Convergence insufficiency symptom survey (CISS) scores are predictive of severity and number of clinical signs of convergence insufficiency in young adult Africans

Purpose: This study aimed to investigate the correlation between convergence insufficiency symptom survey (CISS) score and the signs of convergence insufficiency (CI) and to evaluate the sensitivity and specificity of the CISS to predict CI and ametropia among young adult university students.Method: This prospective cross-sectional clinic-based study included 300 first year university students (mean age = 21.58 (SD ± 2.2) years) who consecutively reported for eye examination. Participants were administered the CISS questionnaire and investigated for the signs of CI. Diagnosis of CI was based on presence of three or four signs. The correlation between the CISS score and the signs of CI were determined and Receiver Operation Characteristics (ROC) curves were used to evaluate sensitivity and specificity.Results: There were significant correlations between CISS score and the clinical signs of CI namely NPC break (rs = 0.622, p = 0.0001), NPC recovery (rs = 0.620, p = 0.0001), near exophoria (rs = 0.434, p = 0.0001), near PFV blur (rs = -0.359, p = 0.0001), near PFV break (-0.306, p = 0.0001), near PFV recovery (rs = -0.326, p = 0.0001) and gradient AC/A ratio (rs = -0.290, p = 0.0001). There was a significant positive correlation between CISS score and the number of clinical signs of CI (rs = 0.575, p-value = 0.0001). The CISS had good sensitivity (AOC = 0.882) to predict CI and poor sensitivity (AOC = 0.642) to predict ametropia.Conclusion: The CISS score is correlated with the severity and number of signs of CI in young adult Ghanaian university students. Its use in addition to clinical investigative testing may give a definitive diagnosis of symptomatic CI. (AU)

Microbial safety implications of in-use topical diagnostic ophthalmic medications in eye clinics in Ghana / Implicaciones sobre seguridad microbiana de los fármacos oftálmicos diagnósticos tópicos utilizados en las clínicas oftalmológicas de Gana

PURPOSE: To determine the microbial contaminants and its clinical importance in topical diagnostic ophthalmic medications (cycloplegics/mydriatics and miotics) in eye clinics in Ghana. Method: A cross-section of eye clinics was sampled for the diagnostic agents (Atropine, Phenylephrine, Tropicamide and Cyclopentolate, Pilocarpine). Standard laboratory procedures and protocols were observed in culturing the samples on different Agars. Microscopy and various biochemical tests were performed to identify microbial species. Antimicrobial susceptibility testing was also performed to ascertain the clinical importance of the isolated microbes. RESULTS: A total of 113 samples were obtained, from which 334 bacteria were isolated which included Bacilli spp. 91(27.25%), Coagulase Negative Staphylococci spp. 59(17.66%), Moraxella spp. 47(14.07%), Staphylococcus aureus 41(12.27%), Streptococcus spp. 21(6.29%), Klebsiella spp. 20(5.99%), Pseudomonas spp. 13(3.89%), Proteus spp. 12(3.59%), Escherichia coli. 12 (3.59%), Serratia spp. 10(2.99%), Shigella spp. 7(2.09%), Salmonella spp. 1(0.3%). There were 96 isolated fungal contaminants mainly Penicillium spp. 41(42.71%), Cephalosporium spp. 19(19.79%), Cladosporium spp. 15(15.63%), Aspergillus spp. 13(13.54%), Cercospora spp. 8(8.33%). The diagnostic agent with the most bacteria contamination was Phenylephrine 90 (26.95%) and the least being Pilocarpine 49 (14.67%). Also, the diagnostic agent with the most fungal contamination was Cyclopentolate 29 (30.2%) and the least was Tropicamide and Pilocarpine with 15 (15.63%) each. Gentamicin and Ciprofloxacin were the only antibiotics that showed 100% activity against all the bacterial isolates. Fungal contaminants were more susceptible to Ketoconazole as compared to Fluconazole. Conclusion: Topical diagnostic ophthalmic preparations used in clinical settings in Ghana are contaminated with clinically important bacteria and fungi

