Department of Surgery
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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 Utilisation Of Traditional Medicine Among Women Diagnosed With Breast Cancer In Ghana: A Descriptive Phenomenological Study(BMC Complementary Medicine and Therapies, 2024) Mensah, A.B.B.; Asuo, S.B.; Clegg-Lamptey, J.N.; et al.Background: Women living with breast cancer (BC) rely on traditional medicine (TM) in addition to orthodox medicine. There is a need to understand how and why women diagnosed with BC utilise TM. This study explored and described the lived experiences of women living with BC in terms of their utilisation of traditional medicine. Methods A descriptive phenomenology design was used to purposefully conduct 20 face-to-face, in-depth interviews using a semi-structured interview guide. The data were analysed using NVivo-12 based on Collaizzi’s framework for thematic data analysis. Results Overall, five main themes emerged, namely: sources of knowledge on TM, motivations for using TM, treatment modalities, timing for the initiation of TM, the reasons for discontinuing use of TM, and the decision to seek orthodox medicine. Under the category of motivations for using TM, four themes emerged: financial difficulties and perceived cost effectiveness of TM, influence of social networks, including family and friends, assurance of noninvasive treatment, delays at the healthcare facility, and side effects of orthodox treatment. Non-invasive treatments included herbal concoctions, natural food consumption, and skin application treatments. Regarding the timing of initiation, TM was used in the initial stage of symptom recognition prior to the decision to seek orthodox medicine. and was also used complementarily or as an alternative after seeking orthodox medicine. However, patients eventually stopped using TM due to the persistence of symptoms and the progression of cancer to a more advanced stage, and disapproval by orthodox practitioners. Conclusion Women living with BC in Ghana utilise traditional medicine (TM) for many reasons and report their family, friends, and the media as a main source of information. A combination of herbal concoctions and skin Application modalities are obtained from TM practitioners to treat their BC. However, they eventually discontinue TM when symptoms persist or when disapproval is expressed by their orthodox healthcare providers. We conclude that There is an opportunity to better integrate TM into the standard of oncological care for BC patients.Item Comparison of preoperative trans‑thoracic echocardiography with intraoperative findings in patients with congenital heart disease undergoing surgery(Journal of Cardiothoracic Surgery, 2021) Njem, J.M.; Edwin, F.; Tettey, M.Objective: To determine the diagnostic accuracy and safety of trans-thoracic echocardiography alone for indicating surgery by correlating preoperative trans-thoracic echocardiography with intra-operative findings in patients with congenital heart disease (CHD) in a low resource, low volume center. Methodology: The pre-operative trans-thoracic echocardiography and intra-operative findings of two hundred and fifty patients with CHD, undergoing surgery at the National Cardiothoracic Centre (NCTC), Korle Bu Teaching Hospital, from 2012 to 2017 were prospectively compared. Included in this prospective study, were all patients with CHD who had trans-thoracic echocardiography alone at the NCTC. Excluded were patients who were operated at the NCTC based on echocardiography done elsewhere, those who had echocardiography at the NCTC but were operated elsewhere, as well as those whose operative decision were based on cardiac catheterization or CT angiography and patients with acquired heart defects. The analysis included profiling of patients on different demographic and clinical parameters. SPSS software was used for analysis. Results: Of the 250 patients ages ranged from 2 months to 60 years. The mean was 4 years 95 days, median 1 year 180 days. The female sex accounted for 152 (60.6%). The preoperative trans-thoracic echocardiography correlated with intra-operative findings completely in 228 (91.2%) of patients, affirming the accuracy of this imaging modality. There were however, 19 (7.6%) false negatives and 3 (1.2%) false positive. Neither the false positive nor false negative errors resulted in complications