Incidence and outcome of injury in Ghana: a community-based survey

Injury is an increasingly significant health problem in most low-income countries. However, strategies for preventing injury have not been well addressed. The present study was carried out to measure the incidence and outcome of various mechanisms of injury in Ghana in order to provide data for use in developing priorities for injury prevention efforts. For this purpose, using two-stage cluster sampling and household interviews, we surveyed 21,105 persons living in 431 urban and rural sites. During the preceding year, 1609 injuries resulting in one or more days of loss of normal activity were reported. Injury-related mortality was slightly higher in the urban (83 per 100,000) than in the rural area (53 per 100,000). However, the burden of disability from nonfatal injuries, as assessed by disability days, was higher in the rural (4697 disability days per 1000 person-years) than in the urban area (2671 days per 1000 person-years). Based on incidence rates and disability times, the major types of injury in the urban area were transport-related injury and falls. In the rural area, agricultural injuries predominated, followed by falls and transport-related injury. In rural and urban areas combined, 73% of motor vehicle-related injuries involved commercial vehicles. In this and other similar developing-country settings, injury prevention efforts should focus on falls and on transport safety in both urban and rural areas, with special attention being paid to commercial vehicles. In rural areas, agricultural injuries contributed the largest burden of morbidity, and should be a priority for prevention efforts.     

Burden of Neonatal Surgical Conditions in Northern Ghana

World Journal of Surgery - Congenital anomalies have risen to become the fifth leading cause of under-five mortality globally. The majority of deaths and disability occur in low- and middle-income...     

Using mortuary statistics in the development of an injury surveillance system in Ghana

OBJECTIVE: To develop, in a mortuary setting, a pilot programme for improving the accuracy of records of deaths caused by injury. METHODS: The recording of injury-related deaths was upgraded at the mortuary of the Komfo Anokye Teaching Hospital, Kumasi, Ghana, in 1996 through the creation of a prospectively gathered database. FINDINGS: There was an increase in the number of deaths reported annually as attributable to injury from 72 before 1995 to 633 in 1996-99. Injuries accounted for 8.6% of all deaths recorded in the mortuary and for 12% of deaths in the age range 15-59 years; 80% of deaths caused by injury occurred outside the hospital and thus would not have been indicated in hospital statistics; 88% of injury-related deaths were associated with transport, and 50% of these involved injuries to pedestrians. CONCLUSIONS: Injury was a significant cause of mortality in this urban African setting, especially among adults of working age. The reporting of injury-related deaths in a mortuary was made more complete and accurate by means of simple inexpensive methods. This source of data could make a significant contribution to an injury surveillance system, along with hospital records and police accident reports.     

Strengthening care of injured children globally

Part of the solution to the growing problem of child injury is to strengthen the care that injured children receive. This paper will point out the potential health gains to be made by doing this and will then review recent advances in the care of injured children in individual institutions and countries. It will discuss how these individual efforts have been aided by increased international attention to trauma care. Although there are no major, well-funded global programmes to improve trauma care, recent guidance documents developed by WHO and a broad network of collaborators have stimulated increased global attention to improving planning and resources for trauma care. This has in turn led to increased attention to strengthening trauma care capabilities in countries, including needs assessments and implementation of WHO recommendations in national policy.Most of these global efforts, however, have not yet specifically addressed children. Given the special needs of the injured child and the high burden of injury-related death and disability among children, clearly greater emphasis on childhood trauma care is needed. Trauma care needs assessments being conducted in a growing number of countries need to focus more on capabilities for care of injured children. Trauma care policy development needs to better encompass childhood trauma care. More broadly, the growing network of individuals and groups collaborating to strengthen trauma care globally needs to engage a broader range of stakeholders who will focus on and champion the improvement of care for injured children.     

Assessment of capacity for surgery,obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool

Objectives To survey infrastructure characteristics, personnel, equipment and procedures of surgical, obstetric and anaesthesia care in 17 hospitals in Ghana. Methods The assessment was completed by WHO country offices using the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, which surveyed infrastructure, human resources, types of surgical interventions and equipment in each facility. Results Overall, hospitals were well equipped with general patient care and surgical supplies. The majority of hospitals had a basic laboratory (100%), running water (94%) and electricity (82%). More than 75% had the basic supplies needed for general patient care and basic intra‐operative care, including sterilization. Almost all hospitals were able to perform major surgical procedures such as caesarean sections (88%), herniorrhaphy (100%) and appendectomy (94%), but formal training of providers was limited: a few hospitals had a fully qualified surgeon (29%) or obstetrician (36%) available. Conclusions The greatest barrier to improving surgical care at district hospitals in Ghana is the shortage of adequately trained medical personnel for emergency and essential surgical procedures. Important future steps include strengthening their number and qualifications.     

