Department of Community Health
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Item Optimized Recovery of DNA and Subsequent Short Tandem Repeat Profiling of Different Tissues Sampled from Embalmed Human Cadavers(Journal of Forensic Science and Medicine, 2023) Afrifah, K.A.; Yankey, M.; Badu-Boateng, A.; et al.Introduction: Storage of specimens sampled from human remains for pathological testing, embalming for burial purposes, and human identification often requires formalin fixation and/or paraffin embedding. Current knowledge in molecular biology techniques and forensic DNA analysis makes it possible to optimize the extraction of amplifiable DNA from formalin-fixed tissues by improving the pre-treatment, optimizing the digestion condition of proteinase K, simplifying the extraction protocol, and purifying the extracted DNA with optimized volumes of alcohol. Aim: This research sought to extract amplifiable DNA from thirteen brain, bone marrow, and cartilage samples from four formalin-embalmed human cadavers. Materials and Methods: Brain, cartilage, and bone marrow samples were taken from four different cadavers at autopsy at the Ghana Police Hospital mortuary in Accra, Ghana sixty-two days after embalming. An optimized preparation and DNA extraction protocowereas were carried out on all the samples. Brain samples were also taken from a non-formalin-treated fifth cadaver of known STR profile, and standard DNA extraction was performed to serve as a positive control. Results: Our optimized protocol yielded detectable quantities of DNA from the samples when quantified with the 7500 Real-Time PCR equipment. The extracted DNA also yielded full STR profiles with varying peak heights for forensic identification purposes. The measured degradation indexes of the DNA samples were greater than 1.0, with peak heights of generated STR profiles above the limits of detection of the 3500 genetic analyzers. Conclusion: Our current study demonstrated an optimized method of DNA extraction from tissues (brain, cartilage, and bone marrow) sampled from formalin-embalmed human cadavers. The optimized protocol reduced the concentration of formalin fixation residues in extracted DNA from formalin-fixed tissues, thereby improving the amplification efficiency for STR profiling. Brain, bone marrow, and cartilage can be a good source of DNA from embalmed and degraded human remains, though for skeletonized human remains together with teeth and long bones.Item Opportunistic Infections among newly diagnosed HIV patients in the largest tertiary facility in Ghana(Annals of Global Health, 2024) Tetteh, J.; Puplampu, P.; Asafu-Adjaye, O.; et alBackground: Opportunistic infections (OIs) among newly diagnosed HIV patients are a marker for inadequateness of HIV awareness and testing. Despite global efforts at creating awareness for early detection, late HIV diagnosis and its associated OIs still exist. This study sought to determine the prevalence and patterns of OIs and associated factors among newly diagnosed HIV patients in Ghana. Methods: A retrospective study using data extraction was conducted among 423 newly diagnosed HIV patients aged ≥18 years at the Korle-Bu Teaching Hospital from July 1st 2018 to December 2019. Multivariate logistic regression was adopted to assess factors associated to OIs. Analysis was performed using SPSS version 16, and p-value < 0.05 was deemed significant. Results: The mean age of patients with a new HIV diagnosis was 40.15 ± 11.47 years. Male versus female sex differential was 30.3% and 69.7%, respectively. The prevalence of OIs among newly diagnosed HIV patients was 33.1% (95% CI = 34.6–44.1). About 70% (120/166) of patients with OIs were classified into WHO clinical stage III and IV. The most common OIs were candidiasis (oro-pharyhngeal-esophageal) (36.9%), and cerebral toxoplasmosis (19.9%). The odds of an OI at the time of HIV diagnosis among females was 51% lower than in males (aOR = 0.49, 95% CI = 0.28–0.86). Being employed increased the odds of OIs by 2.5 compared to the unemployed (aOR = 2.5; 95% CI = 1.11–5.61). Participants classified as World Health Organization (WHO) HIV clinical stage III and IV were 15.88 (95% CI = 9.41–26.79) times more likely to experience OIs. Conclusion: One in three patients newly diagnosed with HIV presented with an opportunistic infection, with men more likely to experience such infections. Significant attention should be given to improving case-finding strategies, especially among men.Item Seroprevalence of hepatitis B virus infection (HBsAg) and associated factors among antenatal clinic attendees in a secondary-level facility in southern Ghana(Clinical Epidemiology and Global Health, 2024) Eduku, A.; Senoo-Dogbey, V.E.Introduction: Vertical transmission of Hepatitis B Virus (HBV) infection is the predominant mode of HBV trans mission in highly endemic settings worldwide where the HBV seroprevalence is above 8%. Newborns who contract HBV at birth have a higher risk of chronic infections that can result in liver cancer and liver cirrhosis. Preventing mother-to-child transmission of HBV through screening of pregnant women during the antenatal period and universal vaccination of newborns are important strategies for eliminating new childhood HBV in fections. This study sought to estimate the prevalence of HBV infection among pregnant women in the study area and to determine the factors associated with a positive HBV disease status. The findings from this study will help