or adversely affected the surgical outcome. Conclusion: Based on the results of this study, preoperative transthoracic echocardiography done by cardiologists at the National Cardiothoracic Center, Korle Bu Teaching Hospital Accra, demonstrated a high correlation with intraoperative findings. Echocardiography also proved to be sensitive, accurate and safe for indicating surgery in patients with congenital heart disease. Keywords: Trans-thoracic echocardiography, Congenital heart disease, Intra-operative findingsItem Ambiguous genitalia: clinical management of adult female with male assigned gender: a case report(Journal of Medical Case Reports, 2021) Ali, M.A.; Maalman, R.S-E; Donkor, Y.O.; Mensah, J.E.Background: Disorders of sex development are anomalies in which the development of urogenital ridge is undif‑ ferentiated for the male and female child. Imaging plays a vital role in investigating the gross anatomy and associated anomalies. Ultrasonography, such as genitography and magnetic resonance, is the primary modality for demonstrat‑ ing internal gonads and genitalia. Early multidisciplinary approach in the management of ambiguous genitalia includ‑ ing early surgical intervention is the predominant practice, with few current considerations on deferral of genital reconstruction until adolescent age. Case presentation: We report the rare case of a 24-year-old adult female from a majority ethnic group of the Volta region, Ghana who was diagnosed and raised as male, now requiring surgical restoration to the female gender. The surgical team decided to assign external genitalia to correspond with the already intact internal organs, thus con‑ structing the vulva. Consent was given by the client and her family members for management and surgical interven‑ tion. The surgery was scheduled and duly performed with a successful outcome. Understanding and consent was sought from the patient for the purpose of using her images for teaching, scientifc publication, and demonstrations. Conclusion: The advantages of deferring surgical reconstruction with psychological counseling after early assess‑ ment need to be considered to prevent inappropriate gender assignmentItem Genome-wide meta-analysis identifies 127 open-angle glaucoma loci with consistent effect across ancestries(NATURE COMMUNICATIONS, 2021) Gharahkhani, P.; Jorgenson, E.; Hysi, P.; Khawaja, A.P.; Pendergrass, S.; Han, X.; Ong, J.S.; Hewitt, A.W.; Segrè, A.V.; Rouhana, J.M.; Hamel, A.R.; Igo Jr, R.P.; Choquet, H.; Qassim, A.; Josyula, N.S.; Bailey, J.N.C.; Bonnemaijer, P.W.M.; Iglesias, A.; Siggs, O.M.; Young, T.L.; Vitart, V.; Thiadens, A.A.H.J; Karjalainen, J.; Uebe, S.; Melles, R.B.; Nair, K.S.; Luben, R.; Simcoe, M.; Amersinghe, N.; Cree, A.J.; Hohn, R.; Poplawski, A.; Chen, L.J.; Shi-Song, R; Aung, T.; Vithana, E.N.; Akafo, S.Primary open-angle glaucoma (POAG), is a heritable common cause of blindness world-wide. To identify risk loci, we conduct a large multi-ethnic meta-analysis of genome-wide association studies on a total of 34,179 cases and 349,321 controls, identifying 44 previously unreported risk loci and confirming 83 loci that were previously known. The majority of loci have broadly consistent effects across European, Asian and African ancestries. Cross ancestry data improve fine-mapping of causal variants for several loci. Integration of multiple lines of genetic evidence support the functional relevance of the identified POAG risk loci and highlight potential contributions of several genes to POAG pathogenesis, including SVEP1, RERE, VCAM1, ZNF638, CLIC5, SLC2A12, YAP1, MXRA5, and SMAD6. Several drug compounds targeting POAG risk genes may be potential glaucoma therapeutic candidates.Item Morbidity and Complications of Diabetes Mellitus in Children andAdolescents in Ghana:Protocol for a Longitudinal Study(JMIR Research Protocols, 2021) Essuman, V.A.; Tagoe, N.N.; Akpalu, J. et.alBackground: Diabetes is associated with premature morbidity and mortality from its many complications. There are limiteddata on the chronic complications of diabetes in children and adolescents in sub-Saharan Africa.Objective: The study aims to determine the (1) burden and related factors of chronic systemic complications of diabetes,including diabetic and nondiabetic ocular conditions in children and adolescents, and (2) quality of life (QoL) of participantscompared to healthy