Ghana College of Physicians and Surgeons

This study aimed to discuss differences among national clinical guidelines for prevention, diagnosis and management of cryptococcal meningitis (CM) across sub-Saharan Africa and how they compare to WHO’s 2022 guidelines.

BackgroundGlobally, adolescent health remains a public health priority given that adolescents often face unique vulnerabilities to health issues like mental disorders, substance abuse, and sexual health risks. In developing countries like Ghana, primary healthcare facilities (PHCs) are often the first point of contact for addressing these issues. However, there is a lack of literature examining the capacity of PHCs to address adolescent sexual and reproductive health (ASRH) issues. This study aims to fill this gap in the literature by assessing the availability and readiness of ASRH services within Ghana’s PHCs.MethodsThe study utilized a multi-stage sampling approach to select 67 PHCs across four districts in the Greater Accra region, reflecting Ghana's broad demographic diversity. We employed the WHO's Services Availability and Readiness Assessment (SARA) tool to measure the availability and readiness of ASRH services. This framework focused on key domains including service availability and readiness, assessing aspects such as HIV testing, family planning, and availability of contraceptives and necessary staff training. Data analysis was conducted using Stata version 17.0, analysing frequencies and percentages to capture the extent of service provision across the selected facilities.ResultsThe study highlighted significant disparities in the availability and readiness of essential ASRH services (HIV services, family planning, contraceptive pills, IUCD provisions, and male condoms) across selected districts and facility types. In Shai Osudoku, 65% of facilities offered a full range of selected ASRH services, the highest among the districts, whereas Ningo Prampram had the lowest at just 16%. In terms of facility types, 57% of CHPS facilities, 59% of health centres, and 44% of clinics provided all the selected ASRH services. Urban areas reported a 51% provision rate of these services, slightly less than the 54% observed in rural areas. Additionally, readiness disparities were evident: only 21% of urban facilities had adequate service guidelines compared to 29% in rural areas, and a higher percentage of rural facilities (46%) had trained staff, compared to 23% in urban areas.ConclusionThis study examined the availability and readiness of ASRH services in PHCs across the Greater Accra region, revealing significant disparities by location and facility type. Particularly, rural and public facilities demonstrated a higher availability of ASRH services compared to urban and private facilities. These findings suggest an uneven distribution of resources and highlight a potential urban underutilization of public health services. Moreover, the study identified a critical lack of service guidelines and trained staff across many facilities, emphasizing the need for enhanced training and resource allocation to improve service readiness. Targeted interventions are necessary to elevate the quality and accessibility of ASRH services, ensuring equitable health care delivery across all regions. Future research should expand to other regions to validate these findings and inform nationwide health strategies.

Abstract Background Mental health conditions are a significant threat to global health and have recently seen increased efforts to tackle them. Despite these efforts, common mental health conditions like stress, anxiety disorders, depression, schizophrenia, bipolar disorder, and substance use disorder continue to affect many people worldwide. In West Africa, the situation is worse because of the many factors that hinder access to primary care for these conditions. Our scoping review explored the factors that influence primary care access for common mental health conditions among adults in West Africa. Methods Using the approach for the conduct of scoping reviews described by Arksey and O’Malley in 2005, five electronic databases (PubMed, Embase, PsycINFO, CAIRN INFO, and Google Scholar), were searched for articles published between 1st January 2002 and 31st January 2024. Papers were screened by two independent reviewers and selected based on predetermined inclusion and exclusion criteria. This review adheres to the requirements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, extension for scoping reviews. Results After removing duplicate records titles and abstracts were screened for 1736 articles resulting in 39 articles eligible for full-text screening. After full-text screening, 28 articles were included in the review. Our review revealed that the factors that influence primary care access for common mental health conditions in West Africa act either at the level of the patient, the primary healthcare facility, or outside these two levels at the contextual level. Contextual factors include social norms, cultural beliefs, traditions, and socio-economic status. They influence primary care access for mental health by affecting the patient level and healthcare facility-level factors. Furthermore, the domains of influence at the patient level and facility level are interrelated. Conclusion Factors influencing primary care access for common mental health conditions among adults in West Africa are multiple, complex, and interrelated. Effective Interventions to improve primary care access for mental health need to be multi-faceted addressing individual, facility and systems, as well as contextual factors.

Objective: The study aimed at exploring factors leading to medico-legal issues and why they are under reported. Methodology: This was a qualitative study in which 16 key informants were interviewed with a semi-structured questionnaire. Ethical approval was obtained from the Ghana Institute of Management and Public Administration (GIMPA) Ethical Review Board. Data was analysed thematically. A written informed consent was obtained from each participant. Results: A medico-legal issue arose if the standard of care was perceived to have been breached or when a complaint was not managed according to the complainant’s expectations. Reasons for low reporting included the long emotionally exacting and expensive adjudication process. Additionally, procedures at the facilities to address complaints are considered non-transparent and prejudicial. Finally, interviewees were credulous believing in predetermined death. They have the attitude of ‘leave judgement to God.’ Even if the victim wants to take the matter up, others may impress upon them to stop it. Conclusion: The study concludes that factors leading to medico-legal issues include a breach in the approved standard of care of the patient and whether the complainant is unhappy with the handling of the matter. The emotionally and financially exacting nature of dealing with these issues, and the perceived unfair processes account for the low reporting. Belief in fatalism is a contributory factor.

