Department of Child Health
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Item Adherence to hydroxyurea therapy and health-related quality of life in children with sickle cell anaemia at Korle Bu Teaching Hospital in Ghana(Health Science Investigations Journal, 2023) Dwuma-Badu, D.; Segbefia, C.I.; Druye, A.A.; Dei-Adomakoh, Y.A.Background: Sickle cell anaemia (SCA) causes numerous acute and chronic complications, which can result in significant morbidity and mortality. Hydroxyurea (HU) therapy in individuals with SCA is associated with a reduction in disease severity. Objective: The study aimed to determine the relationship between adherence to HU therapy and health-related quality of life (HRQOL) scores in children with SCA (HbSS) at Korle Bu Teaching Hospital (KBTH) and identify any barriers to HU adherence. Methods: A cross-sectional descriptive study was conducted at the paediatric sickle cell clinic of the KBTH. One hundred and fifteen children aged 2 – 12 years with HbSS receiving HU therapy and their primary caregivers were enrolled on this study. Demographic and HU-related data were obtained from medical records and interviews with caregivers. The 8-item Morisky Medication Adherence Scale (MMAS-8 © ) and haematologic response based on mean corpuscular volume (MCV) were used to assess HU adherence. Caregivers and children aged 8 - 12 years also completed the Paediatric Quality of Life Inventory (PedsQLTM) SCD-module version 3.0. For children aged 5 – 7 years, the PedsQLTM SCD-module version 3.0 was administered by interview. Results: Seventy-nine (68.7%) of children had high adherence to HU therapy using the MMAS-8 © . The mean PedsQLTM scores were 96.9 ± 6.0 and 96.3 ± 7.2 for the child (n = 91) and caregiver (n = 114), respectively. Children with high HU adherence had significantly higher PedsQLTM scores than those with low or moderate adherence. Neither child's current MCV nor mean change in MCV correlated with child or caregiver PedsQLTM scores. The main barrier to HU adherence identified by children aged 8 years was forgetfulness, while the cost of HU was the main barrier to adherence reported by caregivers. Conclusion: Children with SCA with high adherence to HU had the highest HRQOL scores using the PedsQLTM SCD-module version 3.0. Routine assessment of barriers to HU adherence can provide important information to help guide relevant interventionsItem Validating a Sclera-Based Smartphone Application for Screening Jaundiced Newborns in Ghana(Pediatrics, 2022) Enweronu-Laryea, C.; Outlaw, F.; Brako, N.O.; Insaidoo, G.; Hagan-Seneadza, N.A.; Ani-Amponsah, M.; Nixon-Hill, M.; Meek, J.OBJECTIVES Reducing the burden of bilirubin-induced neurologic complications in low-resource countries requires reliable and accessible screening tools. We sought to optimize and validate a sclera-based smartphone application, Neonatal Scleral-Conjunctival Bilirubin (neoSCB), for screening neonatal jaundice.METHODS Using a cross-sectional design, consecutive eligible infants (aged 0–28 days, in the hospital, not critically ill) were enrolled in Ghana from March 2019 to April 2020. Jaundice screening was performed with neoSCB (Samsung Galaxy S8) to quantify SCB and JM-105 (Dräger) for transcutaneous bilirubin (TcB). Screening values were compared with total serum bilirubin (TSB) measured at the point of care.RESULTS Overall, 724 infants participated in the optimization and validation phases of the study. The analysis for validation included 336 infants with no previous treatment of jaundice. Single neoSCB image captures identified infants with TSB >14.62 mg/dL (250 μmol/L) with reasonably high sensitivity, specificity, and receiver operating characteristic area under the curve at 0.94 (95% confidence interval [CI], 0.91 to 0.97), 0.73 (95% CI, 0.68 to 0.78), and 0.90, respectively. These findings were comparable to the sensitivity and specificity of JM-105 (0.96 [95% CI, 0.90 to 0.99] and 0.81 [95% CI, 0.76 to 0.86], respectively). The TcB/TSB had a larger correlation coefficient (r = 0.93; P < .01) than SCB/TSB (r = 0.78; P < .01). Performance of both devices was lower in infants with previous phototherapy (n = 231).CONCLUSIONS The diagnostic performance of neoSCB was comparable to JM-105 and is a potential, affordable, contact-free screening tool for neonatal jaundice.Item Fanconi pancytopenia syndrome: report of a case in Ghana.(Ghana Medical Journal, 1988-06) Commey, J.O.O.A fatal case of Fanconi Pancytopenia Syndrome in Q young Ghanaian girl is presented. At her initial presentation growth failure was her chief complaint though other physical stigmata were present from birth. Pancytopenia subsequently developed. The diagnosis warrants consideration in all children presenting with growth failure, pancytopenia or skeletal abnormalities particularly of the hands and forearm.Item Clinical presentation of malaria in Ghana.