OBJETIVO: Determinar los contaminantes microbianos y su importancia clínica en los fármacos oftálmicos diagnósticos tópicos (ciclopléjicos/midriáticos y mióticos) en clínicas oftalmológicas de Gana. MÉTODO: Se realizó una muestra transversal de clínicas oftalmológicas para los agentes diagnósticos (Atropina, Fenilefrina, Tropicamida y Ciclopentolato, Pilocarpina). Se observaron procedimientos y protocolos de laboratorio estándar en cuanto al cultivo de muestras en diferentes soluciones de Agar. Se realizaron diversas pruebas microscópicas y bioquímicas para identificar las especies microbianas. También se realizó la prueba de susceptibilidad antimicrobiana para comprobar la importancia clínica de los microbios aislados. RESULTADOS: Se obtuvieron un total de 113 muestras, de las cuales se aislaron 334 bacterias que incluyeron Bacilli spp. 91(27,25%), Staphylococci spp. Coagulasa negativos 59(17,66%), Moraxella spp. 47(14,07%), Staphylococcus aureus 41(12,27%), Streptococcus spp. 21(6,29%), Klebsiella spp. 20(5,99%), Pseudomonas spp. 13(3,89%), Proteus spp. 12(3,59%), Escherichia coli. 12(3,59%), Serratia spp. 10(2,99%), Shigella spp. 7(2,09%), Salmonella spp. 1(0,3%). Se encontraron 96 contaminantes fúngicos aislados, principalmente Penicillium spp. 41 (42,71%), Cephalosporium spp. 19 (19,79%), Cladosporium spp. 15 (15,63%), Aspergillus spp. 13 (13,54%), Cercospora spp. 8 (8,33%). El agente diagnóstico con mayor contaminación bacteriana fue Fenilefrina 90(26,95%), siendo Pilocarpina 49 (14,67%) el que reflejó una menor contaminación bacteriana. De igual modo, el agente diagnóstico con mayor contaminación fúngica fue Ciclopentolato 29 (30,2%), siendo Tropicamida y Pilocarpina, con 15 (15.63%) cada uno, los que reflejaron menos contaminación fúngica. Gentamicina y Ciprofloxacina fueron los únicos antibióticos que reflejaron un 100% de actividad frente a todos los aislados bacterianos. Los contaminantes fúngicos fueron más susceptibles a Ketoconazol, en comparación con Fluconazol. CONCLUSIÓN: Los preparados oftálmicos diagnósticos tópicos en entornos clínicos en Gana están contaminados por bacterias y hongos clínicamente importantes

Source of medicines and medicine information by self-reported persons living with hypertension and diabetes in rural and urban Ghana

