Research Articles
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A research article reports the results of original research, assesses its contribution to the body of knowledge in a given area, and is published in a peer-reviewed scholarly journal. The faculty publications through published and on-going articles/researches are captured in this community
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Item Trends for Diarrhea Morbidity in the Jasikan District of Ghana: Estimates from District Level Diarrhea Surveillance Data, 2012-2016(Journal of Tropical Medicine, 2018-10) Tetteh, J.; Takramah, W.K.; Ayanore, M.A.; Adoliba Ayanore, A.; Bisung, E.; Alamu, J.About 22% of childhood deaths in developing countries are attributable to diarrhea. In poor resource settings, diarrhea morbidities are correlated with poverty and socio-contextual factors. Diarrhea rates in Ghana are reported to be high, with cases estimated at 113,786 among children under-five years in 2011. This study analyzed the trends of diarrhea morbidity outcomes in the Jasikan District of Ghana. A retrospective analysis of records on diarrhea data for a five years’ period (January 2012 to December 2016) was undertaken. There was a total of 17740 diarrhea case reports extracted from District Health Information Management System (DHIMS) II database in an Excel format which was then exported to Stata version 14 for data cleaning, verification, and analysis. Excel version 2016 was used to plot the actual observed cases by years to assess trends and seasonality. There was a period incidence rate of 272.02 per 1000 persons with a decreasing annual growth rate of 1.85%. Declines for diarrhea generally occurred from November to December and increased from January upwards, evidence that most cases of diarrhea in this study were reported in the harmattan season. High incidence of diarrhea was found to be common among under-five children and among females. Decreasing trend of diarrhea incidence which was identified in this research within the five years’ period understudied shows that, by the year 2020, there will be a sharp decline in the incidence rate of diarrhea reported cases in Jasikan District, given improvements in the external environmental conditions in the district, all things being equal.Item Differences in Alcohol Consumption and Drinking Patterns in Ghanaians in Europe and Africa: The RODAM Study(PloS one, 2018-11) Addo, J.; Cook, S.; Galbete, C.; Agyemang, C.; Klipstein-Grobusch, K.; Nicolaou, M.; Danquah, I.; Schulze, M.B.; Brathwaite, R.; Mockenhaupt, F.P.; Beune, E.; Meeks, K.; de-Graft Aikins, A.; Bahendaka, S.; Owusu-Dabo, E.; Smeeth, L.BACKGROUND: Little is known about alcohol consumption among Africans living in rural and urban Africa compared to African migrants in Europe. We compared the patterns of alcohol consumption in a group of Ghanaians living in different locations in Ghana and in Europe and examined the factors associated with drinking alcohol. METHODS: Data were from a cross-sectional study (RODAM) of Ghanaians aged 25-70 years living in rural and urban Ghana and in Amsterdam, Berlin and London. Information on how often participants consumed at least one standard alcoholic drink in the preceding 12 months, the type of alcoholic beverage and the average serving size was obtained using a food propensity questionnaire. The associations between drinking alcohol and socio-demographic variables, and frequency of attending religious services were investigated using logistic regression models stratified by site and sex. For Ghanaians living in Europe, the number of years since migration and acculturation were also included in the model as covariates. RESULTS: 4280 participants (62.2% women) were included in the analyses. In both men and women, the prevalence of drinking and amount of alcohol consumed per day was highest in Berlin (prevalence of drinking 71.0% and 61.7%) and lowest in urban Ghana (41.4% and 26.8%). After adjustment for age and education in both men and women in Europe, those attending religious services less frequently reported higher levels of drinking alcohol than non-attendants (never attend/no religion compared to attending service at least once a week men OR 4.60 95% CI 2.85, 7.44; women OR 1.80 95% CI 1.12, 2.90) p-trend with frequency <0.001 in men; 0.002 in women); this association was seen also in men in rural Ghana (p-trend = 0.001) and women in urban Ghana (p-trend = 0.02). The prevalence of drinking was positively associated with years since migration in both men and women in Europe ((OR per years increase in time lived in Europe 1.25 (95% CI 1.02,1.53) test for trend p = 0.03 in women; OR 1.29 (95% CI 1.03, 1.62 p = 0.03 in men) but no association was found with self-reported measures of acculturation (ethnic identity, cultural orientation or social networks). CONCLUSION: There are marked differences in alcohol consumption between Ghanaians living in Europe and in Ghana suggesting