A pilot study evaluating the prescribing of ceftriaxone in hospitals in Ghana: findings and implications

Background and Objectives: Widespread empiric use of antibiotics exists especially in developing countries. This is a concern since inappropriate use of antibiotics, including their extended inappropriate use, will increase resistance rates. Consequently, there is a need to evaluate antibiotic utilisation across healthcare sectors to improve future use. This includes ceftriaxone, widely used among hospitals including those in Ghana.

Methods: A cross-sectional study to evaluate the appropriateness of ceftriaxone prescribing in a leading hospital in Ghana. Ceftriaxone prescribing in patient-record cards was assessed using a modified WHO drug-utilization evaluation criteria as well as referencing the national standard treatment guidelines in Ghana and the ceftriaxone package insert.

Results: A total of 251 patients were assessed. Ceftriaxone was most commonly prescribed for comorbid malaria with bacterial infections, urinary tract infections, sepsis and gastroenteritis. The appropriateness of the indication was 86% (n = 218). The doses most prescribed were 1g (41%) and 2g (39%). Stat dose and once-daily dosage regimen constituted 51.4% and 84.5%, respectively. The most common duration of treatment was 1 (51.4%) and 2 days (35.1%). The overall appropriateness of prescribing was 93% against a pre-set threshold of 97%.

Conclusion: The appropriateness of ceftriaxone prescribing was high in this leading hospital in Ghana; however, there is room for improvement with targeted education initiatives, with further research planned.     

Methicillin-resistant Staphylococcus aureus resistance to non–β-lactam antimicrobials in the United States from 1996 to 2008

We report the resistance rates of Staphylococcus aureus to non–β-lactam antimicrobials from The Surveillance Network Database-USA (Eurofins-Medinet, Chantilly, VA). Specimens studied were from lower respiratory tract, wounds, and blood. Patients were stratified by age group and patient setting. There were 2,053,219 isolates of S. aureus and 973,116 of methicillin-resistant S. aureus (MRSA). The MRSA rate increased until 2004 and then leveled off. MRSA showed decreasing resistance to tetracycline and trimethoprim–sulfamethoxazole (TMP–SMX). By age group, the greatest MRSA rate increase was for individuals 17 years and younger. Non–β-lactam antimicrobials and particularly TMP–SMX should be considered therapeutic options for staphylococcal infections.     

Systematic approach to training occupationally exposed workers in Ghana and the rest of Africa

The International Basic Safety Standards requires that all personnel on whom protection and safety depends be trained and qualified. The Radiation Protection Institute of the Ghana Atomic Energy Commission has adopted a systematic approach to training those occupationally exposed to ionizing radiation in the course of their work. In collaboration with the International Atomic Energy Agency several training courses have been implemented at the national level and in the African region. From 1993 to 2008, more than 400 occupationally exposed workers in Ghana were trained on radiation safety. Several African regional training events on radiation safety have also been executed with a total participation number of 583 individuals. The training events have contributed towards upgrading the safety culture within institutions that have participated.     

A comparison of women with induced abortion, spontaneous abortion and ectopic pregnancy in Ghana

Background

Despite having one of the most liberal abortion laws in sub-Saharan Africa, complications from induced abortion are the second leading cause of maternal mortality in Ghana.

Study Design

The sample is composed of patients with pregnancy termination complications in Ghana between June and July 2008. The majority of patients report having had a spontaneous abortion (75%; n=439), while 17% (n=100) and 8% (n=46) report having had an induced abortion or an ectopic pregnancy, respectively. Factors associated with women in each of the three groups were explored using multinomial logistic regression.

Results

When compared to women with spontaneous abortions, women with induced abortions were younger, poorer, more likely to report no religious affiliation, less likely to be married, more likely to report making the household decisions and more likely to fail to disclose this pregnancy to their partners. Within the induced abortion subsample, failure to disclose the most recent pregnancy was associated with already having children and autonomous household decision making.

Conclusion

Identifying the individual and relationship characteristics of induced abortion patients is the first step toward targeted policies and programs aimed at reducing unsafe abortion in Ghana.     

A silicon retina that reproduces signals in the optic nerve

Prosthetic devices may someday be used to treat lesions of the central nervous system. Similar to neural circuits, these prosthetic devices should adapt their properties over time, independent of external control. Here we describe an artificial retina, constructed in silicon using single-transistor synaptic primitives, with two forms of locally controlled adaptation: luminance adaptation and contrast gain control. Both forms of adaptation rely on local modulation of synaptic strength, thus meeting the criteria of internal control. Our device is the first to reproduce the responses of the four major ganglion cell types that drive visual cortex, producing 3600 spiking outputs in total. We demonstrate how the responses of our device's ganglion cells compare to those measured from the mammalian retina. Replicating the retina's synaptic organization in our chip made it possible to perform these computations using a hundred times less energy than a microprocessor-and to match the mammalian retina in size and weight. With this level of efficiency and autonomy, it is now possible to develop fully implantable intraocular prostheses.     

Outcome of left heart mechanical valve replacement in West African children - A 15-year retrospective study

Background  

The West African sub-region has poor health infrastructure. Mechanical valve replacement in children from such regions raises important postoperative concerns; among these, valve-related morbidity and complications of lifelong anticoagulation are foremost. Little is known about the long-term outcome of mechanical valve replacement in West Africa. We sought to determine the outcome of mechanical valve replacement of the left heart in children from this sub-region.