Abstract Background In many developing countries such as Niger, a variety of interventions have been implemented to improve adolescent sexual and reproductive health. Nevertheless, the reality is that the levels of adolescent sexual and reproductive health (ASRH) indicators remain critical in these countries. Unfortunately, very few studies have examined the reasons why these interventions fail. This study aimed to improve the knowledge on this topic. Specifically, it described the history of ASRH interventions and examined the profile of the actors who contributed to the emergence of these interventions in Niger. Methods A literature review was first conducted covering the period 1975–2021. Then, individual interviews were conducted with 46 actors involved in the process of designing, financing, and implementing ASRH interventions in Niger. For the data analysis, a descriptive historical approach was carried out using an analysis grid to exploit the information collected. Qualitative data were transcribed and coded using Nvivo 12 software, and a content analysis was carried out. Conclusion Several interventions have been implemented to improve the sexual and reproductive health of adolescents in Niger since 1994, but their impact is questionable.

The prevalence of diabetes in West Africa is increasing, posing a major public health threat. An estimated 24 million Africans have diabetes, with rates in West Africa around 2-6% and projected to rise 129% by 2045 according to the WHO. Over 90% of cases are Type 2 diabetes (IDF, World Bank). As diabetes is ambulatory care sensitive, good primary care is crucial to reduce complications and mortality. However, research on factors influencing diabetes primary care access, utilisation and quality in West Africa remains limited despite growing disease burden. While research has emphasised diabetes prevalence and risk factors in West Africa, there remains limited evidence on contextual influences on primary care. This scoping review aims to address these evidence gaps. Using the established methodology by Arksey and O'Malley, this scoping review will undergo six stages. The review will adopt the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR) guidelines to ensure methodological rigour. We will search four electronic databases and search through grey literature sources to thoroughly explore the topic. The identified articles will undergo thorough screening. We will collect data using a standardised data extraction form that covers study characteristics, population demographics, and study methods. The study will identify key themes and sub-themes related to primary healthcare access, utilisation, and quality. We will then analyse and summarise the data using a narrative synthesis approach. The findings and conclusive report will be finished and sent to a peer-reviewed publication within six months. This review protocol aims to systematically examine and assess the factors that impact the access, utilisation, and standard of primary healthcare services for diabetes in West Africa.

Goiter is a major source of morbidity in the world, especially in the developing world, where dietary iodine deficiency, a known cause of this condition, is endemic. The diagnosis is mostly by ultrasonography (USG) scan, which can give anatomical, pathological, and functional information for the management of goiter. This study aimed to determine the commonest ultrasound findings of goiter in Ghana. The records of all 213 patients with goiter diagnosed by USG scanover a 5-year period were retrieved. Data collected were sociodemographics, ultrasound features, thyroid nodules diameter, and Thyroid Imaging Reporting and Data System (TI-RADS) scores, which were analyzed using GNU PSPP, version 1.2.0-3.χ 2and two-tailed independent samples t-test were also employed, with p ≤ 0.05. A total of 213 patients with goiter diagnosed by USG scanwere obtained over the study period. The mean age of the participants was 50.01 ± 17.27 years, with an age range of 16-92 years and females constituting the majority (82.16%). The commonest ultrasound features were well-defined solid nodules. The lesion sites for most patients were the whole thyroid (28.17%), both lobes (24.41%), and the right lobe (20.19%). The mean difference in sizes of cysts and solid nodules among genders was 0.26 (CI: -0.14 to 0.67, p = 0.20) and 0.12 (CI: -0.43 to 0.66, p = 0.67), respectively. The TI-RADS score featured TI-RADS 4 (36.62%), TI-RADS 1 (28.17%), TI-RADS 3 (25.82%), TI-RADS 5 (5.16%), and TI-RADS 2 (4.23%). Solid nodules (49.32%, p = 0.001) and cysts (35.71%, p = 0.003) were more common within 41-60 years and less frequent in those <21 years. A p ≤ 0.05 was considered significant in this study. The predominant ultrasound features were well-defined solid nodules, simple cysts, and solid nodules with cystic changes, mostly located in the entire thyroid gland and least located in the isthmus only. Cysts and solid nodules were mostly seen in the 41-60 years age group.

IntroductionDespite breakthroughs in cervical cancer detection, resource-constrained countries continue to have a disproportionately high incidence and death rate. Mhealth has been identified as an important tool for increasing cervical cancer screening rates in Sub-Saharan Africa. We determined whether sending Ghanaian women culturally tailored one-way mobile phone SMS text messages about cervical cancer would encourage the uptake of the human papillomavirus (HPV) test.MethodsFrom August to November 2016, 88 women aged 18 to 39 living or working in an urban community (Accra, Ghana) participated in a quasi-experimental study. For 8 weeks, 32 SMS messages regarding cervical cancer were developed and sent to the personal phones of intervention arm participants (n = 42). Women in the control group (n = 46) received SMS texts with general health and lifestyle advice. Fischer’s exact tests were performed to assess cervical cancer screening uptake and associated reasons for non-uptake between the intervention and control groups (p < 0.05).ResultsAt the baseline, women differed in terms of ethnicity and wealth. After the intervention, participants’ self-reported risk factors for cervical cancer, such as early menarche, usual source of medical treatment, family history of cancer, smoking, and alcohol history, changed. None of the women in the intervention group sought cervical cancer screening after the intervention, but only one (2.2%) of the control arm participants did. Almost all the women (> 95%) agreed that an HPV test was essential and that regular healthcare check-ups could help prevent cervical cancer. Some women believed that avoiding particular foods could help prevent cervical cancer (23.8% intervention vs. 58.7% control, p < 0.001). Time constraints and out-of-pocket expenses were significant barriers to cervical cancer screening. Conclusion: A one-way SMS delivered to urban women did not increase cervical cancer screening attendance. The time spent in screening facilities and the lack of coverage by the National Health Insurance Scheme limited screening uptake. We urge for the establishment of screening centers in all healthcare facilities, as well as the inclusion of cervical cancer screening in healthcare programs through cost-sharing.