In the eyes of the beholder:assessment by clients on healthcare delivery in a large teaching hospital in Ghana.

BACKGROUND: Improving quality of health care delivery is a primary goal of all health care institutions. Health care systems face challenges in providing quality health care to the citizenry due to rising health care cost and clients demanding higher standards of care. OBJECTIVES: The study aimed at finding out clients' perceptions of the quality of health care delivery at the tertiary care level in Ghana, using the Central Outpatient Department (COPD) of the largest teaching hospital in Ghana as a case study. STUDY DESIGN: Overall 665 clients were selected through systematic random sampling procedure over a four-week period, between September and October 2010. Clients were interviewed after a visit to the COPD of the hospital during the survey period using a structured questionnaire.Two focus group discussions were held for clients during the period. RESULTS: Majority of clients (56%) were females and most (84%) were clients coming for review. During the focus group discussion, clients'considered one hour as the mean maximum time they would like to wait while seeking medical help,however, more than half of clients (51.9%)waited for over an hour (after registration) to see a doctor. About 86% had their condition explained to them and 87% were physically examined. In all, 83% of clients were satisfied, and 6% very satisfied with care given at the COPD. Clients however, considered poor attitude of some health workers, long waiting times,late starting times of clinic, uncomfortable physical environment and inadequate staff as being detrimental to the effective delivery of quality healthcare. CONCLUSION: Overall quality of health care as measured by the indicators used were generally perceived to be high except with client waiting time for services, lack of directional signs in the hospital and an uncomfortable waiting area at the COPD. There were concerns about attitude of some staff and late starting times of outpatient clinics. These when addressed would further improve quality.

Detection and characterization of drug-resistant conferring genes in Mycobacterium tuberculosis complex strains: A prospective study in two distant regions of Ghana.

We spoligotyped and screened 1490 clinical Mycobacterium tuberculosis complex strains from Northern and Greater Accra regions of Ghana against INH and RIF using the microplate alamar blue phenotypic assay. Specific drug resistance associated genetic elements of drug resistant strains were analyzed for mutations. A total of 111 (7.5%), 10 (0.7%) and 40 (2.6%) were mono-resistant to INH, RIF, and MDR, respectively. We found the Ghana spoligotype to be associated with drug resistance (INH: 22.1%; p = 0.0000, RIF: 6.2%; p = 0.0103, MDR: 4.6%; p = 0.0240) as compared to the Cameroon spoligotype (INH: 6.7%, RIF: 2.4%, MDR: 1.6%). The propensity for an isolate to harbour katG S315T mutation was higher in M. tuberculosis (75.8%) than Mycobacterium africanum (51.7%) (p = 0.0000) whereas the opposite was true for inhApro mutations; MAF (48.3%) compared to MTBSS (26.7%) (p = 0.0419). We identified possible novel compensatory INH resistance mutations in inhA (G204D) and ahpCpro (-88G/A and -142G/A) and a novel ndh mutation K32R. We detected two possible rpoC mutations (G332R and V483G), which occurred independently with rpoB S450L, respectively. The study provides the first evidence that associate the Ghana spoligotype with DR-TB and calls for further genome analyses for proper classification of this spoligotype and to explore for fitness implications and mechanisms underlying this observation.

A novel arylsulfatase A protein variant and genotype in two patients with major depression.

A new, 'diffuse, multiple banding', electrophoretic variant of arylsulfatase A protein was found in two patients with major depression. Protein analyses showed that this variant and the normal enzyme differed in amino acid sequence and/or post-translational modifications unrelated to phosphate groups and oligomannose glycans. Analysis of the arylsulfatase A genes from a subject with the new variant identified three mutations; one gene had the two mutations associated with arylsulfatase A pseudodeficiency, and the other had a G to T transversion which changes a tryptophan to cysteine in the protein. These mutations result in an arylsulfatase A protein heteromer with diffuse electrophoretic banding. The possible association of these mutations with major depression is discussed.