy outcome. A better understanding of the impact of malaria parasites on the placenta morphology is crucial for better management of pregnant women and their babies. Aim: To assess by stereology the histomorphology of selected placental structures in placenta malaria compared with normal placentae at term. Method: A total of 10 placentae comprising 5 controls and 5 cases were selected from 50 placentae that were collected at term (38 weeks ± 2 weeks) from the maternal delivery suit of Korle-Bu Teaching Hospital in Accra, Ghana. Blood from the placentae was collected for both rapid diagnostic test and microscopic examinations. Samples collected were examined for Plasmodium parasites, after which they were classified as study group (Plasmodium positive) or control (Plasmodium negative). Stereological quantification using systematic uniform random sampling technique with test point and intersection counting of photomicrographs were employed to estimate the mean volume densities of syncytial knots, syncytial necrosis, foetal capillaries, and intervillous spaces of the placentae on a total of 1,600 photomicrographs. Results: Out of the fifty placental samples from the maternal side tested for Plasmodium, six representing 12% were found to be infected with the parasite by both rapid diagnostic test and microscopy. On stereological assessment, the mean volume density of syncytial knots was significantly higher in the placental malaria group compared with the control placentae at term (P = 0.0080), but foetal capillaries (P = 0.7813), intervillous spaces (P = 0.8078), and syncytial necrosis (P = 0.8249) were not significantly different. Conclusion: This preliminary result indicates that placental malaria may cause significant increase in the syncytial knots but not foetal capillaries, intervillous spaces, or syncytial necrosis. This finding signifies early maturation of the placenta and may be crucial in understanding perinatal outcomes.Item Perinatal autopsy in Ghana: Healthcare workers knowledge and attitude(Frontiers in Global Women’s Health, 2023) Swarray-Deen, A.; Attah, D.A.; Sefogah, P.E.; Oduro, N.E.; Nuamah, H.G.; Nuamah, M.A.; Adzadi, C.; Oppong, S.A.Background: Perinatal mortality refers to stillbirths and early neonatal deaths. Stillbirth, the death of a foetus from 28 weeks or with a birth weight 1,000 g or above, and early neonatal deaths, the death of a newborn within 24 h of delivery, are among the most distressing global health problems, with approximately 2 million stillbirths occurring annually. Although a post-mortem examination of the stillborn baby is essential for understanding and learning the cause of stillbirth, many couples decline the procedure. Sub-Saharan Africa has one of the highest stillbirth rates in the world, yet there is a dearth of studies on post-mortem uptake from the region. Aim: To explore healthcare professionals’ views and perceptions of perinatal autopsy in Ghana. Methods: Mixed-method approach consisted of semi-structured interviews and an electronic cross-sectional survey to evaluate the views and perceptions of healthcare professionals at Korle-Bu Teaching Hospital on autopsy for stillbirths and early neonatal deaths. Descriptive quantitative data were summarised in frequencies and percentages, and statistical results and descriptions were tabulated and coded in terms of types of barriers. For the qualitative aspect, the audio-taped interviews were transcribed, themes generated, and direct quotes and descriptions were coded for all knowledge, beliefs, attitudes and practices concerning the barriers and facilitators for post-mortem. Results: Ninety-nine healthcare professionals participated. No participant had formal training regarding counselling for perinatal autopsy and 40% had “no idea” who is responsible for counselling and obtaining consent for a perinatal autopsy. Forty-four percent (44%) of the participants knew of only the “Conventional/ Full” autopsy and <4% were aware of less invasive methods of performing an autopsy. Qualitative data showed healthcare worker influence, religious and financial considerations impede the implementation of perinatal autopsies. Despite the low uptake of perinatal autopsies, interviews from healthcare workers suggest acceptance rates would improve if parents knew about different options, especially less invasive procedures. Conclusion: At Ghana’s largest referral centre, perinatal autopsy counselling and uptake are at extremely low levels. Most healthcare professionals have little knowledge, skills, and capacity to advise parents regarding perinatal autopsies. Training is needed to update the workforce on recommended perinatal autopsy practices.Item Risk factors for ectopic pregnancy among pregnant women attending a tertiary healthcare facility in Accra, Ghana(International Federation of Gynecology and Obstetrics, 2019-07-18) Asah-Opoku, K.; Oppong, S.A.; Ameme, D.K.; Nuamah, M.A.; Mumuni, K.; Yeboah, A.O.; Ndanu, T.A.; Nkyekyer, K.Objective: To