controls. This manuscript describes the study methodology.Methods: Demographic information, medical history, anthropometric measurements, and laboratory characteristics werecollected, and the participants were screened for microvascular and macrovascular complications as well as nondiabetic oculardisease. QoL questionnaires were administered to participants, their caregivers, and controls. Participants were followed upannually up to 3 years to determine the natural history of and trends in these conditions. SPSS Version 25.0 will be used for dataanalysis. Continuous and categorical data will be presented as mean (SD) and as percentages (%), respectively. t tests and analysisof variance will be used to compare means, and chi-square tests will be used to compare categorical data. Correlation, regression,and logistic regression analyses will be employed to establish linear associations and causal associations as appropriate. Relative risk and odds ratios will be used to estimate risk. QoL outcomes in Ghanaian children and adolescents with diabetes mellituscompared with caregivers and healthy controls will be assessed using the Pediatric Quality of Life inventory. Significance willbe set at α=.05.Results: Institutional approval from the Ethical and Protocol Review Committee of the University of Ghana Medical Schoolwas received on August 22, 2014 (Protocol Identification Number: MS-Et/M.12-P4.5/2013-2014). Funding for the project wasreceived from the University of Ghana Research Fund (#UGRF/9/LMG-013/2015-2016) in March 2016. Patient recruitment,clinical examination, and data collection commenced in August 2016 and was completed in September 2019. A total of 58 childrenand adolescents with diabetes mellitus have been recruited. Blood samples were stored at –80 °C for analysis, which was completedat the end of July 2020. Data analysis is ongoing and will be completed by the end of December 2020. Investigators plan to submitthe results for publication by the end of February 2021.Conclusions: The prevalence, natural history, trends in diabetic complications and nondiabetic ocular disease, and QoL willbe provided. Our data may inform policies and interventions to improve care given to children and adolescents with diabetes.Item Incidence and risk factors of retinopathy of prematurity in Korle-Bu Teaching Hospital a baseline prospective study(BMJ, 2020-08) Braimah, I.Z.; Enweronu-Laryea, C.; Sackey, A.Objective To determine the incidence of retinopathy of prematurity (ROP) and any associated risk factors among preterm infants at the Neonatal Intensive Care Unit (NICU) of Korle-Bu Teaching Hospital (KBTH). Design Prospective study. Setting Level 3 NICU of KBTH from June 2018 to February 2019. Participants Eligible infants with birth weight (BW) less than 2 kg or gestational age (GA) less than 37 weeks were examined at scheduled intervals until full maturity of their retina. Outcome measures The primary outcome measure was cumulative incidence of ROP and secondary outcome measure was risk factors associated with ROP. Results Of the 401 infants, 222 were females (55.4%), mean±SD GA was 32.3±2.4 weeks (median 32, IQR 31 to 34) and mean BW 1.6±0.4 kg (median 1.5, IQR 1.3 to 1.9). The cumulative incidence of ROP was 13.7% (95% CI: 10.5 to 17.5%), with 1.8% (seven infants) having type 1 ROP. Increased risk of ROP was observed in babies with supplemental oxygen exposure (p<0.001), BW less than 1.5 kg (p=0.019), confirmed neonatal sepsis (p=0.001), nasogastric tube feeding (p=0.03) and poor pupillary dilation (0.032). A reduced risk of ROP was observed in boys (p=0.004) and after delivery by caesarean section (p=0.019). Conclusion The rates of ROP at KBTH are comparable to other NICUs in sub-Saharan Africa. Birth weight less than 1.5 kg, confirmed neonatal sepsis, nasogastric tube feeding and poor pupil dilation were independently associated with increased incidence of ROP. ROP screening should be a part of the routine service for premature infants in Ghana.Item European Position Paper on Rhinosinusitis and Nasal Polyps 2020(Rhinology, 2020-02) Searyoh, K.; Fokkens, W.J.; Lund, V.J.; Hopkins, C.; Hellings, P.W.; Kern, R.; Reitsma, S.; Toppila-Salmi, S.; Bernal-Sprekelsen, M.; Mullol, J.; Alobid, I.; Anselmo-Lima, W.T.; Bachert, C.; Baroody, F.; von Buchwald, C.; Cervin, A.; Cohen, N.; Constantinidis, J.The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are