in obtaining a baseline for comparing future trends and identifying risk factors for HBV that need to be elimi nated in southern Ghana. Methods: This was a cross-sectional hospital-based analytic study in which 225 pregnant women were surveyed using a semi structured questionnaire. Blood samples were taken and analysed qualitatively for HBsAg. The data were entered into Epi-data version 3.1 and exported into STATA version 17 for analysis, with a significance level set at <0.05. Results: This study revealed that the seroprevalence of HBV infection (HBsAg positivity) was 8.0% CI (5%–12.4%) among the pregnant women. The HBV vaccination coverage was 50.2%. Pregnant women with a history of sexually transmitted diseases were six times more likely to test positive for HBsAg aOR: 6.36 (CI = 0.35–2.92, p = 0.019). Additionally, women who had received at least one dose of the HBV vaccine had lower odds of having HBV infection than did those who failed to vaccinate (aOR = 0.08, 95% CI = 0.01–0.66, P = 0.020). Conclusions: The prevalence of HBV infection is relatively high in this population. HBV vaccination and sexually transmitted infections play significant roles in HBV infection and transmission in the study area. Interventions to promote HBV vaccination among the adult population as well as among newborns and STI prevention strategies are needed to reverse the trend of HBV infections in the study area.Item A qualitative enquiry into the challenging roles of caregivers caring for children with Autism Spectrum Disorders in Ghana(Journal of Pediatric Nursing, 2024) Appah, A.; Senoo-Dogbey, V.E.; Armah, D.; Wuaku, D.A.; Ohene, L.A.Background: Autism Spectrum Disorder (ASD) is a condition commonly characterized by challenges with social interaction, repetitive atypical behaviour, and restricted interest. It is estimated that about 1 in 160 children has ASD. Caring for children with ASD is challenging for many parents or caregivers. Objectives: The study aims at exploring the challenges experienced by caregivers of children with ASD. Methods: A qualitative phenomenological study was employed using an exploratory descriptive research design. A total of 10 participants were recruited in this study using a purposive sampling technique. Data were analysed using content analysis procedures. Result: Caregivers of children with ASD face social, financial, and emotional challenges, challenges in accessing health care, education and training of their children in mainstream school settings. Conclusion: The numerous challenges have implications for the quality of life of the caregivers and their children. The financial challenges and inaccessibility of specialist health services have serious implications for the contin uous medical care and monitoring of children with ASD. The challenges in education and training of children with ASD has negative consequences for enrolment and retention of children with ASD in mainstream school settings.Item Nurses' behavioural intentions towards intravenous fluid administration for pediatric patients: Application of the theory of planned behaviour(Journal of Pediatric Nursing, 2023) Grace, K.A.; Senoo-Dogbey, V.E.Background: For pediatric patients, the demand for quality and safe Intravenous Fluid (IVF) therapy is huge. This is because, compared to adults, children have a lower tolerance for IVF therapy errors and present devastating phys iological responses to errors. Nurses play a vital role in IVF administration; therefore, adequate knowledge, positive attitudes, positive perceived behavioural control, and good behavioural intentions are required to achieve effective and successful therapy, patient safety and prevention of complications, and overall positive patient outcomes. This study sought to assess the behaviour of nurses towards IVF administration for pediatric patients. Method: A cross-sectional facility-based study was designed and randomly recruited 112 nurses. The theory of planned behaviour was used as a conceptual framework to assess nurses' behavioural intentions towards IVF ad ministration for pediatric patients. Mean scores and their respective standard deviations, reliability tests, explor atory factor analysis, and linear logistic regression were all performed using SPSS version 27, with the level of significance set at 0.05. Results: Nurses' behavioural intentions for IVF administration for pediatric patients were influenced by their knowledge of standards and protocols for IVF use (β = 0.320; p = 0.01), attitudes (β = 0.339; p = 0.006) subjec tive norms (β 0.240; p = 0.003) and perceived behavioural control (β = 0.26; p = 0.001). Conclusion: Nurses' behavioural intentions for IVF administration were significantly influenced by their knowledge of procedures and standards for IVF administration. Additionally, the nurses' subjective norms, perceived behav ioural control, and attitude towards IVF administration have a significant effect on their behavioural intentions to administer IVFs to pediatric patients. For nurses to administer IVF effectively, safely, and successfully to pediatric patients, there is a need to enhance their knowledge of standards and guidelines for IVF administration. The nurses need to have good attitudes and positive support and influence from all others to be able to administer IVFs safely and successfully to their pediatric patients.Item Response to patient safety incidents in healthcare settings in Ghana: the role of teamwork, communication openness, and