Browsing by Author "Ohene-Yeboah, M."
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Item Cost-Effectiveness Analysis of Inguinal Hernia Repair With Mesh Performed by Surgeons and Medical Doctors in Ghana(Value In Health Regional Issues, 2022) Beard, J.H.; Ohene-Yeboah, M.; Lwin, Z.M.T.; et al.Objectives: Task-sharing is the pragmatic sharing of tasks between providers with different levels of training. To our knowledge, no study has examined the cost-effectiveness of surgical task-sharing of hernia repair in a low-resource setting. This study has aimed to evaluate and compare the cost-effectiveness of mesh repair performed by Ghanaian surgeons and medical doctors (MDs) following a standardized training program. Methods: This cost-effectiveness analysis included data for 223 operations on adult men with primary reducible inguinal hernia. cost per surgery was calculated from the perspective of the healthcare system. Disability weights were calculated using pre- and postoperative pain scores and benchmarks from the Global Burden of Disease Study 2017. Results: The mean cost/disability-adjusted life-year (DALY) averted in the surgeon group was 444.9 United States dollars (USD) (95% confidence interval [CI] 221.2-668.5) and 278.9 USD (95% CI 199.3-358.5) in the MD group (P = .168), indicating that the operation is very cost-effective when performed by both providers. The incremental cost (DALY) averted showed that task-sharing with MDs is also very cost-effective (95% bootstrap CI 2436.7 to 454.9). The analysis found that increasing provider salaries is cost-effective if productivity remains high. When only symptomatic cases were analyzed, the mean cost/DALY averted reduced to 232.0 USD (95% CI 17.1-446.8) for the surgeon group and 129.7 USD (95% CI 79.6- 179.8) for the MD group (P = .348), and the incremental cost/DALY averted increased by 45% but remained robust. Conclusions: Elective inguinal hernia repair with mesh performed by Ghanaian surgeons and MDs is a low-cost procedure and very cost-effective in the context of the study. To maximize cost-effectiveness, symptomatic patients should be prioritized over asymptomatic patients and a high level of productivity should be maintainedItem International Consensus and External Validity in Global Surgery Research and Task Shifting - Reply(JAMA Surgery, 2019-10-23) Ohene-Yeboah, M.; Beard, J.H.; Löfgren, J.Globally, the acceptance and use of herbal and traditional medicine is on the rise. Africa, especially Ghana, has its populace resorting to African Traditional Herbal Medicine (ATHMed) for their healthcare needs due to its potency and accessibility. However, the practice involving its preparation and administration has come into question. Even more daunting is the poor and inadequate documentation covering the preservation and retrieval of knowledge on ATHMed for long-term use, resulting in invaluable healthcare knowledge being lost. Consequently, there is the need to adopt strategies to help curtail the loss of such healthcare knowledge, for the benefit of ATHMed stakeholders in healthcare delivery, industry and academia. This paper proposes a hybrid-based computational knowledge framework for the preservation and retrieval of traditional herbal medicine. By the hybrid approach, the framework proposes the use of machine learning and ontology-based techniques. While reviewing literature to reflect the existing challenges, this paper discusses current technologies suited to approach them. This results in a framework that embodies an ontology driven knowledge-based system operating on a semantically annotated corpus that delivers a contextual search pattern, geared towards a formalized, explicit preservation and retrieval mechanism for safeguarding ATHMed knowledge.Item Massive Inguino-scrotal Hernia(Management of Abdominal Hernias: Fifth Edition, 2018-04) Ohene-Yeboah, M.Introduction Inguinal hernia is very common worldwide. In low- and middle-income countries, the estimated repair rate is 30 per 100,000 population per year. Inguino-scrotal Hernia Definition. Kingsnorth H3 and H4 hernias that are 20–30 cm below the pubic crest are massive. Massive hernias are associated with loss of domain as abdominal contents lie in the hernia sac over time. These massive hernias often cause difficulty in walking, sitting or lying down, with mobility dramatically restricted. These hernias are repaired with the patient in the standard prone position with general anaesthesia and endotracheal intubation. The standard oblique groin incision that is extended 1 or 2 cm beyond the pubic tubercle onto the crest adequately exposes the mass of tissue entering the scrotum. Operative steps: The inguinal canal is opened in the standard manner. The internal ring is extended lateral, and the hernia is reduced. If this fails, an omentectomy and/or a colectomy is performed. The posterior wall is repaired with the Lichtenstein procedure. Preoperative progressive pneumoperitoneum and plastic techniques or procedures may be used to increase the capacity of the abdominal cavity and prevent postreduction intra-abdominal hypertension. Closure: The groin and the lower abdominal incisions are closed in the standard manner. Post-operative management: In the immediate post-operative hours, the blood pressure, the urine output and the nasogastric aspirate have to be closely monitored.Item