Korle Bu Teaching Hospital

Breast cancer remains a global concern as the most common diagnosed cancer and the leading cause of cancer death among women. In Sub-Saharan Africa, although breast cancer accounts for the highest burden of mortality in women, there is little documentation on the experience of living with breast cancer. This article explores the lived experiences of a group of Ghanaian women receiving breast cancer treatment at the Korle Bu Teaching Hospital and the National Radiotherapy, Oncology and Nuclear Medicine Center in Ghana. The findings presented here, are drawn from a broader mixed methods study on breast cancer and fertility preservation that employed an explanatory sequential design. This article focuses on the qualitative phase of this work. A total of fifteen women were purposively sampled to take part in semi-structured interviews, following their participation in the quantitative phase of the study. The semi-structured interviews were audio-recorded, transcribed, and analysed using Braun and Clarkes analysis framework. The diagnosis of breast cancer constituted a pivotal point in the lives of these women. This precipitated an acute focus on survival and triggered a cascade of initial psychological responses, including catastrophic thinking and an overwhelming preoccupation with mortality and worst-case scenarios, eliciting anxiety and sadness. The ramifications of cancer treatment further exacerbated the emotional and physical toll, manifesting in a myriad of challenges, including reproductive health concern, impaired daily functioning, diminished social, occupational, and educational performance. Despite this life-altering circumstance, some participants demonstrated adaptive coping as they navigated the recovery trajectory, utilizing coping strategies largely influenced by personal choice, religious faith, trusted social support networks, and medical expertise. The women’s narratives highlight a journey of recovery characterized by initial grief reactions, acceptance, adaptation, and the hope of recovery. Religious beliefs and social connections played vital roles in the recovery process, underscoring the need to incorporate these into existing service delivery care models. By amplifying the voices and experiences of women living with breast cancer, we can culturally inform routine services and targeted strategies to enhance support, education, and resources for individuals and communities affected by breast cancer in Ghana.

Red blood cell transfusions are commonly required in pediatric cranial vault remodeling (CVR); however, they carry risks and potential complications. This study evaluates the evidence on perioperative blood conservation agents assessing their efficacy in optimizing and reducing transfusion requirements in CVR. A systematic review was conducted using PubMed/MEDLINE, Scopus, Embase, Web of Sciences, and Google Scholar according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to assess articles discussing blood conservation agents in pediatric CVR. A network meta-analysis compared the effectiveness of different agents including tranexamic acid (TXA), aminocaproic acid (ACA), aprotinin, erythropoietin (EPO), and iron. Sixteen studies analyzing 1072 patients with a mean age of 15.6 months and weight of 8.78 kg were included. The most reported craniosynostosis subtypes were sagittal (30.2%) and metopic (13.8%). TXA and ACA were independently associated with lower transfusion rates and volumes compared with placebo (ACA: odds ratio [OR], 0.25; 95% CI, 0.08-0.80; TXA: OR, 0.17; 95% CI, 0.07-0.42). Combination therapy with TXA + EPO + iron (OR: 0.004, 95% CI: 0.002-0.10) or ACA + EPO (OR: 0.04, 95% CI: 0.01-0.32) were associated with reductions in transfusion rates. Network meta-analysis ranking revealed TXA + EPO + iron (Surface Under the Cumulative Ranking [SUCRA]: 98.90%) and ACA + EPO (SUCRA: 75.41%) as the most effective treatments for reducing transfusion rates. While TXA was associated with significant reductions in blood loss compared with placebo (standard mean difference: -1.26, 95% CI: -1.97 to -0.56), ACA ranked highest for blood loss reduction (ACA: SUCRA, 84.58% vs TXA: SUCRA, 72.43%). Combination of TXA + EPO + iron was associated with significantly reduced hospital length of stay (standard mean difference: -1.00, 95% CI: -1.71 to -0.29). No treatment significantly affected the duration of surgery, and there were no reported treatment-associated thromboembolic events. Our meta-analysis reveals that TXA + ACA reduce red blood cell transfusion rates and volumes, with TXA + EPO + iron and ACA + EPO being most effective. This highlights the superiority of combination therapies and underscores the need for structured multimodal protocols in perioperative blood conservation for pediatric CVR.

