Reproductive age mortality survey (RAMOS) in Accra, Ghana

Background  

Maternal mortality remains a severe problem in many parts of the world, despite efforts to reach MDG 5. In addition, underreporting is an issue especially in low income countries. Our objective has been to identify the magnitude of maternal deaths and the degree of underreporting of these deaths in Accra Metropolis in Ghana during a one year period.     

Psychotropic medicine beliefs,side effects and adherence in schizophrenia: a patient–caregiver dyad perspective

Background Medication adherence is essential in the management of schizophrenia. Yet poor treatment uptake has negative consequences on patients and their primary caregivers. Objective To examine the association among beliefs about psychotropic medications, side effects and adherence from a patient-caregiver dyad perspective. Setting This study was conducted in a public psychiatric hospital setting in Accra, Ghana. Methods A cross-sectional study was conducted among 121 patient-caregiver dyads using an interviewer-administered data collection approach.Main outcome measure Beliefs about medicines, side-effects and medication adherence. Results The patient and caregiver-reported level of medication adherence was 28.1?%. Using the Kappa index, the level of agreement between the responses of patients and their caregivers ranged from slight to moderate. Both patients and caregivers rated necessity higher than concern (patients: 1.67?±?0.84, caregiver: 1.79?±?0.96). Significant positive relations between specific-necessity, necessity–concerns differential and medication adherence were recorded while specific–concern, general harm and side-effects correlated negatively with medication adherence from the dyad. The odds of adhering to medications increased by 58 and 64?% for each unit increase in specific-necessity and general overuse scores respectively. However, a unit increase in specific–concern score and high side-effects scores were associated with lower odds of adherence. Conclusions This study highlights the need for patient-caregiver collaborations in decision-making relating to medication adherence in schizophrenia. Thus, in clinical practice, there is the need to recognize that caregivers are essential partners, and patient-caregiver views about psychotropic medications are critical in enhancing adherence for positive mental health outcomes.

     

Profil étiologique et évolutif de l’insuffisance rénale de l’enfant en milieu hospitalier au Togo

ObjectiveTo determine the etiological and evolutionary profile of renal failure of chidren in Togo.MethodsThis is a cross-sectional study over the period of 12 months (2016–2017) including children aged 1 to 18 years hospitalized in the pediatric ward of Sylvanus Olympio university teaching hospital of Lome (Togo) for renal failure.ResultsOf 2374 patients hospitalized in our unit, 58 (2.4%) had renal failure. The mean age was 8.17 ± 4 years with a sex ratio of 1.32. The average consultation time was 11.9 days. The mean duration of hospitalization was 12.7 ± 7.7 days. Thirty-seven patients (63.8%) were referred from a peripheral center. Thirty-seven children out of 58 (63.1%) were oligoanuric. Renal failure was acute in 94.8% and chronic in 5.2%. Anemia was found in 84.4% of children. The main etiologies found were severe malaria (63.8%), glomerulonephritis (10.3%) and nephrotic syndrome (10.3%). Thirteen children (22.4%) benefited from dialysis sessions. The evolution was favorable in 79.3% of the cases.ConclusionThe renal failure of child is relatively common in our daily practice. The low socio-economic level and the lack of adapted equipment make the care difficult.     

Maternal mortality in the Greater Accra region in Ghana: assessing completeness of registration and data quality

OBJECTIVE: To assess the completeness of registration of maternal mortality by comparing various data sources and to review the quality of information pertaining to individual cases. DATA SOURCE AND METHODS: Female deaths aged 10-50 years in the Greater Accra region in Ghana from January 1, 2000 to December 31, 2000 were recorded. Identified maternal deaths (International Classification of Diseases, 9th revision) in four major hospitals in the region were compared with those registered in the civil registers. RESULTS: During the study period, 148 maternal deaths were identified and a total of 21,183 live births were recorded in the study hospitals, yielding a maternal mortality ratio of 699/105 live births. This ratio is more than six times the officially reported maternal mortality ratio for the whole region in the same period. Ninety-two percent of the deaths were due to direct obstetric causes and 8% to indirect causes. One hundred and twenty-one of the cases were correctly classified and registered. By using the multiple source approach, 27 new cases were identified, an under-registration of 18%. The sources of error were misclassification (n=25) and error in registration (n=2). CONCLUSION: The process of registration of deaths in this region is incomplete. Enhanced registration systems (including routine linkage of death and birth certificates) on a regular basis could be used in Ghana.     

Placental tumor necrosis factor-α protein expression during normal human gestation

Objective: Placental tumor necrosis factor-α (TNF-α) is a cell signaling protein. During pregnancy, TNF-α induces synthesis of matrix metalloproteinases (MMPs) which allows cytotrophoblasts to reach the spiral arteries deeper within the uterine decidua. TNF-α also augments apoptosis of vascular smooth muscle cells surrounding these arteries. In this study, chorionic villi TNF-α protein expression throughout normal human gestation were investigated.

Methods: Placental chorionic villi tissues obtained from elective surgical terminations of pregnancy and from uncomplicated term births were assayed using EIA kits (Cayman Chemicals, Ann Arbor, MI, Item # 589201).

