Practice and Sociodemographic Factors Influencing Self-Monitoring of Blood Pressure in Ghanaians with Hypertension.

BACKGROUND: In sub-Saharan Africa, the prevalence of hypertension has assumed epidemic levels and currently accounts for numerous complications such as stroke, heart failure, and kidney damage. Management of hypertension involves both drug and nonpharmacological approaches. Self-monitoring of blood pressure is an important nonpharmacological approach that facilitates early detection of deteriorating blood pressures and complications. AIMS: We determined the practice and sociodemographic factors influencing self-monitoring of blood pressure among Ghanaians with hypertension. METHODS: In a cross-sectional design, we recruited four hundred and forty-seven (447) Ghanaians with hypertension receiving care at the hypertensive Outpatient Department (OPD) Clinics of the Medical Department at the Korle-Bu Teaching Hospital (KBTH). The respondents were sampled using a simple random sampling technique of balloting without replacement. A structured questionnaire was used to gather data on the practice of self-monitoring of blood pressure and sociodemographic factors influencing self-monitoring in the respondents. We also measured some anthropometric and haemodynamic indices of the respondents. The data was entered in Microsoft Excel 2010 and exported into SPSS 21.0 to aid with the data analysis. A chi-square test and Student's t-test analysis were done to determine the relationship between the practice of self-monitioring and other sociodemographic variables. Data analayses were conducted at a significant level (alpha 0.05) and power of 95% confidence. Thus, p < 0.05 was considered statistically significant. RESULTS: The practice of self-monitoring of blood pressure was 25.3% with more female respondents claiming to practice self-monitoring as compared to their male counterparts (28.6% vs. 20.7%). Awareness of self-monitoring of blood pressure was associated with increased practice of self-monitoring of blood pressure. Health workers (46.8%), colleague patients (39.8%), relatives/spouses (6.7%), and the media (6.7%) were identified as the sources of information about self-monitoring of blood pressure. Awareness of self-monitoring, level of education, valid health insurance, occupation, income levels, and marital status had a significant relationship with self-monitoring of blood pressure among the respondents. Thus, respondents with higher education, awareness of self-monitoring, valid health insurance, formal employment, and higher income were likely to monitor their blood pressure. CONCLUSION: Several sociodemographic factors influence the practice of self-monitoring of blood pressure in Ghanaians with hypertension. Thus, targeted hypertension education and social-cognitive interventions should focus on these sociodemographic factors so as to improve self-monitoring of blood pressure in order to reduce the complications of hypertension.

Expectation and Satisfaction with Nursing Care among Hypertensives Receiving Care at a Resource-Constrained Hospital in Ghana.

BACKGROUND: Hypertension accounts for a third of the global preventable premature deaths. In Sub-Saharan Africa, hypertension is the most rapidly increasing cardiovascular disease (CVD) and the second leading cause of death. Proper management of hypertension requires adherence to management by patients and this is partly possible if patients feel satisfied with the nursing care they receive. Satisfaction with nursing care is only possible if there is a congruence between the expectations of care and the actual care received from nurses. AIM: We explored the expectations and satisfaction of Ghanaian hypertensives with nursing care received at the Korle-Bu Teaching Hospital (KBTH). METHODS: In this qualitative study, a phenomenological approach was used to gather data about the lived experiences of patients with hypertension about nursing care. In-depth interviews (IDIs) were conducted among sixteen (16) patients with hypertension from the hypertensive Out-Patient Department (OPD) Clinics of the Medical Department at the KBTH. Only patients with history of previous admission(s) at the KBTH during the immediate past six months were purposively recruited. The respondents were interviewed about the nursing care received during their immediate past admission(s) at the KBTH using an IDI-guide. The IDIs were recorded digitally, transcribed verbatim, and reviewed severally and thematic analysis was done. Nvivo 11 software was used to manage the data and aid with the thematic analysis. RESULTS: The results of this study showed that Ghanaian hypertensive patients perceived nurses as key players in the management of patients. On the respondents' expectations from nurses prior to their immediate past admissions at the KBTH, the data revealed the responsiveness of nurses to patient needs, prompt pain management, high confidentiality level of nurses, rendering of efficient health education, maintenance of therapeutic work environment, and ensuring effective communication as well as professional/ethical practice from the nurses. On the question of what made nursing care satisfying, it was observed from the respondents that they considered the competence of nurses, maintenance of therapeutic environment, and also effective handling of confidential information as determinants of their satisfaction with nursing care. Further, the respondents identified some key areas of dissatisfaction and these included the responsiveness of nurses to patient needs, prompt pain management, effectiveness of health education, and provision of culturally sensitive communication. Disproportionate distribution of nursing staff across the three nursing shifts, unethical practice among some nurses, inadequate resources for work, and low work morale of some nurses were identified as factors responsible for the gaps between patient expectations and actual care received. CONCLUSION: Our study concludes that continuous professional development programs for nurses should focus on the areas of dissatisfaction so as to improve care for hypertensives. We also recommend that nursing staff distribution across the various shifts should be of keen interest to nurse managers if hypertension care in particular and overall patient care in general are to improve.