handoffs(BMC Health Services Research, 2023) Poku, C.A.; Attafuah, P.Y.A.; Anaba, E.A.; Abor, P.A.; Nketiah-Amponsah, E.; Abuosi, A.A.Background Patient safety incidents (PSIs) in healthcare settings are a critical concern globally, and Ghana is no exception. Addressing PSIs to improve health outcomes requires various initiatives to be implemented including improving patient safety culture, teamwork and communication between healthcare providers during handoffs. It is essential to acknowledge the significance of teamwork, communication openness, and effective handoffs in preventing and managing such incidents. These factors play a pivotal role in ensuring the well-being of patients and the overall quality of healthcare services. Aim This study assessed the occurrence and types of PSIs in health facilities in Ghana. It also examined the role of teamwork, handoffs and information exchange, and communication openness in response to PSIs by health professionals. Methods A cross-sectional study was conducted among 1651 health workers in three regions of Ghana. Using a multi-staged sampling technique, the Survey on Patient Safety Culture Hospital Survey questionnaire and the nurse reported scale were used to collect the data and it was analysed by descriptive statistics, Pearson correlation, and linear multiple regression model at a significance of 0.05. Results There was a reported prevalence of PSIs including medication errors (30.4%), wound infections (23.3%), infusion reactions (24.7%), pressure sores (21.3%), and falls (18.7%) at least once a month. There was a satisfactory mean score for responses to adverse events (3.40), teamwork (4.18), handoffs and information exchange (3.88), and communication openness (3.84) among healthcare professionals. Teamwork, handoffs and information exchange and communication openness were significant predictors of response to PSIs, accounting for 28.3% of the variance. Conclusions Effective teamwork, handoffs and information exchange, and communication openness in the healthcare environment are critical strategies to enhance PSI response. Creating a culture that encourages error response through teamwork, communication and handoffs provides healthcare professionals with opportunities for learning and improving patient outcomes. Training programs should therefore target health professionals to improve patient safety and competency. Through the implementation of evidence-based practices and learning from past incidents, the healthcare system will be able to deliver safe and high-quality care to patients nationwide. Patient safety must be recognized as an ongoing process. Therefore, a meaningful improvement in patient outcomes requires all stakeholders’ commitment.Item The impact of anti-malarial markets on artemisinin resistance: perspectives from Burkina Faso(Malaria Journal, 2023) Guissou, R.M.; Amaratunga, C.; Tindana, P.; et al.Background Widespread artemisinin resistance in Africa could be catastrophic when drawing parallels with the failure of chloroquine in the 1970s and 1980s. This article explores the role of anti-malarial market characteristics in the emergence and spread of arteminisin resistance in African countries, drawing on perspectives from Burkina Faso. Methods Data were collected through in-depth interviews and focus group discussions. A representative sample of national policy makers, regulators, public and private sector wholesalers, retailers, clinicians, nurses, and commu nity members were purposively sampled. Additional information was also sought via review of policy publications and grey literature on anti-malarial policies and deployment practices in Burkina Faso. Results Thirty seven in-depth interviews and 6 focus group discussions were conducted. The study reveals that the current operational mode of anti-malarial drug markets in Burkina Faso promotes arteminisin resistance emergence and spread. The factors are mainly related to the artemisinin-based combination therapy (ACT) supply chain, to ACT quality, ACT prescription monitoring and to ACT access and misuse by patients. Conclusion Study fndings highlight the urgent requirement to reform current characteristics of the anti-malarial drug market in order to delay the emergence and spread of artemisinin resistance in Burkina Faso. Four recommenda tions for public policy emerged during data analysis: (1) Address the suboptimal prescription of anti-malarial drugs, (2) Apply laws that prohibit the sale of anti-malarials without prescription, (3) Restrict the availability of street drugs, (4) Sensitize the population on the value of compliance regarding correct acquisition and intake of anti-malarials. Funding systems for anti-malarial drugs in terms of availability and accessibility must also be stabilized.Item RTS,S/AS01E vaccine defaults in Ghana: a qualitative exploration of the perspectives of defaulters and frontline health service providers(Malaria Journal, 2023) Okyere, J.; Bediako, V.B.; Nwameme, A.U.; et al.Background While Ghana has a good track record in the Expanded Programme on Immunization, there are sub stantial challenges with regards to subsequent vaccinations, particularly after the frst year of life of the child. Given that the last dose of the RTS, S/AS01E vaccine against malaria is administered at 24 months, there is a high likelihood of default. Hence, it is imperative to understand the dynamics and reasons for the defaults to enable the develop ment of efective implementation