Results: The median, 25th percentile and 75th percentile values in the first (N?=?99), second (N?=?58) and third trimester (N?=?42) were: 36.46, 27.25, 45.90?pg/100?mg tissue; 55.43, 40.09, 110.88?pg/100?mg tissue; and 16.63, 9.32, 31.92?pg/100?mg tissue, respectively.

Conclusions: Variations in placental TNF-α protein expression noted at different trimesters may suggest gestational age specific roles for the cytokine. The increase in TNF-α protein expression observed in the second trimester may be involved in upregulating synthesis of MMP and in augmenting apoptosis of vascular smooth muscle cells of the spiral arteries. A failure in this second trimester increase in TNF-α protein could contribute to gestational compromise.     

Harmed patients gaining voice: Challenging dominant perspectives in the construction of medical harm and patient safety reforms

Patient safety is a central issue in healthcare. In the United Kingdom, where there is more accurate information on National Health Service (NHS) hospitals than on primary care or the private sector, the evidence on adverse incidents shows that avoidable medical harm is a major concern. This paper looks at the occurrence of medical harm and argues that in the construction of patient safety reforms, it is important to be aware of alternative narratives about issues of power and accountability from harmed patients and self-help groups, that challenge dominant perspectives on the issues. The paper draws upon evidence from two sources. First, the paper draws on experiences of self-help groups set up as a result of medical harm and part of a campaigning network, where evidence was gathered from 14 groups over more than 2 years. In addition, data were obtained from 21 individuals affected by harm that attended a residential workshop called the Break Through Programme; 18 questionnaires were completed from participants and a written narrative account of their experiences and observational data were gathered from a range of workshop sessions. Looking at the issues from harmed patients’ perspectives, the research illustrates that a model of medical harm focussing predominantly upon the clinical markers and individual agency associated with a medical model operates to obscure a range of social processes. These social processes, connected to the power and dominance of the medical profession and the activities of a wider state, are seen to be a major part of the construction of harm that impacts upon patients, which is further compounded by its concealment. Understanding the experiences of harmed patients is therefore seen as an important way of generating knowledge about the medical and social processes involved in harm, that can lead to a broader framework for addressing patient safety.     

CO2 to green fuel: Photocatalytic process optimization study

Over the years, the world has been battling global warming issues caused by excess carbon dioxide (CO₂) in the atmosphere. There is a need to reduce, convert and utilize the emitted CO₂ to the atmosphere_. One of the efficient approaches is to convert CO₂ to fuel through photocatalysis. The present work concentrates on process modeling and simulation of CO₂ conversion to methanol using Cu/TiO₂ photocatalyst. Design expert 11.1.2.0. Response Surface Methodology was implemented to study the effect of process parameters, including temperature, pressure, and feed flow rate. 3D surface plots were used to analyze the impact of parameters. P-value <0.0001 showed that the model is significant. The optimized conditions of 350°C temperature, the pressure of 100 kPa, and the H₂O/CO₂ molar ratio of 5 are obtained through response surface methodology and the desirability function. With the desirability of 1.000, the optimized conditions reported the predicted conversion and yield of 48.496% and 54.071%, respectively. The simulated conversion and yield obtained are 48.99% and 54.42%, respectively. The energy analysis found that the electricity, cooling water, and steam generation costs were 65,772.886 USD yr^-1, 2,674.944 USD yr^-1, and 18,43,556.2 USD yr^-1 respectively. The agreement between the simulated and predicted value supports mathematical modeling to predict CO₂ conversion and methanol yield.     

Quality of life, optimism/pessimism, and knowledge and attitudes toward HIV Screening among pregnant women in Ghana.

OBJECTIVE: We sought to explore optimism/pessimism, knowledge of HIV, and attitudes toward HIV screening and treatment among Ghanaian pregnant women. METHOD: Pregnant women in Accra, Ghana, completed a self-administered questionnaire including the Life Orientation Test-Revised (LOT-R, an optimism/pessimism measure), an HIV knowledge and screening attitudes questionnaire, the Short Form 12 (SF-12, a measure of health-related quality of life [HRQOL]), and a demographic questionnaire. Data were analyzed using t-tests, ANOVA, correlations, and the chi2 test. RESULTS: There were 101 participants; 28% were nulliparous. Mean age was 29.7 years, and mean week of gestation was 31.8. All women had heard of AIDS, 27.7% had been tested for HIV before this pregnancy, 46.5% had been tested during this pregnancy, and 59.4% of the sample had ever been tested for HIV. Of those not tested during this pregnancy, 64.2% were willing to be tested. Of all respondents, 89% said they would get tested if antiretroviral drugs (ARVs) were readily available and might prevent maternal-to-child transmission. Neither optimism/pessimism nor HRQOL was associated with attitudes toward HIV screening. Optimism was negatively correlated with HIV knowledge (p = .001) and was positively correlated with having never been tested before this pregnancy (p = .007). CONCLUSION: The relationship between optimism/pessimism and HIV knowledge and screening behavior is worthy of further study using larger samples and objective measures of testing beyond self-report.