Objectives: This study was conducted to determine the source of medicines and medicine information of persons living with hypertension and diabetes in rural and urban Ghana and assessing if they are influenced by predisposing and enabling factors as defined by Andersen's behavioural model. Methods: A population based cross sectional study was conducted in four (4) rural and four (4) urban districts in the Ashanti Region of Ghana. A multistage and proportional sampling method was used in enrolling participants aged 18 years and above. A pre-tested structured questionnaire was used to collect primary data from respondents. Data collected was exported to STATA for analysis. Descriptive analysis was performed. Chi-square tests/Fisher's exact test and multinomial logistic regression models were used to establish association between variables. Results: A total of 336 self -reported persons with hypertension and diabetes were enrolled in the study with 199(59.23%) living in urban communities. The majority of participants with hypertension and diabetes living in the rural communities 77 (56.20%) were females contrasting with the male majority in urban communities 106 (53. 27%). In the rural communities, 49 (35.77%) of participants sourced medicines from the health centre while 45 (32.85%) and 35(25.55%) sourced medicines from the hospital and over the counter medicine shop (OTCMS) respectively. In the urban communities, 153 (76.88%) sourced medicines from the hospital while 33 (16.58%) sourced medicines from the pharmacy. The predisposing factor age (OR: 1.1, 95%CI 1.040-1.210) under OTCMS, age (OR 1.0, 95%CI: 1.002-1.066) under hospital and enabling factor socioeconomic status (OR: 0.3, 95%CI 0.085-0.855) under Hospital influenced participant's source of medicine in the urban communities. The results also revealed that majority of participants in both rural 99 (72.26%), and urban 164 (82.41%) communities sourced medicine information mainly from public healthcare facilities, pre-disposing factors; age (OR 1.1 95%CI 1.032-1.270) under family member, age (OR 1.1, 95%CI 1.022-1.167) under friend health professional, age (OR 1.1, 95%CI 1.050-1.147) under nearest health institution, marital status (OR: 0.004, 95%CI 0.003-0.441) under friend health Professional were found to influence participants' source of medicine information in the urban communities while in the rural communities the predisposing factor marital status (OR 10.6, 95%CI 1.044 -106.835), education (OR: 26.1, 95%CI 1.271-537.279) under friend health professional, age (OR 1.1, 95%CI 1.002-1.187), educational level (OR 30.6, 95%CI 1.718-546.668) under nearest health institution and enabling factor socio-economic status (OR 6.6, 95%CI 1.016 -43.510) under nearest health institution influenced one's source of medicine information. Conclusions: Majority of inhabitants with hypertension and diabetes in both rural and urban communities, sourced medicines and medicine information from public health institutions though a larger proportion was recorded in the urban communities. More participants in the rural communities than in the urban communities sourced medicines and medicine information from community pharmacies. Participants' source of medicine and medicine information was influenced by both predisposing and enabling factors

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Deciding to cooperate in northern Ghana: trust as an evolutionary constraint across cultural diversity

The upper-east and northern regions of Ghana offers a unique opportunity to study the influence of evolutionary social dynamics in making cooperation possible, despite cultural differences. These regions are occupied by several distinct ethnic groups, in interaction, such as the Kussasi, Mamprusi, Bimoba, Konkomba, and Fulani. We will report our fieldwork related to how cooperation takes places there, both within each group and among people from the different groups. Methods included personal networks of cooperation (ego networks), interviews and analysis of group contexts. The most important result is that, while each ethnic group may differ in terms of family and clan structure, a similar pattern can be found in all of them, of cooperation structured around small groups of trust-based close relationships. The study suggests that habitual decisions about cooperation are not strategic or self-interested, but instead are based on unconscious processes sustained by the emotional bonds of trust. These kind of emotional bonds are claimed to be relevant from an evolutionary point of view (AU)

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Patient knowledge of medicines dispensed from Ghanaian community pharmacies / Conocimiento de los pacientes sobre medicamentos dispensados en las farmacias comunitarias de Ghana

Background: One vital requirement for patient adherence to medicines is good patient knowledge of the medicines dispensed and this will invariably be linked to good labelling and counselling. Objective: The aim of this study was to evaluate the quality of labelling of medicines and determine patient knowledge of the administration of medicines dispensed from a community pharmacy in Ghana. Methods: From 6th to 29th January, 2010, dispensed prescriptions of 280 clients were purposely sampled to evaluate the quality of labelling. These clients were also interviewed about their knowledge of the last medicine received immediately after dispensing. A scoring system was employed by awarding a point for each attribute written on the package and each attribute stated by the patient. The dispensing attributes noted were name, dosage, frequency, duration, quantity and route of administration. Results: Of the 280 patients interviewed, 157 (56%) were males. Thirty one (11%) had no education and 99(35%) were secondary school graduates. Antimalarials comprised 17.9% and analgesics, 15.4% of medicines dispensed. The name, quantity, dosage, frequency, duration of therapy and route of administration were written on the label in 98%, 99%, 55%, 54%, 6% and 2% respectively of the dispensed medicines. The mean labelling score was 3.096 (SD=1.05) out of 6. The corresponding patient knowledge values were 63%, 80%, 80%, 75%, 57% and 86%. The mean knowledge score was 4.375 (SD; 1.38) out of 6. The chi square test p-value for the effect of demographic characteristics (sex, educational background, location) on patient knowledge of medicines dispensed were p=0.454; p=0.000, and p=0.138 respectively Conclusion: Patient knowledge of the administration of dispensed medicines was rated good; and this largely corresponded with the quality of labelling, except that the duration of therapy and route of administration was not frequently written and so labelling was rated just above average (AU)