Due to the higher prevalence of sputum scarce pulmonary tuberculosis (TB) and extrapulmonary TB among people with HIV compared to HIV-negative people, diagnosis of HIV-associated TB cannot rely solely on sputum-based methods. We estimated the TB diagnostic yield of urine Xpert MTB/RIF Ultra (Ultra) and its prognostic significance among inpatients with HIV. Adults admitted with HIV in Ghana between October 2019 and November 2021 were enrolled if they had a positive WHO 4-symptom screen, advanced HIV, or severe illness according to WHO criteria for people with HIV. Urine samples were frozen and later analyzed using Ultra. Two TB reference standards were used: an extended microbiological reference (eMRS) including culture, Xpert/Ultra on non-urine samples, or urine LF-LAM; and a composite reference (CRS) including eMRS or TB diagnosis by microscopy, recommended TB treatment, or TB at death. Patients were followed for 8 weeks. Of 141 participants, 118 (83.7%) provided urine samples for storage. TB prevalence was 25.0% by eMRS and 37.3% by CRS. Urine Ultra was positive in 34/118 (28.8%) patients. Ultra-positive patients had lower median CD4 count compared to Ultra-negative patients (31 vs 78 cells/mm3, P = 0.025). If urine Ultra had been used to guide TB diagnosis, it would have identified an additional 20 patients not detected by CRS. No difference in 8-week mortality was observed between Ultra-positive and negative patients. Urine Ultra shows promise as a supplementary point-of-care TB test among inpatients with HIV.

In Togo, despite efforts to achieve optimal vaccination coverage, measles continues to be prevalent in the country. The objective of this study was to describe the epidemiological, diagnostic, and preventive aspects of measles in children. This was a cross-sectional study of measles data from 2020 to 2024 in Togo among children under 18 years of age. The measles database of the “Institut National d’Hygiène” was used for the study. It was a secondary analysis of national measles surveillance data. A time, place, and person analysis was performed. A total of 3,135 suspected cases were recorded. There were 1,251 confirmed cases. The confirmation rate was 39.9% (CI 38.2–41.6%) with 3 deaths among confirmed cases. The median age was 3.7 years (IQR 1.9–6.0) for confirmed cases. The sex-ratio was 1.03 among confirmed cases. A higher proportion of confirmed cases was observed among females compared to males (42.0% vs. 37.8%, p = 0.016). In rural areas 707 cases were confirmed, compared with 397 cases in urban areas. The number of confirmed cases was highest in the Maritime and the Plateaux regions, with 380 and 352 cases respectively (p < 0.001). Most confirmed cases were notified in the years 2022 and 2023 with 619 and 444 cases respectively (p < 0.001). The frequency of confirmed cases was lower among vaccinated suspected cases compared to unvaccinated suspected cases (p < 0.001). Measles confirmed cases was highest in the Maritime and the Plateaux regions and the frequency of confirmed cases was lower among vaccinated suspected cases. Response measures and awareness campaigns to improve vaccination coverage are needed.

Providing comprehensive vascular and trauma care requires a functional surgical system, but these can often be complex. To better understand this system complexity, we aimed to develop multiple visualisation techniques, combining qualitative and quantitative data, using vascular and trauma surgery services in Korle Bu Teaching Hospital, Ghana, as a case study. Data collection was undertaken through a mixed methods approach. Qualitative data was generated from workshops on vascular and trauma care, and quantitative data was derived from observational data on trauma laparotomy patients collected as part of a larger multi-centre study. Visualisation tools were used to represent the varying aspects of the data obtained, each refined through an iterative process with local healthcare professionals. Five separate data visualisations were generated: Directed Acyclic Graphs, Swimlane Diagrams, Data Flow Diagrams, Parallel Coordinate Maps, and Sankey Diagrams.These were chosen to illustrate key areas of clinical interest. The use of multiple visualisation techniques based on mixed data allows for the complexity of a healthcare system to be appreciated. Such visualisations can support a range of further research and improvement efforts to strengthen healthcare systems and improve patient outcomes, even in lower resource settings. A complex system cannot be visualised in one map and the use of multiple visualisations can provide a more comprehensive understanding of a healthcare system.

Plummer-Vinson syndrome (PVS), also known as Paterson-Brown Kelly syndrome, is a clinical condition that is characterized by the triad of iron deficiency anemia, dysphagia and oesophageal web. This condition is rare and is diagnosed more in middle aged to older white women. However, in some studies, younger individuals have also been found to have this condition. We present a 26-year-old woman with a 5-year history of progressive difficulty in swallowing and a long history (approximately 18 years) of iron deficiency anaemia and has been on intermittent iron supplementation. A barium swallow showed narrowing in the upper third of the oesophagus, and she underwent serial dilatation of the oesophageal web stenosis and iron therapy with resultant improvement in the dysphagia. This patient was found to be pregnant 3 months postdiagnosis of PVS. The prevalence of PVS has decreased due to early diagnosis of iron deficiency and repletion of iron stores.