Department of Obstetrics and Gynaecology
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Item African Women in Neurosurgery: An Exploration of Historical Perspectives, Current Realities, and Future Prospects(Women in Neurosurgery, 2024-11-10) Boi-Dsan,A.A.N.; Venkatesh,P.; Tenkorang,P.; Omoba,O.; Limann,B.; Opara,A.; Osunjimi,A.A.; Barrie,U.; Totimeh,T.; Ibironke,E.; Banson,M.BACKGROUND: Gender disparities remain significant issue, particularly impacting African women in the field of neurosurgery. METHODS: Databases, articles, and perspectives were reviewed to identify challenges faced by African Women in Neurosurgery (AWIN), and explore solutions for recruitment, retention, and career advancement of AWIN. RESULTS: In 1982, Africa saw its first female neurosurgeon, with the first female president of the World Federation of Neurosurgical Societies appointed 4 null decades later. Presently, the continent hosts 245 female neurosurgeons, with North Africa comprising the majority at 76.3%, with Algeria notably contributing 72.2% of this total. Southern Africa contributes 7.8%, while West Africa, East Africa, and Central Africa contributed 6.5%, 6.1%, and 3.3%, respectively. Thirteen countries lack neurosurgeons entirely and 30 out of the 54 African nations face shortages of female neurosurgeons, with distributions as follows: North Africa (1-country), Southern Africa (6-countries), West Africa (8-countries), East Africa (9-countries), and Central Africa (6 countries). Our analysis mapped the distribution of 245 AWIN across the African regions and examined the professional trajectories and achievements of 17 pioneering AWIN. Additionally, we compiled registries for: 1) 76 neurosurgical training programs across 26 African countries, 2) organizations tackling gender disparities in neurosurgery, and 3) recommendations to promote AWIN across governmental, community, and academic spheres. CONCLUSIONS: To boost AWIN representation in neurosurgery, concerted and comprehensive efforts are vital. Collaboration among medical schools, training programs, and governments are key to fostering diversity and inclusivity in African neurosurgical settings.Item Women’s experiences of mistreatment during childbirth and their satisfaction with care: findings from a multicountry community-based study in four countries(BMJ, 2021) Maung, T.M.; Mon, N.O.; Mehrtash, H.; Bonsaffoh, K.A.; Vogel, J.P.; Aderoba, A.K.; Irinyenikan, T.A.; Balde, M.D.; Pattanittum, P.; Tuncalp, O.; Bohren, M.A.Introduction Experiences of care and satisfaction are intrinsically linked, as user’s experiences of care may directly impact satisfaction, or indirectly impact user’s expectations and values. Both experiences of care and satisfaction are important to measure so that quality can be monitored and improved. Globally, women experience mistreatment during childbirth at facilities; however, there is limited evidence exploring the mistreatment and women’s satisfaction with care during childbirth. Methods This is a secondary analysis of a cross sectional survey within the WHO study ‘How women are treated during facility-based childbirth’ exploring the mistreatment of women during childbirth in Ghana, Guinea, Myanmar and Nigeria. Women’s experiences of mistreatment and satisfaction with care during childbirth was explored. Multivariable logistic regression modelling was conducted to evaluate the association between mistreatment, women’s overall satisfaction with the care they received, and whether they would recommend the facility to others. Results 2672 women were included in this analysis. Despite over one-third of women reporting experience of mistreatment (35.4%), overall satisfaction for services received and recommendation of the facility to others was high, 88.4% and 90%, respectively. Women who reported experiences of mistreatment were more likely to report lower satisfaction with care: women were more likely to be satisfied if they did not experience verbal abuse (adjusted OR (AOR) 4.52, 95% CI 3.50 to 5.85), or had short waiting times (AOR 5.12, 95% CI 3.94 to 6.65). Women who did not experience any physical or verbal abuse or discrimination were more likely to recommend the facility to others (AOR 3.89, 95% CI 2.98 to 5.06). Conclusion Measuring both women’s experiences and their satisfaction with care are critical to assess quality and provide actionable evidence for quality improvement. These measures can enable health systems to identify and respond to root causes contributing to measures of satisfaction.Item Navigating with logics: Care for women with hypertensive disorders of pregnancy in a tertiary hospital in Ghana(Social Science & Medicine, 2021) Vestering, A.; Kok, B.C.D.; Browne, J.L.; Adu-Bonsaffoh, K.This paper explores how care for women with hypertensive disorders of pregnancy (HDP) is practiced in a tertiary hospital in Ghana. Partly in response to the persistently high maternal and neonatal mortality rates in Low- and Middle-income countries, efforts to improve quality of maternity care have increased. Quality improvement initiatives are shaped by the underlying conceptualisation of quality of care, often driven by global (WHO) standards and protocols. However, there are tensions between global standards of care and local clients’ and providers’ understandings of care practices and quality of care. Implementation of standards