Postoperative complications after surgery for typhoid perforation in children in Ghana

One of the most severe complications of typhoid fever is perforation of the ileum (TPI); it is also a cause of high morbidity and mortality in endemic areas. After surgery for TPI, other complications may set in postoperatively, compounding the problem. A prospective study of 121 children who were operated upon for TPI to identify the postoperative complications showed that the most common was wound infection. The most serious were: mechanical intestinal obstruction, abdominal dehiscence, and enterocutaneous fistulae. Physicians caring for such children should be aware of these complications and their mode of presentation so as to quickly and decisively manage them to prevent more deaths. Accepted: 8 April 1998     

Expression of aldehyde dehydrogenase 1 as a marker of mammary stem cells in benign and malignant breast lesions of Ghanaian women

BACKGROUND:

Breast cancers that are negative for the estrogen receptor (ER), the progesterone receptor (PR), and the HER2 (human epidermal growth factor receptor 2) marker are more prevalent among African women, and the biologically aggressive nature of these triple‐negative breast cancers (TNBCs) may be attributed to their mammary stem cell features. Little is known about expression of the mammary stem cell marker aldehyde dehydrogenase 1 (ALDH1) in African women. Novel data are reported regarding ALDH1 expression in benign and cancerous breast tissue of Ghanaian women.

METHODS:

Formalin‐fixed, paraffin‐embedded specimens were transported from the Komfo Anoyke Teaching Hospital in Kumasi, Ghana to the University of Michigan for centralized histopathology study. Expression of ER, PR, HER2, and ALDH1 was assessed by immunohistochemistry. ALDH1 staining was further characterized by its presence in stromal versus epithelial and/or tumor components of tissue.

RESULTS:

A total of 173 women contributed to this study: 69 with benign breast conditions, mean age 24 years, and 104 with breast cancer, mean age 49 years. The proportion of benign breast conditions expressing stromal ALDH1 (n = 40, 58%) was significantly higher than those with cancer (n = 44, 42.3%) (P = .043). Among the cancers, TNBC had the highest prevalence of ALDH1 expression, either in stroma or in epithelial cells. More than 2‐fold higher likelihood of ALDH1 expression was observed in TNBC cases compared with other breast cancer subtypes (odds ratio = 2.38, 95% confidence interval 1.03‐5.52, P = .042).

CONCLUSIONS:

ALDH1 expression was higher in stromal components of benign compared with cancerous lesions. Of the ER‐, PR‐, and HER2‐defined subtypes of breast cancer, expression of ALDH1 was highest in TNBC. Cancer 2013. © 2012 American Cancer Society.     

Community-based education: The influence of role modeling on career choice and practice location

Introduction: Research findings in medical education support the importance of positive role models in enhancing learning and influencing the career path of medical students and graduates. The authors explored the characteristics of positive and negative role models during Community-Based Education and Service (COBES), as well as their effect on trainees’ career paths.

Method: A cross-sectional survey was conducted by means of a questionnaire among medical students to explore the characteristics of positive and negative role models during COBES. Associations between gender, choice of specialty, and practice location were assessed using the chi-square test. All qualitative data analysis was performed using the principles of primary, secondary, and tertiary coding.

Result: The majority of the students indicated that role modeling during COBES will affect their choice of specialty and practice location with a significant gender difference in terms of practice location (p?Conclusion: The desire and willingness to work in a rural community combined with good communication and excellent interpersonal skills as well as good leadership skills are attributes of good role modeling that could influence medical students’ career choice during COBES.     

Priorities for improving hospital-based trauma care in an African city

BACKGROUND: This study sought to identify potential cost-effective methods to improve trauma care in hospitals in the developing world. METHODS: Injured patients admitted to an urban hospital in Ghana over a 1-year period were analyzed prospectively for mechanism of injury, mode of transport to the hospital, injury severity, region of principal injury, operations performed, and mortality. In addition, time from injury until arrival at the hospital and time from arrival at the hospital until emergency surgery were evaluated. RESULTS: Mortality was 9.4%. Most deaths (65%) occurred within 24 hours of admission. Sixty percent of emergency operations were performed over 6 hours after arrival. Tube thoracostomy was performed on only 13 patients (0.6%). Only 58% of patients received intravenous crystalloid and only 3.6% received 1 or more units of blood. CONCLUSION: We identified several specific interventions as potential low-cost measures to improve hospital-based trauma care in this setting, including shorter times to emergency surgery and improvements in initial resuscitation. In addition to addressing each of these aspects of trauma care individually, quality improvement programs may represent a feasible and sustainable method to improve trauma care in hospitals in the developing world.