migration has an important influence of drinking patterns and also suggesting the possibility of requiring different strategies in alcohol reduction campaigns among Ghanaians in different locations.Item Multidisciplinary care results in similar maternal and perinatal mortality rates for women with and without SCD in a low-resource setting(American Journal of Hematology, 2019-02) Oppong, S.A.; Asare, E.V.; Olayemi, E.; Boafor, T.; Dei-Adomakoh, Y.; Swarry-Deen, A.; Mensah, E.; Osei-Bonsu, Y.; Crabbe, S.et.al.In Africa, the maternal mortality rate in sickle cell disease (SCD) is ~10%. Our team previously demonstrated an 89% decrease in mortality rate in a before-and-after feasibility study among women with SCD living in low-resource setting in Ghana. In the same cohort including additional participants with and without SCD, we used a prospective cohort design to test the hypothesis that implementing a multidisciplinary care team for pregnant women with SCD in low-resource setting will result in similar maternal and perinatal mortality rates compared to women without SCD. We prospectively enrolled pregnant women with and without SCD or trait and followed them up for 6-week postpartum. We tested the newborns of mothers with SCD for SCD. We recruited age and parity matched pregnant women without SCD or trait as the comparison group. Maternal and perinatal mortality rates were the primary outcomes. A total of 149 pregnant women with SCD (HbSS, 54; HbSC, 95) and 117 pregnant women without SCD or trait were included in the analysis. Post-intervention, maternal mortality rates were 1.3% and 0.9% in women with and without SCD, respectively (P = 1.00); the perinatal mortality rates were 7.4% and 3.4% for women with and without SCD, respectively (P = 0.164). Among the mothers with SCD, ~15% of newborns had SCD. Multidisciplinary care of pregnant women with SCD may reduce maternal and perinatal mortality rates to similar levels in pregnant women without SCD in low-resource settings. Newborns of mothers with SCD have a high rate of SCD.Item Adult hypertrophic Pyloric Stenosis(Ghana Medical Journal, 1967-03) Takyi, H.K.; Haddock, D.R.W.Item A randomized, double-blind, placebo-controlled, dose-ranging trial of tafenoquine for weekly prophylaxis against Plasmodium falciparum(Clinical Infectious Diseases, 2003-03) Hale, B.R.; Owusu-Agyei, S.; Fryauff, D.J.; Koram, K.A.; Adjuik, M.; Oduro, A.R.; Prescott, W.R.; Baird, J.K.; Nkrumah, F.; Ritchie, T.L.; Franke, E.D.; Binka, F.N.; Horton, J.; Hoffman, S.L.Tafenoquine is a promising new 8-aminoquinoline drug that may be useful for malaria prophylaxis in non-pregnant persons with normal glucose-6-phosphate dehydrogenase (G6PD) function. A randomized, double-blind, placebo-controlled chemoprophylaxis trial was conducted with adult residents of northern Ghana to determine the minimum effective weekly dose of tafenoquine for the prevention of infection by Plasmodium falciparum. The primary end point was a positive malaria blood smear result during the 13 weeks of study drug coverage. Relative to the placebo, all 4 tafenoquine dosages demonstrated significant protection against P. falciparum infection: for 25 mg/week, protective efficacy was 32% (95% confidence interval [CI], 20%-43%); for 50 mg/week, 84% (95% CI, 75%-91%); for 100 mg/week, 87% (95% CI, 78%-93%); and for 200 mg/week, 86% (95% CI, 76%-92%). The mefloquine dosage of 250 mg/week also demonstrated significant protection against P. falciparum infection (protective efficacy, 86%; 95% CI, 72%-93%). There was little difference between study groups in the adverse events reported, and there was no evidence of a relationship between tafenoquine dosage and reports of physical complaints or the occurrence of abnormal laboratory parameters. Tafenoquine dosages of 50, 100, and 200 mg/week were safe, well tolerated, and effective against P. falciparum infection in this study population.Item Endoscopic evaluation of upper abdominal symptoms in adult patients, Saudi Aramco-Ai Hasa Health Center, Saudi Arabia(West African Journal of Medicine, 2002-01) Nkrumah, K.N.Upper oesophago-gastro-duodenoscopies (UGI endoscopies) were performed on adult patients who attended Saudi Aramco Health Centre at Al Hasa, Saudi Arabia, between June 1986 and December 1993, with complaint of upper abdominal pain. During this period, three hundred and fifteen (315) patients were examined. Sixty one percent were females and the rest males. Peptic ulcer disease including gastritis was the most common diagnosis made. Helicobacter pylori-like organisms were documented historically in biopsy samples in 113 of 178 (63%) patients. Nearly all were associated with gastritis; no organisms were reported in normal histology specimens. This confirms the association of this organism with gastritis. Gastric cancer suspected radiologically were not confirmed endoscopically or histologically. It is important to endoscope and biopsy for histology suspected