Maternal mortality among the Kassena-Nankana of northern Ghana

This report presents key findings from a maternal mortality study conducted in the Kassena-Nankana District of northern Ghana in 1997-98. Sibling history data collected in the course of this survey are analyzed together with longitudinal data from the Navrongo Demographic Surveillance System (NDSS). A comparison between mortality data from these two sources indicates that obtaining reasonably accurate estimates of age-specific death rates is possible by using the sisterhood method. Direct and indirect estimates from the maternal mortality study and the NDSS suggest a decline in the maternal mortality ratio for the Kassena-Nankana District from 800 to 600 maternal deaths per 100,000 live births over the past 14 years.     

Does radical cure of asymptomatic Plasmodium falciparum place adults in endemic areas at increased risk of recurrent symptomatic malaria?

A cohort of 197 adults in Kassena-Nankana District (northern Ghana) was radically cured of malaria parasites to study subsequent incidence of malaria infection. During the following 20 weeks of the malaria transmission season, 49% experienced clinical attacks associated with Plasmodium falciparum parasitaemia. In a group of 202 adults identically followed-up 1 year later without being treated, only 38% experienced such episodes (log-rank test for equality of survivor functions, P=0.035). Clinical attacks in radically cured individuals presented with lower parasite densities but more symptoms. Randomized studies are needed to test the hypothesis that radical cure of P. falciparum enhances the risk and severity of subsequent clinical malaria attacks.     

Stillbirths and early neonatal mortality in rural Northern Ghana

Objective To calculate perinatal mortality (stillbirth and early neonatal death: END) rates in the Upper East region of Ghana and characterize community‐based stillbirths and END in terms of timing, cause of death, and maternal and infant risk factors. Methods Birth outcomes were obtained from the Navrongo Health and Demographic Surveillance System over a 7‐year period. Results Twenty thousand four hundred and ninty seven pregnant women were registered in the study. The perinatal mortality rate was 39 deaths/1000 deliveries, stillbirth rate 23/1000 deliveries and END rates 16/1000 live births. Most stillbirths were 31 weeks gestation or less. Prematurity, first‐time delivery and multiple gestation all significantly increased the odds of perinatal death. Approximately 70% of END occurred during the first 3 postnatal days, and the most common causes of death were birth asphyxia and injury, infections and prematurity. Conclusion Stillbirths and END remain a significant problem in Navrongo. The main causes of END occur during the first 3 days and may be modifiable with simple targeted perinatal policies.     

Survey of enteropathogenic agents in children with and without diarrhoea in Ghana

A survey was carried out over 1 year in a rural area of Ghana on the isolation, detection and/or identification of enteric pathogens from children under 5 years of age with and without diarrhoea. The isolation and detection rate of Shigella flexneri, Shigella dysenteriae, Giardia lamblia and Rotavirus were higher in children with diarrhoea than in controls. Yersinia enterocolitica, Vibrio cholerae and Vibrio parahaemolyticus were not isolated during the period of this survey. The incidence of other enteropathogenic bacteria and parasites identified in the diarrhoeal and non-diarrhoeal children was calculated and is discussed in this study.     

Transabdominal versus endovaginal pelvic sonography: prospective study

Transabdominal and endovaginal pelvic sonograms were obtained in 108 nonpregnant patients referred for pelvic sonography. The studies were independently obtained by two radiologists and interpreted on the basis of identical clinical information. The sonograms were then compared for anatomic detail and abnormalities. A determination was made about which examination, if either, was superior. Follow-up was performed through a review of the medical records and follow-up studies. Overall, the endovaginal study was judged superior in 65 cases (60.2%), equal in 39 (36.1%), and inferior in four (3.7%). The authors conclude that the endovaginal examination can effectively replace the transabdominal examination as the initial approach for routine pelvic sonography.