strategies. This study explored why caregivers default on the RTS, S/AS01E vaccine from the perspective of health service providers and caregivers. Methods This study employed an exploratory, descriptive approach. Using a purposive sampling technique, caregiv ers who defaulted and health service providers directly involved in the planning and delivery of the RTS, S/AS01E vaccine at the district level were recruited. A total of fve health service providers and 30 mothers (six per FGD) par ticipated in this study. Data analysis was done using NVivo-12 following Collaizi’s thematic framework for qualitative analysis. The study relies on the Standards for Reporting Qualitative Research. Results Reasons for defaulting included the overlap of timing of the last dose and the child starting school, dis respectful attitudes of some health service providers, concerns about adverse side efects and discomforts, travel out of the implementing district, the perception that the vaccines are too many, and lack of support from partners. Conclusion To reduce the occurrence of defaulting on the RTS, S/AS01E vaccine programme, stakeholders must reconsider the timing of the last dose of the vaccine. The schedule of the RTS, S/AS01E vaccine should be aligned with the established EPI schedule of Ghana. This will signifcantly limit the potential of defaults, particularly for the last dose. Also, the fndings from this study underscore a need to encourage male partner involvement in the RTS, S/AS01E vaccine programme. Health promotion programmes could be implemented to raise caregivers’ awareness of potential adverse reactions and discomforts—this is necessary to prepare the caregiver for the vaccine process psychologically.Item Impacts of the COVID-19 pandemic on access to healthcare among people with disabilities: evidence from six low- and middle-income countries(International Journal for Equity in Health, 2023) Hunt, X.; Hameed, S.; Ganle, J.; et al.Background The pandemic has placed considerable strain on health systems, especially in low- and middle-income countries (LMICs), leading to reductions in the availability of routine health services. Emerging evidence suggests that people with disabilities have encountered marked challenges in accessing healthcare services and supports in the context of the pandemic. Further research is needed to explore specific barriers to accessing healthcare during the pandemic, and any strategies that promoted continued access to health services in LMICs where the vast majority of people with disabilities live. Methods Qualitative in-depth interviews were conducted with persons with disabilities in Ghana, Zimbabwe, Viet Nam, Türkiye (Syrian refugees), Bangladesh, and India as part of a larger project exploring the experiences of people with disabilities during the COVID-19 pandemic and their inclusion in government response activities. Data were analysed using thematic analysis. Results This research found that people with disabilities in six countries - representing a diverse geographic spread, with different health systems and COVID-19 responses - all experienced additional difficulties accessing healthcare during the pandemic. Key barriers to accessing healthcare during the pandemic included changes in availability of services due to systems restructuring, difficulty affording care due to the economic impacts of the pandemic, fear of contracting coronavirus, and a lack of human support to enable care-seeking. Conclusion These barriers ultimately led to decreased utilisation of services which, in turn, negatively impacted their health and wellbeing. However, we also found that certain factors, including active and engaged Organisations of Persons with Disabilities (OPDs) and Non-Governmental Organizations (NGOs) played a role in reducing some of the impact of pandemic-related healthcare access barriers.Item Family Needs Assessment of Patients with Cerebral Palsy Attending Two Hospitals in Accra, Ghana(Children, 2023) Aduful, A.K.; Boamah-Mensah, F.; Calys-Tagoe, B. N. L.The family represents the most essential and supportive environment for children with cerebral palsy (CP). To improve children’s outcomes, it is crucial to consider the needs of families in order to offer family-centered care, which tailors services to these needs. Objective: We conducted a needs assessment to identify the family needs of patients with CP attending two hospitals in Accra. Methods: The study was a cross-sectional study involving primary caregivers of children with CP attending neurodevelopmental clinics. Structured questionnaires were used to collect data spanning an 8-month period. The data were summarized, and statistical inference was made. Results: Service needs identified were childcare, counseling, support groups, financial assistance, and recreational facilities. Information needs included adult education, job training/employment opportunities, education, health and social programs, knowledge about child development, and management of behavioral and feeding/nutrition problems. Reducing extensive travel time was desirable to improve access to healthcare. With the increasing severity of symptoms came the need for improved accessibility in the home to reduce the child’s hardship, as well as assistive devices, recreational facilities, and respite for the caregiver(s). Conclusion: Families of children with CP have information, service, and access needs related to their disease severity and family context.