gastric cancer and ulcer; a negative result may save the patient from unnecessary surgery, ideally all normal looking gastric mucosa should be biopsied so that histological gastritis is not missed.Item Continent cutaneous diversion for bladder exstrophy in adults(African Journal of Urology, 2013-06) Mensah, J.E.; Asante, E.K.; Mensah, W.A.; Glover-Addy, H.Objectives: Bladder exstrophy is a rare and devastating congenital anomaly. These patients are usually seen immediately after birth where correction can be attempted. Presentation in adulthood where bony fusion has occurred and bladder capacity is very low presents a major surgical challenge. Such patients require urinary diversion. This is a review of our initial experience with continent cutaneous urinary diversion in patient with classic bladder exstrophy who presented in adulthood. Patients and methods: We reviewed the social and clinical characteristics, operative reports, and postoperative course of two female and five male patients who have been living with bladder exstrophy since birth. They underwent augmentation cystoplasty or simple cystectomy, bladder neck transection, repair of epispadias followed by a continent cutaneous diversion. The continent catheterizable outlet was constructed using the serous lined extramural tunnel technique as a continence mechanism. Postoperative continence, renal function, and changes in social life were documented. Results: Follow-up has ranged from 17 months to 5 years in these initial patients. Thus far, all these patients have achieved complete daytime and night time continence, Complications consisted of pouch cutaneous fistula which was successfully repaired with interposition of a rectus abdominis flap and one case of urosepsis. All upper urinary tract imaging studies have shown stable function. All the patients are doing well with improved social interaction. Conclusion: Bladder neck closure in conjunction with continent cutaneous diversion is a reliable and safe method for achieving continence in adults presenting with bladder exstrophy. Total continence can be achieved without resorting to multiple complex and expensive surgeries. © 2013 Pan African Urological Surgeons' Association.Item Relationships among obesity, inflammation, and insulin resistance in african americans and west africans(Obesity, 2010-03) Doumatey, A.P.; Lashley, K.S.; Huang, H.; Zhou, J.; Chen, G.; Amoah, A.; Agyenim-Boateng, K.; Oli, J.; Fasanmade, O.; Adebamowo, C.A.; Adeyemo, A.A.; Rotimi, C.N.Several research studies in different populations indicate that inflammation may be the link between obesity and insulin resistance (IR). However, this relationship has not been adequately explored among African Americans, an ethnic group with disproportionately high rates of obesity and IR. In this study, we conducted a comparative study of the relationship among adiposity, inflammation, and IR in African Americans and West Africans, the ancestral source population for African Americans. The associations between obesity markers (BMI and waist-to-hip ratio (WHR)), inflammatory markers (high-sensitivity C-reactive protein (hsCRP), haptoglobin, interleukin (IL)-6, and tumor necrosis factor (TNF)-α), and IR (homeostasis model assessment of insulin resistance (HOMA IR)) were evaluated in 247 West Africans and 315 African Americans. In average, African Americans were heavier than the West Africans (by an average of 1.6 BMI units for women and 3 BMI units for men). Plasma hsCRP, haptoglobin, and IL-6 (but not TNF-α level) were higher in African Americans than in West Africans. In both populations, BMI was associated with markers of inflammation and with HOMA IR, and these associations remained significant after adjusting for sex and age. However, the pattern of associations between measured inflammatory markers and IR was different between the two groups. In West Africans, hsCRP was the only inflammatory marker associated with IR. In contrast, hsCRP, haptoglobin, and IL-6 were all associated with IR in African Americans. Interestingly, none of the associations between markers of inflammation and IR remained significant after adjusting for BMI. This finding suggests that in African Americans, the relationship between inflammatory markers and IR is mediated by adiposity.Item The changing patterns of hypertension in Ghana: A study of four rural communities in the Ga District(Ethnicity & Disease, 2006-09) Addo, J.; Amoah, A.G.; Koram, K.A.Objective: To determine the prevalence, distribution and risk factors of hypertension among rural residents in Ghana. Design and Setting: Cross sectional study in four rural communities in the Ga District of Ghana. Subjects and Methods: All adults aged $18 years in four rural communities were asked to participate. The average of two blood pressure readings taken with a mercury sphygmomanometer after 10 minutes of rest was used in the analysis. Hypertension was defined as blood pressure ≥140/90 mm Hg. Results: 