Outcomes After Elective Inguinal Hernia Repair Performed by Associate Clinicians vs Medical Doctors in Sierra Leone(JAMA Network Open, 2021) Ashley, T.; Ashley, H.; Wladis, A.; Bolkan, H.A.; van Duinen, A.J.; Beard, J.H.; Kalsi, H.; Palmu, J.; Nordin, P.; Holm, K.; Ohene-Yeboah, M.; Löfgren, J.Task sharing of surgical duties with medical doctors (MDs) without formal surgical training and associate clinicians (ACs; health care workers corresponding to an educational level between that of a nurse and an MD) is practiced to provide surgical services to people in low-resource settings. The safety and effectiveness of this has not been fully evaluated through a randomized clinical trial. To determine whether task sharing with MDs and ACs is safe and effective in mesh hernia repair in Sierra Leone. This single-blind, noninferiority randomized clinical trial included adult, healthy men with primary inguinal hernia randomized to receiving surgical treatment from an MD or an AC. In Sierra Leone, ACs practicing surgery have received 2 years of surgical training and completed a 1-year internship. The study was conducted between October 2017 and February 2019. Patients were followed up at 2 weeks and 1 year after operations. Observers were blinded to the study arm of the patients. The study was carried out in a first-level hospital in rural Sierra Leone. Data were analyzed from March to June 2019. All patients received an open mesh inguinal hernia repair under local anesthesia. The control group underwent operations performed by MDs, and the intervention group underwent operations performed by ACs. MAIN OUTCOMES AND MEASURES The primary end point was hernia recurrence at 1 year. Outcomes were assessed by blinded observers at 2 weeks and 1 year after operations. A total of 230 patients were recruited (mean [SD] age, 43.0 [13.5] years), and all but 1 patient underwent inguinal hernia repair between October 23, 2017, and February 2, 2018, performed by 5 MDs and 6 ACs. A total of 114 patients were operated on by MDs, and 115 patients were operated on by ACs. There were no crossovers between the study arms. The follow-up rate was 100% at 2 weeks and 94.1% at 1 year. At 1 year, hernia recurrence occurred in 7 patients (6.9%) operated on by MDs and 1 patient (0.9%) operated on by ACs (absolute difference, −6.0 [95% CI, −11.2 to 0.7] percentage points; P < .001). These findings demonstrate that task sharing of elective mesh inguinal hernia repair with ACs was safe and effective. The task sharing debate should progress to focus on optimizing surgical training programs for nonsurgeons and building capacity for elective surgical care in low- and middle-income countries.Item Outcomes After Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana.(JAMA Surgery Sign In Individual Sign In Sign inCreate an Account Institutional Sign In OpenAthens Shibboleth Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal, 2019-06-26) Ohene-Yeboah, M.; Beard, J.H.; Tabiri, S.; Amoako, J.K.A.; Abantanga, F.A.; Sims, C.A.; Nordin, F.; Wladis, A.; Harris, H.W.; Löfgren, J.Importance Inguinal hernia is the most common general surgical condition in the world. Although task sharing of surgical care with nonsurgeons represents one method to increase access to essential surgery, the safety and outcomes of this strategy are not well described for hernia repair. Objective To compare outcomes after inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana. Design, Setting, and Participants This prospective cohort study was conducted from February 15, 2017, to September 17, 2018, at the Volta Regional Hospital in Ho, Ghana. Following successful completion of a training course, 3 medical doctors and 2 surgeons performed inguinal hernia repair with mesh according to the Lichtenstein technique on 242 men with primary, reducible inguinal hernia. Main Outcomes and Measures The primary end point was hernia recurrence at 1 year. The noninferiority limit was set at 5 percentage points. Secondary end points included postoperative complications at 2 weeks and patient satisfaction, pain, and self-assessed health status at 1 year. Results Two-hundred forty-two patients were included; 119 men underwent operations performed by medical doctors and 123 men underwent operations performed by surgeons. Preoperative patient characteristics were similar in both groups. Two-hundred thirty-seven patients (97.9%) were seen at follow-up at 2 weeks, and 223 patients (92.1%) were seen at follow-up at 1 year. The absolute difference in recurrence rate between the medical doctor group (1 [0.9%]) and the surgeon group (3 [2.8%]) was −1.9 (1-tailed 95% CI, −4.8; P < .001), demonstrating noninferiority of the medical doctors. There were no statistically significant differences in postoperative complications (34 [29.1%] vs 29 [24.2%]), patient satisfaction (112 [98.2%] vs 108 [99.1%]), severe chronic pain (1 [0.9%] vs 4 [3.7%]), or self-assessed health (85.9 vs 83.7 of 100) for medical doctors and surgeons. Conclusions and Relevance This study shows that medical doctors can be trained to perform elective inguinal hernia repair with mesh in men with good results and high patient satisfaction in a low-resource setting. This finding supports surgical task sharing to combat the global burden of hernia disease.Item Penetrating abdominal injuries in adults seen at two teaching