Antecedentes: Un requisito básico pata la adherencia del paciente a la medicación es el buen conocimiento de los medicamentos dispensados, lo que estará invariablemente ligado a un buen etiquetado y asesoramiento. Objetivo: El objetivo de este estudio fue evaluar la calidad del etiquetado de los medicamentos y determinar el conocimiento de los pacientes sobre la administración de os medicamentos dispensados en farmacia comunitaria en Ghana. Métodos: Para evaluar la calidad del etiquetado, entre 6 y 29 de enero de 2010, se muestrearon propositivamente los medicamentos dispensados. También se entrevistó a estos clientes sobre su conocimiento de la última medicina recibida en la dispensación. Se utilizó un sistema de puntuación que asignaba un punto a cada atributo que aparecía escrito en el embalaje y a cada atributo respondido por el paciente. Estos atributos eran; nombre, dosis, frecuencia, duración, cantidad y vía de administración. esultados: De los 280 pacientes entrevistados, 157 (56%) eran hombres. 31 (11%) no tenía educación y 99 (35%) eran graduados en escuela secundaria. Los antimaláricos supusieron el 17,9% de las medicinas dispensadas y los analgésicos el 15,4%. El nombre, cantidad, dosis, frecuencia, duración del tratamiento y vía de administración estaban escritos en el 98%, 99%, 55%, 54%, 6% y 2% de los medicamentos dispensados. La media de la puntuación del etiquetado fue de 3,096 (SD=1.05) sobre 6. Los valores equivalentes del conocimiento de los pacientes fueron 63%, 80%, 80%, 75%, 57% y 86%. La puntuación promedio del conocimiento fue de 4,375 (SD=1,38) sobre 6. El valor de los p en la prueba chi-cuadrado para el efecto de las características demográficas (sexo, educación, localidad) sobre el conocimiento del paciente fueron p=0.454; p=0.000, and p=0.138 respectivamente. Conclusión: El conocimiento de los pacientes sobre los medicamentos dispensados fue calificado de bueno, y se corresponde con la calidad del etiquetado, excepto para la duración del tratamiento y vía de administración, que no estaban escritas normalmente, lo que provocó que el etiquetado fuese calificado solo como sobre la media (AU)

Prognostic significance of biochemical markers in African Burkitt's lymphoma

BACKGROUND AND PURPOSE Endemic Burkitt's lymphoma (eBL) remains the prevalent form of paediatric cancer in tropical Africa with subtle pathological differences. This calls for intensified efforts to validate the global prognostic markers within local settings for improved cancer treatment and survival. This study proposes prognostic markers for enhanced eBL treatment and management. PATIENTS AND METHOD One hundred and eighty histologically and/or clinically diagnosed BL patients at Komfo Anokye Teaching Hospital, Kumasi, Ghana were eligible for this cross-sectional eight-year retrospective study. Biochemical, clinical and demographic data, before chemotherapy administration, were documented and examined for their progression-free (PFS) and overall survival (OS) significance. RESULTS A mean age of 6 (SD=2.7, range: 1-16) years was observed with general male dominance (M:F=1.69:1). Total serum lactate dehydrogenase (HR=2.04; 95% CI, 1.25-3.32; log rank=8.3; p=0.004), serum creatinine (HR=3.59; 95% CI, 1.62-7.98; log rank=15.4; p=0.002) and St. Jude stage (HR=1.74; 95% CI, 1.11-2.73; log rank=8.0; p=0.015) were important independent prognostic biochemical markers for both PFS and OS. Age, serum calcium, uric acid, potassium, sodium and phosphorus were non-prognostic. CONCLUSION The better monitoring of these prognostic indices coupled with risk-stratification treatment may improve patients' survival, especially in resource-limited settings (AU)