362 subjects with a mean age of 42.4 ± 18.6 years participated in the study. The prevalence of hypertension was 25.4%. Of those with hypertension, only 32.3% (n=30) had prior knowledge of their condition, and less than half of these (n=12) were on treatment. Of those on treatment 16.7% were well controlled (blood pressure ≤140/90 mm Hg). The adjusted odds ratios for developing hypertension for overweight or obesity were 5.8 (95% confidence interval 1.4-24.3) and 6.9 (95% confidence interval 1.7-28.2), respectively. The adjusted odds ratio for hypertension for age groups 45-54, 55-64, and ≥65 years were 31.9 (95% confidence interval 1.88-539.11), 31.8 (95% confidence interval 1.6-624.2), and 58.8 (95% confidence interval 2.9-1168.7), respectively. The adjusted odds ratio for hypertension with respect to smoking, alcohol consumption, job-related physical activity, family history, education, occupation, and diabetes status did not attain statistical significance. Conclusion: Hypertension is now of public health significance in rural Ga District of Ghana. The high rate of hypertension was associated with low levels of awareness, drug treatment, and blood pressure control. Overweight and obesity are modifiable risk factors for hypertension that can be addressed through lifestyle interventions. Additionally, integrating hypertension care into primary care in rural health facilities may prove beneficial.Item Insulin resistance, beta cell function and cardiovascular risk factors in Ghanaians with varying degrees of glucose tolerance(Ethnicity & Disease, 2002-09) Amoah, A.G.; Schuster, D.P.; Gaillard, T.; Osei, K.Objective: Type 2 diabetes is characterized by beta cell dysfunction and insulin resistance (IR). The disease is associated with high rates of cardiovascular mortality and morbidity. Recently, the American Diabetes Association Expert Committee recommended the measurement of fasting glucose as a tool for screening and diagnosing diabetes, in order to identify patients with a mild form of the disease as well as to enhance the detection of undiagnosed type 2 diabetes. The significance of these criteria with respect to cardiovascular risk factors in native Ghanaians is unknown. The objectives of the present study were to examine the cardiovascular risk factors in a sample of native Ghanaians with varying degrees of glucose intolerance as defined by fasting glucose levels as specified by the ADA criteria. Research and Methods: The population consisted of 200 indigenous Ghanaian subjects, age range 25-74 years, residing in the Accra metropolitan areas. Subjects were categorized using the fasting plasma glucose (FPG) alone as normal fasting glucose (NFG, FPG<110mg/dL), impaired fasting glucose (IFG, 110126mg/dL). Anthropometric parameters (blood pressure, waist circumference and waist-hip circumference ratios) were measured in each subject. Levels of serum glucose, c-peptides and insulin were measured at baseline and after 2 hours of oral glucose challenge. Insulin resistance (HOMA-IR) and beta cell function (HOMA-%B) were assessed by homeostasis model assessment (HOMA). Levels of fasting serum cholesterol, high-density lipoprotein cholesterol (HDL-C), cholesterol, and triglycerides were measured in each subject. Results: There were 181 subjects in the NFG category, 11 in the IFG category, and 8 newly diagnosed type 2 diabetic subjects. The mean age, BMI, waist circumference (WC), and WHR did not differ between the 3 groups. The mean fasting glucose and the corresponding 2-hour glucose levels rose with the worsening of glucose tolerance. Similarly, the means for serum fasting, post-challenge serum insulin, and c-peptide levels were significantly greater in the IFG and DM groups. Fasting serum cholesterol and high density lipoproteins did not differ statistically between the 3 groups, However, the means for serum triglycerides were greater in the IFG and DM groups when compared to the NFG group. The insulin resistance (IR) as assessed by HOMA was 2X and 4X greater in the Conclusions: We have characterized the metabolic and anthropometric risk factors for CVD in native Ghanaians with varying degrees of glucose tolerance, as defined by the ADA criteria. We found that both IFG and DM were associated with beta cell dysfunction, insulin resistance, and elevated serum triglycerides. However, the well established cardiovascular risk factors, such as body mass index, body fat distribution, and blood pressure did not track with the increasing glucose intolerance in the native Ghanaians. We conclude that the Ghanaian patients with IFG and type 2 diabetes were non-obese and exhibited severe beta cell dysfunction, insulin resistance, and elevated triglycerides, but none of the other conventional risk factors, at the time of diagnosis. Future research should focus on the sequential changes in risk factors during development of cardiovascular diseases in native Ghanaians with varying degrees of glucose tolerance.