is further complicated by structural and organisational restrictions that influence providers’ possibilities and priorities. Based on ethnographic fieldwork, we explore how clinical guidelines and professionals’ and patients’ perspectives converge and, more importantly, diverge. We illuminate local, situated care practices and show how professionals creatively deal with tensions that arise on the ground. In this middle-income setting, caring for women with HDP involves tinkering and navigating in contexts of uncertainty, scarcity, varying responsibilities and conflicting interests. We unravelled a complex web of, at times, contradictory logics, from which various forms of care arise and in which different notions of good care co-exist. While practitioners navigated through and with these varying logics of care, the logic of survival permeated all practices. This study provides important initial insights into how professionals might implement and innovatively adapt the latest quality of maternity care guidelines which seek to marry clinical standards and patients’ needs, preferences and experiences.Item Risk factors and pregnancy outcome in women aged over 40 years at Korle-Bu Teaching Hospital in Accra, Ghana(International Federation of Gynecology and Obstetrics, 2020-01-23) Oppong, S.A.; Torto, M.; Beyuo, T.Objective: To examine the risk factors and pregnancy outcomes in women aged 40 years and older at the Korle-Bu Teaching Hospital, Accra, Ghana. Methods: A descriptive case–control study comparing women aged 40 years and older at the time of delivery with those between 20 and 34 who delivered at the Korle-Bu Teaching Hospital between April 1, 2014 and March 31, 2015. Data were collected using interviewer-administered questionnaires and supplemented with information from patients’ medical records. A multivariate logistic regression was used to estimate the odds ratio and the 95% confidence interval of various risk factors and complications associated with delivery in women aged 40 years or older. Statistical significance was set at P<0.05. Results: There were 339 women in the study of which 113 were aged 40 years or older and 226 were aged between 20 and 34 years. Delivery at age 40 years or older was associated with grand multiparity, and unplanned and undesirable pregnancy. There was a higher incidence of gestational diabetes (7.1% vs 2.2%, P=0.036), cesarean delivery (70.1% vs 57.1%, P=0.018), and venous thromboembolism (VTE) (7.1% vs 1.3%, P=0.008) among women older than 40 years. VTE risk was increased sixfold in the women older than 40 years compared with the younger ones. Conclusion: Women delivering after age 40 years had a higher incidence of gestational diabetes, cesarean delivery, and VTE compared with younger women. VTE risk increased sixfold in the older women.Item Open-labelled randomised controlled trial of 12 hours versus 24 hours modified Pritchard regimen in the management of eclampsia and preeclampsia in Ghana (MOPEP Study): study protocol(BMJ Open, 2019-09-24) Beyuo, T.; Lawrence, E.; Langen, E.S.; Oppong, S.A.Introduction Hypertensive disorders of pregnancy continue to be a major contributor to maternal and perinatal morbidity and mortality. Magnesium sulfate therapy is the standard of care for seizure prophylaxis and treatment for pre-eclampsia and eclampsia respectively, despite wide disparities in dosing regimens and routes of administration. This study compares the clinical efficacy of magnesium sulfate in the reduction of seizure occurrence or recurrence with the 12 hours versus 24 hours modified Pritchard regimens in the management of severe preeclampsia and eclampsia. Methods and analysis This study is an open labelled randomised controlled trial. The study participants are patients admitted to the Korle Bu Teaching Hospital (KBTH) in Accra, Ghana with a diagnosis of antepartum, intrapartum or postpartum eclampsia or pre-eclampsia with severe features. All study participants will be administered a loading dose of magnesium sulfate, followed by maintenance dosing. Participants in the control group will receive magnesium sulfate for 24 hours after diagnosis, while those in the treatment group will receive magnesium sulfate for 12 hours after diagnosis. The primary outcome of this study is the occurrence of a seizure any time after the completion of treatment in the assigned group. Secondary outcome measures include maternal health outcomes, magnesium sulfate toxicities and fetal health outcomes. Data collection was started in October 2018 with a target enrolment of 1245 participants with severe pre-eclampsia and 844 participants with eclampsia with a projected study period of 2–3 years. Ethics and dissemination Ethical approval was obtained from the KBTH Institutional Review Board (IRB) in Ghana. University of Michigan involvement is limited to protocol development and statistical analysis of de-identified data, and has been granted a Not Regulated Determination by the University of Michigan IRB. Results of the study will be shared at clinical forums at the KBTH and will be submitted for publication in an international peer-reviewed journal.Item The Ghanaian Woman’s Experience and Perception of Ultrasound Use in Antenatal Care(Ghana Medical Journal, 2014-03) Mensah, Y.B.; Nkyekyer, K.; Mensah, K.Objective: To evaluate how Ghanaian women perceive the use, and their assessment