Antiprotozoan sesterterpenes and triterpenes isolated from two Ghanaian mushrooms.

Bioassay-guided compound isolation led to the discovery of two new scalarane sesterterpenes (1 and 2) and two new triterpenes (3 and 4) from two mushroom species, Pleurotus ostreatus (edible) and Scleroderma areolatum, collected from Ghana. Their structures, including absolute stereochemistry, were established by spectroscopic methods, particularly (+)-ESI-TOF mass spectrometry and 1D and 2D NMR. The four compounds exhibited IC50 values of 1.65-7.63 µM against Plasmodium falciparum 3D7 and 5.04-13.65 µM against Trypanosoma cruzi Tulahuen C4 parasites and were also non-cytotoxic against HepG2 tumoral human liver cells. This is the first report describing the isolation of sesterterpenes belonging to the scalarane structural class from a terrestrial source.

Antimicrobial Activities and Time-Kill Kinetics of Extracts of Selected Ghanaian Mushrooms.

The rapid rise of antimicrobial resistance is a worldwide problem. This has necessitated the need to search for new antimicrobial agents. Mushrooms are rich sources of potential antimicrobial agents. This study investigated the antimicrobial properties of methanol extracts of Trametes gibbosa, Trametes elegans, Schizophyllum commune, and Volvariella volvacea. Agar well diffusion, broth microdilution, and time-kill kinetic assays were used to determine the antimicrobial activity of the extracts against selected test organisms. Preliminary mycochemical screening revealed the presence of tannins, flavonoids, triterpenoids, anthraquinones, and alkaloids in the extracts. Methanol extracts of T. gibbosa, T. elegans, S. commune, and V. volvacea showed mean zone of growth inhibition of 10.00 ± 0.0 to 21.50 ± 0.84, 10.00 ± 0.0 to 22.00 ± 1.10, 9.00 ± 0.63 to 21.83 ± 1.17, and 12.00 ± 0.0 to 21.17 ± 1.00 mm, respectively. The minimum inhibitory concentration of methanol extracts of T. gibbosa, T. elegans, S. commune, and V. volvacea ranged from 4.0 to 20, 6.0 to 30.0, 8.0 to 10.0, and 6.0 to 20.0 mg/mL, respectively. Time-kill kinetics studies showed that the extracts possess bacteriostatic action. Methanol extracts of T. gibbosa, T. elegans, S. commune, and V. volvacea exhibited antimicrobial activity and may contain bioactive compounds which may serve as potential antibacterial and antifungal agents.

Review: African medicinal plants with wound healing properties.

ETHNOPHARMACOLOGICAL RELEVANCE: Wounds of various types including injuries, cuts, pressure, burns, diabetic, gastric and duodenal ulcers continue to have severe socio-economic impact on the cost of health care to patients, family and health care institutions in both developing and developed countries. However, most people in the developing countries, especially Africa, depend on herbal remedies for effective treatment of wounds. Various in vitro and in vivo parameters are used for the evaluation of the functional activity of medicinal plants by using extracts, fractions and isolated compounds. The aim of the review is to identify African medicinal plants with wound healing properties within the last two decades. MATERIALS AND METHODS: Electronic databases such as PubMed, Scifinder(®) and Google Scholar were used to search and filter for African medicinal plants with wound healing activity. The methods employed in the evaluation of wound healing activity of these African medicinal plants comprise both in vivo and in vitro models. In vivo wound models such as excision, incision, dead space and burn wound model are commonly employed in assessing the rate of wound closure (contraction), tensile strength or breaking strength determination, antioxidant and antimicrobial activities, hydroxyproline content assay and histological investigations including epithelialisation, collagen synthesis, and granulation tissue formation. In in vitro studies, single cell systems are mostly used to study proliferation and differentiation of dermal fibroblasts and keratinocytes by monitoring typical differentiation markers like collagen and keratin. RESULTS: In this study, 61 plants belonging to 36 families with scientifically demonstrated or reported wound healing properties were reviewed. Various plant parts including leaves, fruits, stem bark and root extracts of the plants are used in the evaluation of plants for wound healing activities. CONCLUSION: Although, a variety of medicinal plants for wound healing can be found in literature, there is a need for the isolation and characterization of the bioactive compounds responsible for the wound healing properties. Also, cytotoxicity studies should be performed on the promising agents or bioactive fractions or extracts.