Care of Injured Children Compared to Adults at District and Regional Hospitals in Ghana and the Impact of a Trauma Intake Form: A Stepped-Wedge Cluster Randomized Trial.

BACKGROUND: This study aimed to determine the effectiveness of a standardized trauma intake form (TIF) to improve achievement of key performance indicators (KPIs) of initial trauma care among injured children, compared to adults, at non-tertiary hospitals in Ghana. METHODS: A stepped-wedge cluster randomized trial was performed with research assistants directly observing the management of injured patients before and after introducing the TIF at emergency units of 8 non-tertiary hospitals for 17.5 months. Differences in outcomes between children and adults in periods before and after TIF introduction were determined with multivariable logistic regression. Differences in outcomes among children after TIF introduction were determined using generalized linear mixed regression. RESULTS: Management of 3889 injured patients was observed; 757 (19%) were children <18 years. Trauma care KPIs at baseline were lower for children compared to adults. Improvements in primary survey KPIs were observed among children after TIF introduction. Examples include airway assessment [279 (71%) to 359 (98%); adjusted odds ratio (AOR): 74.42, p = 0.005)] and chest examination [225 (58%) to 349 (95%); AOR 53.80, p = 0.002)]. However, despite these improvements, achievement of KPIs was still lower compared to adults. Examples are pelvic fracture evaluation [children: 295 (80%) vs adults: 1416 (88%), AOR: 0.56, p = 0.001] and respiratory rate assessment (children: 310 (84%) vs adults: 1458 (91%), AOR: 058, p = 0.030). CONCLUSIONS: While the TIF was effective in improving most KPIs of pediatric trauma care, more targeted education is needed to bridge the gap in quality between pediatric and adult trauma care at non-tertiary hospitals in Ghana and other low- and middle-income countries. TYPE OF STUDY: Stepped-wedged cluster randomized controlled trial. LEVEL OF EVIDENCE: I.

Decolonising vaccine production: Unpacking Ghanaians' support for made-in-Africa vaccines.

Localisation of vaccine production is essential worldwide, but it is particularly crucial for Africa. This continent is more vulnerable to disease burdens and also lags behind other continents regarding access to vaccines. Moreover, many people in Africa have a long-standing apathy towards locally made products and services. This mindset raises the question of whether Africans will support African-made vaccines and what the associated reasons are. Guided by the theories of nationalism and import substitution industrialisation, we formulated and tested eight hypotheses. To answer these, we analysed survey data from 6,731 residents backed by key informant interviews in Ghana. Our findings identified three types of local vaccine consumers: Afrocentric-ethnocentrics, Apathetic-Afrocentrics and Afrocentric-Fence Sitters. Four out of the eight hypothesised factors explain why some individuals have a positive attitude towards locally made vaccines, compared to those who are unsure of their stance. The proposed typology of local vaccine consumers and their defining characteristics can help design public health campaigns to mobilize support for locally produced vaccines.

Factors associated with head injury among survivors of motorcycle crashes: a case-control study in northern Ghana.

Introduction: the increasing use of motorcycles in northern Ghana is associated with a high incidence of motorcycle crashes and resultant head injuries. This study sought to determine factors associated with head injuries among survivors of motorcycle crashes in northern Ghana. Methods: a prospective unmatched case-control study was conducted at the Tamale Teaching Hospital (TTH). A total of 326 cases (victims who suffered a head injury with or without other injuries) and 294 controls (persons who suffered various injuries except for head injury) from motorcycle crashes were consecutively sampled at TTH from December 15, 2019, to May 15, 2020. A semi-structured questionnaire was used to interview patients in addition to medical records review. Factors associated with head injury were examined using multivariable logistic regression at p<0.05 and a 95% confidence interval. Results: the prevalence of head injury was 53.03% among of 660 survivors of motorcycle crashes. The majority of the patients were young males aged 15-44 years. The rate of helmet use was lower in cases (12.88%) than in controls (57.82%) (p<0.001). Factors associated with head injury were not wearing helmet (AOR= 9.80, 95% CI: 6.22, 15.43), male (AOR=1.75, 95% CI: 1.07, 2.85), student (AOR=0.38, 95% CI: 0.16, 0.91), and alcohol use within 24 hours (AOR=0.17, 95% CI: 0.04, 0.70). Conclusion: non-use of helmet and male gender significantly increased the risk of head injury risk in this study. Alcohol use and being a student were associated with lower odds of head injuries. Motorcycle safety efforts in the study area should emphasize helmet promotion.

A nationwide survey of the potential acceptance and determinants of COVID-19 vaccines in Ghana.

PURPOSE: Safe and effective vaccine together with better treatment remains one of the strategic exist of the coronavirus disease 2019 (COVID-19) pandemic. As in many other countries worldwide, the government of Ghana has expressed its commitment to procuring globally approved and accepted vaccines. This preliminary study aims to analyses these factors that could impact the choice of the vaccine in Ghana. MATERIALS AND METHODS: This cross-sectional survey was conducted among 1,000 Ghanaian respondents from the 14th October to the 12th of December 2020. A structured questionnaire after a series of literature review and was transcribed unto google forms. Dataset was extracted using Excel ver. 2016 (Microsoft Corp., Redmond, WA, USA) and imported into IBM SPSS ver. 22.0 (IBM Corp., Armonk, NY, USA) for analysis. Descriptive statistics, cross-tabulations and logistic regression analyses were conducted at p-value <0.05. RESULTS: The results showed that 541 (54.1%) of the respondents would opt for the vaccines, 907 (90.7%) trusted the healthcare system and 388 (38.8%) had a high-risk perception of acquiring COVID-19. Our inferential analysis found that being married (adjusted odds ratio [aOR], 2.29; 95% confidence interval [CI], 1.10-4.78), salary worker (private: aOR, 2.24; 95% CI, 0.85-5.89; government: aOR, 42.58; 95% CI, 14.09-128.61), and high-risk perception (aOR, 5.35; 95% CI, 3.24-8.82) had a higher OR of accepting COVID-19 vaccine. CONCLUSION: As the government of Ghana prepares to secure COVID-19 vaccines, it is important to understand the state of mind and determinants of COVID-19 vaccine acceptance in the general population. Policymakers and stakeholders should focus on evidence-based community messaging to improve uptake and break the transmission dynamics.