includedItem Does insurance protect individuals from catastrophic payments for surgical care? An analysis of Ghana’s National Health Insurance Scheme at Korle-Bu teaching Hospital(BMC Health Services Research, 2020-01-17) Okoroh, J.; Sarpong, D.O-B.; Essoun, S.; Riviello, R.; Harris, H.; Weissman, J.S.Background: According to the World Health Organization, essential surgery should be recognized as an essential component of universal health coverage. In Ghana, insurance is associated with a reduction in maternal mortality and improved access to essential medications, but whether it eliminates financial barriers to surgery is unknown. This study tested the hypothesis that insurance protects surgical patients against financial catastrophe. Methods: We interviewed patients admitted to the general surgery wards of Korle-Bu Teaching Hospital (KBTH) between February 1, 2017 – October 1, 2017 to obtain demographic data, income, occupation, household expenditures, and insurance status. Surgical diagnoses and procedures, procedural fees, and anesthesia fees incurred were collected through chart review. The data were collected on a Qualtrics platform and analyzed in STATA version 14.1. Fisher exact and Student T-tests were used to compare the insured and uninsured groups. Threshold for financial catastrophe was defined as health costs that exceeded 10% of household expenditures, 40% of non-food expenditures, or 20% of the individual’s income. Results: Among 196 enrolled patients, insured patients were slightly older [mean 49 years vs 40 years P < 0.05] and more of them were female [65% vs 41% p < 0.05]. Laparotomy (22.2%) was the most common surgical procedure for both groups. Depending on the definition, 58–87% of insured patients would face financial catastrophe, versus 83–98% of uninsured patients (all comparisons by definition were significant, p < .05). Conclusion: This study—the first to evaluate the impact of insurance on financial risk protection for surgical patients in Ghana—found that although insured patients were less likely than uninsured to face financial catastrophe as a result of their surgery, more than half of insured surgical patients treated at KBTH were not protected from financial catastrophe under the Ghana’s national health insurance scheme due to out-of-pocket payments. Government-specific strategies to increase the proportion of cost covered and to enroll the uninsured is crucial to achieving universal health coverage inclusive of surgical care. Trial registration: Registered at www.clinical trials.gov identifier NCT03604458.Item Surveillance of surgical site infection in a teaching hospital in Ghana: a prospective cohort study(Journal of Hospital Infection, 2020-01-10) Bediako-Bowan, A.; Owusu, E.; Debrah, S.; Kjerulf, A.; Newman, M.J.; Kurtzhals, J.A.L.; Mølbak, K.Background: Surveillance systems for surgical site infections (SSIs), as a measure of patient safety, help health institutions devise strategies to reduce or prevent them. No surveillance systems exist to monitor SSIs in Ghana. Aim: To establish a system for monitoring trends and detecting outbreaks in order to create awareness of and control SSIs. Methods: An active 30-day surveillance was undertaken at the general surgical unit of the Korle Bu Teaching Hospital, from July 1st, 2017 to December 31st, 2018 to identify SSI. It involved a daily inpatient surveillance of patients who had had a surgical procedure, followed by post-discharge surveillance by means of a healthcare personnel-based survey and a patient-based telephone survey. We supplied quarterly feedback of results to surgeons. Findings: Among the 3267 patients included, 331 were identified with an SSI, a 10% incidence risk. Patients who acquired an SSI experienced increased morbidity including nine extra days in hospital and an adjusted relative mortality risk of 2.3 (95% confidence interval: 1.3 - 4.1; P¼0.006) compared to patients without SSI. Forty-nine per cent (161/ 331) of SSIs were diagnosed post discharge using the healthcare personnel-based survey. The patient-based telephone survey contributed 12 additional cases. SSI incidence risk decreased from 12.8% to 7.5% during the study period. Conclusion: Post-discharge surveillance is feasible using existing healthcare personnel, and the results highlight the high risk and burden of SSIs in Ghana. A surveillance system