(Ghana Medical Journal, 1989-12) Commey, J.O.O.Despite all attempts at control or eradication, malaria continues to affect an estimated 200 million people world wide, accounting for about 10% of all deaths in children under three 'years of age in 'Some parts of Africa. Though some variations exist in the malaria produced by the different plasmodia; in all of them chills, fever, headache, muscle pains, splenomegaly and anaemia are common. Herpes labialis is frequent in well established infections while hepatomegaly. mild icterus and oedema are often observed, especially in falciparum malaria. This discussion will be restricted to the clinical presentations of the more dangerous falciparum malaria which accounts for over 90% of malaria cases in West Africa.Item Nutrition and child development(Ghana Medical Journal, 1990-03) Commey, J.O.O.Of the world's present population of nearly 4,400 million about 38% are children under the age of 15 years. On current average, l25 million children are added to the world each year. Only one-quarter of the world's child ren live in developed countries where there exists significant degrees of compliance with the Declaration of the Rights of the Child adopted by the General Assembly of the United Nations in 1959. The 4th Principles of the Declaration in particular states inter alia that (a) The child shall be entitled to grow and develop in health through the provision of special care and protection to him and his mother both antenatally and after delivery. (b) The child shall have the right to adequate nutrition, housing, recreation and medical services. Both specialists and laymen alike agree that a qualitatively and quantitatively adequate dietary intake is of prime importance in man's life while in the child it is practically a prerequisite for optimal growth and development. Indeed, nutrition is the only omnipresent factor in matters of man's health and well-being.Item Renal Status of Children With Sickle Cell Disease in Accra, Ghana(Ghana medical journal, 2011-12) Osei-Yeboah, C.T.; Rodrigues, O.Introduction: In West Africa, the prevalence of sickle cell disease (SCD) is 2%. The disease adversely affects growth, development and organ function including the kidneys. There is however a dearth of information about the renal status of SCD children in Ghana. Objectives: To assess the renal status of children with SCD in steady state. Design: A cross-sectional case-control study. Setting: Paediatric Sickle Cell Clinic, Korle Bu Teach-ing Hospital, Accra. Participants: Cases-357 SCD cases and 70 of their HbAA siblings as controls. Methods: Documentation of their socio-demographic data, clinical data and dipstick urinalysis findings, and renal ultrasonography on selected participants. Results: The mean [SD] age was 7.18 [3.15]yrs for cases and 5.16[3.28]yrs for controls. The genotypes were Hb SS (76.7%), Hb SC (21.8 %), and Hb Sβthal (1.4%). Urinalysis showed leucocyturia in 12.6% ver-sus 5.7% (χ2=62.5 and the p=0.000)), isolated proteinu-ria in 2.8% versus 1.43% (χ2=10.01 and p=0.001) haematuria in 2.6% versus 0% (χ2=9.233, p=0.002) and nitrites in 2.2% versus 1.4% (χ2 =16.3,p=0.02) of cases and controls respectively. The youngest SCD case with proteinuria was 2yrs. old. Proteinuria prevalence in-creased with age, , occurring in 5.7% of cases aged 9-11yrs. and 20.6% of cases aged 12yrs. Two-thirds of the proteinuria cases were aged 9-12yrs., of whom 50% were aged 12yrs. Renal ultrasound findings were normal in all those examined. Conclusion: Urinary abnormalities suggesting neph-ropathy occur early in SCD patients in Ghana. Routine dipstick screening at clinic visits countrywide would help early detection and prompt intervention to limit renal impairment.Item Attitudes of Ghanaian women toward genetic testing for sickle cell trait(International Journal of Gynecology and Obstetrics, 2011-12) Ross, P.T.; Lypson, M.L.; Ursu, D.C.; Everett, L.A.; Rodrigues, O.; Campbell, A.D.Objective: To explore the attitudes of Ghanaian women toward genetic testing for the sickle cell trait and to investigate key factors that promote or impede the decision to pursue knowledge of the carrier status. Methods: A survey, administered in person to Ghanaian women, collected demographic information and information on the participants' knowledge about their carrier status, their attitudes toward genetic testing, and their perceptions of the implications of being a carrier. The results for women who had previously undergone testing and those who had not were compared. Results: Of 124 participants, 75 had been tested for the sickle cell trait and 49 had not. Some 53% of the women who had been tested did not know their carrier status. Most women agreed that getting a prenatal genetic test was important. However, nontested women were more likely to lack the financial resources to undergo testing, to think that testing is futile because sickle cell disease is not curable, and to believe that the outcome of their child's health is determined by God. Conclusion: The women tended to have favorable attitudes toward genetic testing, but numerous barriers remained that precluded knowledge of their carrier status or the pursuit of this knowledge. