Health Systems Factors Associated With Adverse Events Among Hospitalized Obstetric Clients in a Tertiary Health Care Facility in Ghana.

OBJECTIVES: The risk of an adverse event (AE) in obstetric clients receiving care in hospitals is greater than the risk of dying in aviation, road traffic accidents, and breast cancer. There is little understanding of AEs with respect to their causes at hospitals. The study aimed at assessing factors that are associated with the occurrence of AEs among hospitalized obstetric clients in a tertiary hospital in Ghana. METHOD: This was a case-control study of 650 obstetric clients (equal number in both arms) who were admitted between January 1 and December 31, 2015, at the study site. A retrospective review of the clients' medical records was randomly allocated into both arms of the study. Descriptive and inferential statistics including confirmatory factor analysis were performed. Models were evaluated for goodness-of-fit measures. The reliability and validity of the scale were also tested using Cronbach α coefficient. RESULTS: The mean gestational age of the clients was 37.4 ± 4.9 weeks. Leadership and governance (inadequate use of protocol and adherence) accounted for the most cause of AEs among obstetric clients. The overall Kaiser-Meyer-Olkin score was also 0.87. The scale also demonstrated high reliability (Cronbach α = 0.995; composite reliability > 0.7) and validity (average variance extraction > 0.50). There was a marginal model fit (root mean square error of approximation, 0.067), and the χ2 test was statistically significant (P < 0.05). CONCLUSIONS: Inadequate use of protocol and adherence is a major cause of preventable AEs identified in this study. There is an urgent need to address this to ensure a reduction in the prevalence of AEs among obstetric clients.

Factors affecting early re-displacement of paediatric diaphyseal forearm fractures at Korle Bu Teaching Hospital.

BACKGROUND: Complete fractures of the forearm have the potential to displace and angulate with overriding fracture fragments. Maintaining acceptable reduction is not always possible, and re- displacement or re-angulation is the most commonly reported complication. Factors responsible for the re-displacement after an initial acceptable reduction have not been clearly defined. The study aimed to determine the factors that influence early re-displacement of paediatric diaphyseal forearm fractures in Korle-Bu Teaching Hospital. METHODS: A prospective study in a cohort of 72 children below the age of 12 years with diaphyseal forearm fracture attending the Orthopaedic clinic were followed with close reduction casting from April 2017-December, 2017. Factors analysed included demographics, initial fracture features and the radiographic indices of the cast quality. RESULTS: 93.1% (67) of the fractures were because of the children falling on an outstretched arm. Majority of the children had a fracture of the distal 1/3 of the radius (n=38, 52.6%). The overall C.I was 0.8 (SD 0.1). The only significant predictor for predicting re-displacement was children falling on an outstretched hand (p-value=0.0). CONCLUSION: This study has shown that the degree of initial displacement and the ability to achieve good reduction with a well moulded cast, constitute the major factors for early re-displacement of paediatric forearm fractures. FUNDING: Personal funding.

Validation of three pain scales among adult postoperative patients in Ghana.

BACKGROUND: Pain assessment is an important component of pain management and health professionals require valid tools to assess pain to guide their pain management decisions. The study sought to select, develop, and validate context-appropriate unidimensional pain scales for pain assessment among adult post-operative patients. METHODS: A mixed methods design was adopted. The study was conducted at two hospitals in Accra, Ghana. The qualitative phase involved 17 patients and 25 nurses, and the quantitative phase involved 150 post-operative patients. Qualitative data was collected iteratively through individual interviews and focus groups. RESULTS: Two existing pain scales (0-10 Numeric Rating Scale [NRS] and Wong-Baker FACES [FPS] scales) and one new pain scale (Colour-Circle Pain Scale-[CCPS]) were validated. The psychometric properties of the three scales were assessed when patients had fully recovered from anesthesia. The CCPS had higher scale preference than NRS and FPS. Convergent validity was very good and significant (0.70-0.75). Inter-rater reliability was high (0.923-0.928) and all the scales were sensitive to change in the intensity or level of pain experienced before and after analgesia such as paracetamol and diclofenac suppositories, injectable pethidine, and oral tramadol had been administered. CONCLUSION: Using a valid tool for pain assessment gives the clinician an objective criterion for pain management. Due to the subjective nature of pain, consideration of socio-cultural factors for the particular context ensures that the appropriate tool is used.