investigate risk factors for ectopic pregnancy among pregnant women attending the Korle-Bu Teaching Hospital, Accra, Ghana. Methods: In an unmatched case–control study from September to November 2015, 104 women with ectopic pregnancy (cases) were compared with 208 women with intrauterine pregnancy (controls). Data were collected by interviewer-administered questionnaire and record review. Bivariable analysis was used to compare characteristics. Multivariate logistic regression was used to assess associations between risk factors and ectopic pregnancy. Adjusted odds ratios (aORs) and 95% confidence interval (CIs) were reported. Results: Risk factors for ectopic pregnancy were being single (aOR, 5.5; 95% CI, 2.15– 14.65), sexual debut at younger than 15 years (aOR, 36.4; 95% CI, 2.49–532.49), multiple sexual partners (aOR, 4.8; 95% CI, 1.76–13.36), previous instrumental evacuation of uterus (aOR, 5.8; 95% CI, 1.20–27.99); previous diagnosis of infertility (aOR, 6.1; 95% CI, 1.36–27.28), being uninsured (aOR, 11.8; 95% CI, 4.23–32.74), and condom use (aOR, 6.1; 95% CI, 1.36–27.28). Conclusion: Women who were single with early sexual intercourse, multiple partners, instrumental evacuation of the uterus, and diagnosis of infertility were at risk of ectopic pregnancy. Identification of these factors should facilitate early diagnosis and treatment of ectopic pregnancy.Item Sickle cell education: A survey of antenatal healthcare givers(The American Journal of Tropical Medicine and Hygiene, 2019-06-02) Torto, M.; Aboagye, S.; Asah-Opoku, K.; Nuamah, M.A.; Oppong, S.A.; Samba, A.To explore the educational practices of antenatal care providers toward pregnant women with sickle cell disease (SCD) and sickle cell trait (SCT), a survey was conducted among selected doctors and midwives who provide antenatal care at the outpatient clinic of the Obstetric Department of the Korle-Bu Teaching Hospital, Accra, Ghana. The study explored their practices of screening for and patient education about SCD and SCT. Of the 102 respondents, 100(98%) stated that they were knowledgeable in the medical and genetic aspects of the disease. Regarding screening, 82(80.4%) reported mandatory screening for SCD, 9(8.8%) did not offer screening as routine, and 11(10.8%) gave patients the choice. The majority (93.1%) always informed patients when the test was positive but health-care providers less than six years experience were less likely to communicate SCT status to patients without the trait (odds ratio [OR] = 0.41, 95% CI [0.18-0.93]). Nurses/midwives were less likely to tell patients their carrier status (OR = 0.25, 95% CI [0.10-0.59]). There was also variation in referral practices for genetic counseling, with 26.5% always referring, 28.4% never doing so, and 45.1% only referring if the patient had questions. This may affect patients' awareness of this genetic condition. Therefore, continuous medical education on SCD/SCT and standardization of counseling may help inform couples' family planning choices and reduce the burden of the disease on future generation and health care.Item Surgical site infections following caesarean sections in the largest teaching hospital in Ghana(Infection Prevention in Practice, 2022) Onuzo, C.N.; Sefogah, P.E.; Nuamah, M.A.; Ntumy, M.; Osei, M-M.; Nkyekyer, K.Background: Surgical site infections complicate up to 15% of all surgical procedures depending on surgery type and underlying patient status. They constitute 14e31% of all hospital-acquired infections, placing huge financial burdens on patients, healthcare institutions and the nation. Objective: To determine the incidence, risk factors, microbiological aetiology and antibiotic susceptibility patterns of surgical-site infections following caesarean sections (CSs) at Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Methods: This prospective study involved 500 women who underwent CS from April to July 2017 at KBTH. Overall, 474 women completed the study with 26 women lost to follow-up or opting out of the study. Women were recruited on the first postoperative day and followed-up postnatally. Sociodemographic and obstetric data were obtained using a structured questionnaire. Swabs of infected surgical wounds were taken for culture and sensitivity testing using the KirbyeBauer disk diffusion technique. Data was analysed using SPSS version 22. Results: Sixty-one (61/474) women (12.8%) had SSIs after CS. Of these, 41 (67.2%) were superficial, 18 (29.5%) were deep incisional and 2 (3.3%) were organ space SSIs. Significant risk factors for SSI were: emergency CS after 8 h of active labour, midline incisions, use of stored water for surgeon’s pre-operative scrubbing, maternal status being single and alcohol consumption during pregnancy. Staphylococcus aureus was the commonest pathogen isolated with 6 (9.8%) being meticillin resistant (MRSA). Antibiotic susceptibility was mostly to quinolones. Conclusion: SSI occurred in 12.8% of CS wounds at the KBTH, commonly caused by S. aureus