of the experience, of antenatal ultrasound scanning. Design: Cross-sectional study, using intervieweradministered questionnaire, from 25th February to 16th April, 2011 Setting: Obstetrics Units of Korle Bu Teaching Hospital, Accra, University of Ghana Hospital, Legon and Ga South District Hospital, Weija. Methods: A total of 337 clients were randomly selected after delivery and interviewed. Issues addressed included why women went for antenatal ultrasound, their knowledge of the uses of ultrasound in pregnancy, information provided by health care providers, clients’ eagerness to know the sex of their fetuses, and their overall assessment of the ultrasound scanning experience. Results: The mean number of scans was 2.2(1.1). Most were performed on the request of a doctor or midwife; 154(45.7%) were not told the reasons for the request and 185(54.9%) did not have the results explained to them. For 239(70.9%) women the sonographer did not explain the procedure before the examination; 89(26.4%) were allowed to ask questions and 61(18.1%) were allowed to see their fetuses on the monitor. One hundred and sixty respondents (47.5%) asked for and were told the sex of their fetuses, with accuracy at delivery of 86.5%. Conclusion: Most respondents perceived antenatal ultrasound as a useful tool. There is lack of information flow from health care providers to clients concerning the indications for the ultrasound, the processes involved and the results of the procedure. Improvements in these areas are needed to enhance the experience of antenatal ultrasound among Ghanaian women.Item A Successful Pregnancy in a Patient with a Solitary Kidney(Ghana Medical Journal, 1997) Collison, A.H.K.A 24-year old woman. AM. with a tuberculosis right kidney was treated with right nephrectomy and anti-tuberculosis drugs including. rifampicin. Irregular periods 18 months after nephrectomy prompted investigation including. diagnostic dilatation and curettage (in the second half of her cycle) which yielded Normal secretory endometrium. Six months later. I,e. 2 years after the nephrectomy she presented with an 8-weeks intrauterine pregnancy. investigation revealed that she was in good health: blood urea and Creatinine were normal at 4m.moles and 86 micromoles per liter respectively. She received regular ante-natal care and all parameters remained normal. At 36 weeks she was admitted for closer monitoring and at 38 weeks a 3kg female live baby was delivered by cesarean section. The post-operative period was uneventful and she was discharged home on the tenth post-operative day, The patient has subsequently remained healthy and presented with a second pregnancy 2 years after the above delivery.Item Tuberculosis of the Endometrium(Ghana Medical Journal, 1996) Collison, A.H.K.Two cases of female genital tuberculosis were detected during the management of female. infertility One was found through histological examination of endometrial sample obtained from dilatation and curettage performed in the second half of the menstrual cycle to confirm ovulation. Ovulation can also be confirmed by progesterone assay in the second half of the cycle. The second case was detected through histological examination of specimen, removed at rnyomectomy. In both cases the diagnosis was confirmed with the Ziehl-Neelsen stain. Female genital tuberculosis maybe detected in the very health women. It has no characteristics symptoms and it is often associated with infertility. In view of the resurge of tuberculosis in the subregion dilatation and curettage followed by histological examination of the endometrial sample should remain a method used in the investigation of infertility in our environment.Item An Unusual Cause of Priapism(Ghana Medical Journal, 1996) Kwarko, K.A.; Bentsi, I.K.A 30-year old man was admitted into Korle-Bu Teaching Hospital(KBTH) with a 6-day history of priapism The initial treatment of his priapism was surgical decongestion Of his penis. Haematological investigation tum showed that he had Chronic Granulocytic Leukaemia (CGL) With a very high while cell count. This was felt to be the most likely cause of his priapism In addition to surgical decongestion of his penis he received chemotherapy to lower his white cell count. He developed two of the recognised complication of leukaemia. wound infection and bleeding and therefore had a difficult and prolonged post-operative period of 2 months in hospital.Item The Ghana - Carnegie Postgraduate Program in Obstetrics & Gynaecology(Ghana Medical Journal, 1999-03) Adadevoh, S.W.K.; Martey, J.O.; Wilson, J.B.; Collison, A.H.K.The Carnegie Corporation of New York, the American College of Obstetricians and Gynaecologists (ACOG). USA. the Royal College of Obstetricians and Gynaecologists (RCOG) UK. the Ghana Ministry of Health. University of Ghana Medical School. Accra and the University of Science and Technology School of Medical Sciences. Kumasi. collaborated to establish an innovative community-oriented Postgraduate Training Program in Obstetrics and Gynecology in 1987 (PIG Obgyn). In the 10 years since its inception (1987- 1997), 14 specialists graduated This paper outlines the Aims and Objectives of the Program. the various components of Reproductive Health where most research and publications were done. and the important role that professional training can play in reproductive health research