hospitals in Ghana(Ghana Medical Journal, 2010) Ohene-Yeboah, M.; Dakubo, J.C.; Boakye, F.; Naeeder, S.B.Background The incidence of penetrating abdominal injuries (PAI) has increased in the West African sub-region. Objective To determine the pattern and management outcome of penetrating abdominal injuries (PAI) in the two main teaching hospitals in Ghana. Study Design A prospective and retrospective descriptive study. Setting Komfo Anokye Teaching Hospital (KATH), Kumasi and Korle-Bu Teaching Hospital (KBTH), Accra. Methods Relevant details of all adult patients admitted with penetrating abdominal injuries over a 11-year period were recorded at KATH and KBTH in Accra. The study in KATH was prospective pro forma based and that in the KBTH was a retrospective case review of all penetrating abdominal injuries. Results There were 411 patients, mostly men (M: F-8:1). The peak age of patients was 20–29 years, 164 patients (39.9%). Abdominal stab wound injuries accounted for 251 (61.1%). Three hundred and thirty — one patients (80.5%) had an emergency laparotomy. Twelve patients required 16 emergency thoracotomies. The small bowel (23.2%), stomach (12.9%), colon (10.2%), the liver (10.0%), were the most commonly injured organs. In 92 patients (29.0%) no significant intra-abdominal injury was detected at laparotomy Conclusion Stab wounds are the main penetrating abdominal injuries seen mostly among young male adults in Ghana. Management was by a mandatory laparotomy after clinical assessment. The overall mortality was 4.4%. Selective non-operative management of abdominal stab wounds is possible.Item Quality of referrals for elective surgery at a tertiary care hospital in a developing country: An opportunity for improving timely access to and cost-effectiveness of surgical care(Elsevier International Journal of Surgery, 2015-01) Gyedu, A.; Gyasi Baah, E.; Boakye, G.; Ohene-Yeboah, M.; Otupiri, E.; Stewart, B.T.Introduction: A disproportionate number of surgeries in low- and middle-income countries (LMICs) are performed in tertiary facilities. The referral process may be an under-recognized barrier to timely and cost-effective surgical care. This study aimed to assess the quality of referrals for surgery to a tertiary hospital in Ghana and identify ways to improve access to timely care. Methods: All elective surgical referrals to Komfo Anokye Teaching Hospital for two consecutive months were assessed. Seven essential items in a referral were recorded as present or absent. The proportion of missing information was described and evaluated between facility, referring clinician type and whether or not a structured form was used. Results: Of the 643 referrals assessed, none recorded all essential items. The median number of missing items was 4 (range 1e7). Clinicians that did not use a form missed 5 or more essential items 50% of the time, compared with 8% when a structured form was used (p ¼ 0.001). However, even with the use of a structured form, 1 or 2 items were not recorded for 10% of referrals and up to 3 items for 45% of referrals. Conclusion: Structured forms reduce missing essential information on referrals for surgery. However, proposing that a structured form be used is not enough to ensure consistent communication of essential items. Referred patients may benefit from referrer feedback mechanisms or electronic referral systems. Though often not considered among interventions to improve surgical capacity in LMICs, referral process improvements may improve access to timely surgical care.Item Standardised Competency-Based Training of Medical Doctors and Associate Clinicians in Inguinal Repair with Mesh in Sierra Leone(World Journal of Surgury, 2023) Ashley, T.; Ashley, H.F.; Ohene-Yeboah, M.Introduction In low-income settings, there is a high unmet need for hernia surgery, and most procedures are performed with tissue repair techniques. In preparation for a randomized clinical trial, medical doctors and associate clinicians received a short-course competency-based training on inguinal hernia repair with mesh under local anaesthesia. The aim of this study was to evaluate feasibility, safety and effectiveness of the training. Methods All trainees received a one-day theoretical module on mesh hernia repair under local anaesthesia followed by hands-on training. Performance was assessed using the American College of Surgeon’s Groin Hernia Operative Performance Rating System. Patients were followed up two weeks and one year after surgery. Outcomes of the patients operated on during the training trial were compared to the 229 trial patients operated on after the training. Results During three surgical camps, seven medical doctors and six associate clinicians were trained. In total, 129 patients were operated on as part of the training. Of the 13 trainees, 11 reached proficiency. Patients in the training group had more wound infections after two weeks (8.5% versus 3.1%; p = 0.041). There was no difference in recurrence and mortality after one year, and none of the deaths were attributed to the surgery. Discussion and conclusion Mesh repair is the international standard for inguinal hernia repair worldwide. Never theless, this is not widely accessible in low-income settings. This study has demonstrated that short-course intensive hands-on training of MDs and ACs in mesh hernia repair is effective and safe.