Ketamine Use in Hysterosalpingography (the Jimah Procedure): A Follow-Up of Bilateral Tubal Evaluation of 27 Infertile Women at a Teaching Hospital, Ghana.

BACKGROUND: Pain, anxiety, and distress are common in radiological investigations including hysterosalpingogram (HSG). Studies suggest that sedation allows patients to better tolerate diagnostic imaging and image-guided procedures by relieving anxiety, discomfort, and pain. This study aimed at assessing the safety and effectiveness of ketamine use in HSG and the proportion of true positive bilateral tubal blockage during HSG using the Jimah Procedure. METHODS: We performed repeated HSG workup under IV ketamine (20-40 mg/mL) sedation for 27 infertile women at the Cape Coast Teaching Hospital. The exclusion criteria included unilateral tubular blockage, acute infection of the vagina or cervix, active vaginal bleeding, glaucoma, and high blood pressure at the time of the study. Data were entered with Microsoft Excel and analyzed using SPSS version 21. RESULTS: A total of 27 patients (age range: 25-48 years) previously diagnosed of bilateral tubal blockage or spasm were enrolled for the repeat HSG procedure. The median age was 34 years (IQR: 32-37), while secondary infertility (20) (74.1%) was the commonest indication. None of the patients reported of pain or distress during or after the procedure. Two (7.4%) women vomited after HSG. Twelve patients (44.4%) had bilateral tubal blockage (true positive), while tubal patency was seen in 15 (55.6%) patients on HSG under ketamine sedation. CONCLUSION: This study found IV ketamine sedation produces profound anesthesia and analgesia and eliminates tubal spasm. We recommend that radiologists in developing countries should consider sedating patients during HSG and documenting observations and patients' feedback to help assess safety and effectiveness in local settings.

Knowledge, risk perception and preparedness towards coronavirus disease-2019 (COVID-19) outbreak among Ghanaians: a quick online cross-sectional survey.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is recognized as global pandemic, affecting more than 300,000 worldwide. Ghana joined the international community by confirming first two COVID-19 cases on March 12, 2020. The study aimed to assess the public knowledge, risk perception and preparedness to respond the COVID-19 in the early stage of the outbreak in Ghana. METHODS: A cross-sectional study was conducted to collect information from Ghanaian during the early stage of the outbreak from 12th to 20th March 2020. Electronic based questionnaire was developed to collected information on the public knowledge, risk perceptions and preparedness to respond the COVID-19. All people who were aged 18 years and over were invited to participate in the study. RESULTS: A total of 350 participants were recruited into the analysis; 56% were males, with the majority of the study population aged between 18-30 years (61.4%), single (68.9%) and attained tertiary education (95.1%). Regarding COVID-19, 62.7% had "good" knowledge about the outbreak, 68.3% had a high risk of contracting the COVID-19 infection and 81.4% had a moderate preparedness skill to prevent and control the disease. Internet (77.1%) was the major sources of information. Knowledge of COVID-19 was significantly associated with education (p<0.001), age (p=0.018), employment (p=0.011) and health-related occupation (P=0.001) but only religion was associated with risk perception. CONCLUSION: Though overall public knowledge was good, disparity exist among the least educated population, there was high risk perceptions and moderate preparedness skill to respond to COVID-19 among our study population. We recommend that educational campaigns through timely online update on COVID-19, van mobilization and mass media broadcasting should target all groups including those in the rural communities.

A community-based ultrasound determination of normal thyroid volumes in the adult population, Assin North District, Ghana.

INTRODUCTION: the purpose of this study was to measure thyroid volumes among normal sub-population of Ghanaians using ultrasonography in order to help provide preliminary local thyroid gland volume reference data for use in Ghana. METHODS: this was a cross-sectional study in which the thyroid glands of 320 normal adults aged 18 to 95 years from six (6) communities in the Assin North District of Ghana were examined using ultrasonography. The volumes of the left and right lobes were summed to constitute the total thyroid volume. Information on socio-demographic characteristics and anthropometric parameters of subjects were also collected. The data were summarized using mean, standard deviation and proportions, whilst inferential analysis was done using the T-test, ANOVA test and Pearson correlation. RESULTS: of the 320 adults examined, 284 (88.8%) were found to have normal thyroid glands. This consisted of 164 females and 120 males whose mean ages were 42.3 (±15.9) years and 45.4 (±15.9) years respectively. The overall mean total thyroid volume (MTTV) was 6.8±2.5 mL. This was greater in the males (7.1±2.7 mL) than in the females (6.6±2.2 mL). The MTTVs for three age groups; 30-39 years (7.1±2.1), 40-49 years (7.3±2.8 mL) and 50-59 years (7.1±3.0 mL) were greater than the overall MTTV. Thyroid volume had a positive correlation with body surface area (BSA) (r=0.119, p=0.046), but not with body mass index (BMI) (r=-0.021, p=0.719). CONCLUSION: this study estimated local reference values much lower than the WHO/ICCIDD thyroid volume reference values. This calls for the need for nationally representative studies to inform the establishment of standard local reference values for Ghana.