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.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 Relationship between antibiotic resistance and sickle cell anemia: Preliminary evidence from a pediatric carriage study in Ghana(Infection and Drug Resistance, 2013-07) Donkor, E.S.; Foster-Nyarko, E.; Enweronu-Laryea, C.C.Background: Antibiotics are frequently used among people with sickle cell anemia (homozygous SS or HbSS disease), especially for prophylaxis. However, the relationship between antibiotic resistance and people with HbSS disease has not been adequately studied, especially in the developing world. The objectives of the study were (1) to compare antibiotic resistance patterns of nasal Staphylococcus aureus between children with HbSS disease and children without HbSS disease (healthy children) and (2) to evaluate nasopharyngeal carriage of antibiotic-resistant Streptococcus pneumoniae among children with HbSS disease. Methods: This was a prospective cross-sectional study, and the subjects were children under 12 years old. Nasal swabs were collected from 50 children with HbSS disease and 50 children without HbSS disease. Nasopharyngeal swabs were collected from another group of 92 children with HbSS disease. The nasal and nasopharyngeal swabs were cultured for S. aureus and S. pneumoniae, respectively. Susceptibility testing was carried out on the S. aureus and S. pneumoniae isolates for various antibiotics, including penicillin, ampicillin, cefuroxime, erythromycin, cloxacillin, and cotrimoxazole. Results: The carriage rates of S. aureus among pediatric subjects with HbSS disease and those without HbSS disease were 48% and 50%, respectively (P > 0.05). S. pneumoniae carriage among the pediatric subjects with HbSS disease was 10%. Antibiotic resistance patterns of S. aureus carried by children with HbSS disease and children without HbSS disease were similar, and the S. aureus resistance rates were > 40% for the various antibiotics, with the exception of erythromycin and cloxacillin. Low levels of S. pneumoniae resistance (0%-11%) were observed for the various antibiotics tested except cotrimoxazole, which showed an extremely high-percentage resistance (100%). Conclusion: Sickling status is not a risk factor for carriage of S. aureus. In this cohort of Ghanaian children with HbSS disease, S. aureus is higher in carriage and more antibiotic-resistant, compared to S. pneumoniae. © 2013 Donkor et al, publisher and licensee Dove Medical Press Ltd.Item Electrocardiographic study in Ghanaian children with uncomplicated malaria, treated with artesunate-amodiaquine or artemether-lumefantrine(Malaria Journal, 2012-12) Adjei, G.O.; Oduro-Boatey, C.; Rodrigues, O.P.; Hoegberg, L.C.; Alifrangis, M.; Kurtzhals, J.A.; Goka, B.Q.Background: Several anti-malarial drugs are associated with adverse cardiovascular effects. These effects may be exacerbated when different anti-malarials are used in combination. There has been no report yet on the potential cardiac effects of the combination artesunate-amodiaquine. Methods. Electrocardiographic (ECG) intervals in Ghanaian children with uncomplicated malaria treated with artesunate-amodiaquine (n=47), were compared with that of children treated with artemether-lumefantrine (n=30). The ECG measurements were repeated one, two, three, seven and 28 days after treatment. The ECG intervals of artesunate-amodiaquine treated subjects were correlated with plasma concentrations of desethylamodiaquine (DEAQ), the main metabolite of amodiaquine. Results: The mean ECG intervals were similar in both groups before treatment. After treatment (day 3), ECG intervals changed significantly from baseline in all subjects, but there were no differences between the two treatment groups. A significantly higher proportion of children treated with artesunate-amodiaquine developed sinus bradycardia compared with artemether-lumefantrine treated subjects (7/47 vs 0/30; χ2 p=0.03). Subjects who developed bradycardia were significantly older, and had higher DEAQ concentrations than those who did not develop bradycardia. The proportion of subjects with QTc interval prolongations did not differ significantly between the groups, and no relationship between prolonged QTc intervals and DEAQ levels were observed. No clinically significant rhythm disturbances were observed in any of the subjects. Conclusion: Artesunate-amodiaquine treatment resulted in a higher incidence of sinus bradycardia than artemether-lumefantrine treatment in children with uncomplicated malaria, but no clinically significant rhythm disturbances were induced by combining artesunate with amodiaquine. These findings, although reassuring, may imply that non-amodiaquine based artemisinin combination therapy may be preferable for malaria treatment in patients who are otherwise at risk of cardiac effects. © 2012 Adjei et al.; licensee BioMed Central Ltd.