Kidney transplantation in Ghana: Is the public ready?

BACKGROUND: The burden of end stage renal disease (ESRD) is reported to be higher among people of African ancestry. The majority do not have access to kidney transplantation. Africans, in general, are less likely to donate a kidney or receive a transplant. AIMS: This study surveyed public perceptions of kidney transplantation in an inner city and suburban communities in Ghana. It examined people's willingness to either accept or donate a kidney to save a life. In addition, it evaluated factors that influenced their opinion on the issue. METHODS: A cross-sectional survey was conducted in five purposively selected communities in the Greater Accra region in Ghana. Structured questionnaires and standardized instruments were administered to assess participants' socio-demographic characteristics, religiosity and spirituality, and perception of kidney transplantation. RESULTS: Of the 480 participants, 233 (48.5%) were willing to donate a kidney; 71.6% would only do so after death. Religion, loss of body part, and cultural values influenced participants' willingness to donate a kidney. Uncertainty of health status post-transplantation and uneasiness with the concept of transplantation influenced the participants' willingness to accept a kidney transplant. CONCLUSION: The study revealed that almost half of the participants hold positive views toward kidney transplantation.

Evaluation of antiretroviral therapy (ART) provision in an early cohort of patients initiating ART in Ghana.

INTRODUCTION: Against the background of Ghana's ART program which scaled up rapidly since inception in 2003, the study assessed outcomes of an early cohort of patients initiating ART. METHODS: THE STUDY UTILIZED THE FOLLOWING METHODS: a cross-sectional study involving patient interviews using a structured questionnaire, a review of records and a retrospective cohort analysis of adults initiating ART between 2003 and 2008 from four selected clinics. RESULTS: The 683 study participants consisted of 464 females (67.9%) and the mean age was 41 years. Mean duration of treatment was 25 months (SD =13). More than 95% were on a regimen as per national guidelines. Ninety-five (14.1%) of the respondents had one or two drugs substituted. Seventy-three% of the substitutions were due to adverse drug reactions. On at least one occasion, over half (350) had defaulted on a clinic appointment. In the 3 months preceding the survey, 21.4% (146) had missed treatment doses. About 49% (334) had challenges meeting financial obligations related to care. The median weight increased by 5.9 kg and 8.0 kg at 6 and 12 months after initiating ART respectively over the median baseline weight of 54 kg, (p-value = 0.001). The median CD4 count increased by 128, 170 and 256 cells/µl respectively at 6, 12 and 24 months from the median baseline of 125 cell/µl, (p-value = 0.035). CONCLUSION: This study of Ghanaian PLHIV on ART from four facilities showed encouraging immunological and clinical outcomes. There were however issues of appointment default, sub-optimum adherence to treatment and cost of care barriers needing attention.