Codesarrollo y salud. Prevención de la transmisión del VIH en Ghana: el programa Brothers in Work / Co-development and health. Prevention of HIV transmission in Ghana: the brothers in work programme

Objetivo. Diseñar un programa de salud, en régimen de codesarrollo, destinado a dismuir la incidencia de VIH-sida en población rural africana. Diseño. La Societat Catalana de Medicina Familiar i Comunitària ha desarrollado el programa de salud Brothers in Work (PBW) mediante un grupo de trabajo de médicos españoles y ghaneses. El programa consta de dos fases consecutivas. La primera ­seguridad (being safe)­ destinada a interrumpir la transmisión viral debida a accidentes biológicos con material sanitario. La segunda fase ­intervención (being active)­ se centra en introducir el cribado antenatal voluntario del VIH, el consejo y un protocolo de administración de nevirapina durante el parto a una cohorte de 600 embarazadas seropositivas. Los resultados serán comparados con los de otra cohorte compuesta de 600 embarazadas seronegativas. Emplazamiento. Tres hospitales de distrito de la Región Central (Ghana). Participantes. Un total de 876.000 personas de 3 distritos. Mediciones principales. Valoración de la prevalencia de VIH-sida y supervivencia de los neonatos a los 18 meses. Control de la realación coste-eficacia de las intervenciones. Resultados. Los costes directos estimados son: a) por diagnóstico de paciente seronegativa, 2,43 e (1,75 de copago), y b) por diagnóstico, consejo y tratamiento con nevirapina de paciente seropositiva, 6,6 e (4,65). La relación coste-eficacia estimada del programa es: a) por paciente diagnosticado, aconsejado e incluido en el programa, 23,5 e (15,3), y b) por caso de infección infantil intraparto evitado, 20,03 e (15,5). Se evitaría la transmisión del VIH a 54 niños (el 9% de los partos de mujeres seropositivas; el 6,3‰ del total de mujeres testadas). Conclusiones. El PBW tiene una buena relación baja de coste-beneficio en la interrupción de la transmisión del VIH

Objective. To design a health programme, as part of a codevelopment programme, aimed at reducing the occurrence of HIV-AIDS in a rural African population. Design. The Catalan Society of Community and Family Medicine developed the Brothers in Work Health Programme (BWP) through a working party of Spanish and Ghanaian doctors. The programme has two consecutive stages. The first ("being safe") aims to stop transmission of the virus caused by accidents with health material. The second, intervention stage ("being active") focuses on introducing voluntary antenatal screening for HIV, counselling and a protocol for administering nevirapine to a cohort of 600 seropositive women whilst giving birth. The results will be compared with another cohort of 600 seronegative pregnant women. Setting. Three Area Hospitals in the Central Region of Ghana. Participants. 876 000 people from 3 districts. Main measurements. Assessment of HIV-AIDS prevalence and survival of newborns at 18 months. Monitoring of the cost-efficiency relationship of the interventions. Results. Estimated direct costs are: a) for diagnosis of each seronegative patient, e2.43 (1.75 co-payment), and b) for diagnosis, counselling, and nevirapine treatment of each seropositive patient, e6.6 (4.65). Estimated cost-efficiency relationship of the programme is: a) for every patient diagnosed, counselled and included in the programme, e23.5 (15.3), and b) for each case of intra-delivery infection of baby avoided, e20.03 (15.5). HIV transmission to 54 children would be avoided (9% of the deliveries of seropositive women; 6.3‰ of the total women tested). Conclusions. The BWP has a gool cost/benefice relationship in the interruption of HIV transmission