Acceptance of HPV vaccination in boys among mothers from selected churches in Accra, Ghana.

BACKGROUND: Almost all cases of cervical and anal cancer have been linked to the human papillomavirus (HPV). However, in addition to women who develop HPV-related cervical cancer, both men and women can also develop cancers of the anus, oral cavity, and oropharynx that are attributed to HPV. However, literature on HPV vaccination among boys globally, in Africa, and most especially in Ghana is scarce. Thus, the main objective of this study was to explore the acceptance of HPV vaccination in boys among mothers from selected churches in Accra, Ghana. METHODS: In this study, a qualitative exploratory design was utilized to enlist 30 mothers who have male children aged between 9 and 12 years from the Greater Accra Region of Ghana. The recruitment of participants was carried out using a purposive sampling technique, and they were subsequently interviewed in-depth in a face-to-face setting, with the entire conversation being recorded for reference. After transcription, the recorded data were analyzed through content analysis. FINDINGS: Upon analyzing the data, two (2) primary themes and 11 sub-themes emerged. The research showed that although the majority of the mothers were unaware of HPV in boys, they perceived it as a positive initiative and expressed a willingness to allow their sons to receive the vaccine. However, some participants mentioned certain factors that they believed could hinder the acceptance of HPV vaccination in boys among mothers. These included concerns about injection-related pain, high cost, and fears that the vaccine could make men immoral or infertile. CONCLUSION: The study revealed poor awareness of HPV vaccination in boys among mothers, and hence, suggested the need to increase the awareness on HPV vaccination in boys among mothers as well as the public to increase its acceptance.

Risk Factor Control in Stroke Survivors with Diagnosed and Undiagnosed Diabetes: A Ghanaian Registry Analysis.

BACKGROUND AND PURPOSE: Expert consensus guidelines recommend optimizing global risk factor control in diabetic stroke survivors to improve outcomes. Since relatively little is known about the adequacy of risk factor control among diabetic stroke survivors in sub-Saharan Africa, we sought to assess control rates of key traditional risk factors among Ghanaian stroke survivors with diabetes. A secondary objective was to assess the burden of undiagnosed dysglycemic states among stroke survivors without a prior diagnosis of diabetes mellitus (DM) METHODS: Cross-sectional study of outpatient stroke survivors consecutively enrolled in a stroke registry at a tertiary medical center in Ghana between January 2018 and March 2020. We collected baseline demographic and clinical details including blood pressure, lipid panel, fasting blood glucose results, medications prescribed for secondary prevention, and stroke type information. BP control target was set at <130/80 mmHg, LDL-cholesterol <2.6 mmol/l and Fasting blood glucose (FBG) <7.0 mmol/l. Factors associated with poor control of vascular risk factors were assessed using multivariate logistic regression models. RESULTS: Of 1101 stroke survivors enrolled into the registry, 279 (25.3%) had a comorbid diagnosis of DM. Mean (±SD) age among the diabetic vs. non-diabetic stroke patients was 61.4 ± 12.0 years vs. 57.6 ± 14.6 years (p < 0.0001). Among the diabetic stroke patients, 61.7% had LDL-cholesterol <2.6 mmol/L, 8.2% had BP <130/80 mm Hg and 28.6% had FBG <7.0 mmol/L. Significant predictors of poor control of BP were younger age, having co-morbid DM and number of antihypertensive medication classes while poor LDL-cholesterol was associated with longer duration of stroke diagnosis. Among those without a prior diagnosis of DM, FBG analysis of 540 subjects with available data showed that 21.7% had FBG <5.7 mmol/L, 39.0% had impaired fasting blood glucose and 39.3% had FBG in the diabetes mellitus range. Patients who were older, female, or experienced an ischemic stroke trended towards being more likely to have undiagnosed DM. CONCLUSION: Among Ghanaian diabetic stroke survivors, blood pressure and blood glucose, are especially poorly controlled. There is also a high burden of undiagnosed pre-diabetes and DM among stroke survivors substantially heightening their risk for further adverse CVD outcomes.

Adjustment and coping in spousal caregivers of cervical cancer patients in Ghana: A qualitative phenomenological study.

Cervical cancer is a common and significant health issue for women worldwide. To address the dearth of research on male partners' experiences when their significant others are diagnosed with cervical cancer, we aim to explore the unique challenges and perspectives encountered by men in these circumstances. The study adopted interpretive phenomenological analysis to qualitatively assess the experiences of males with partners diagnosed of cervical cancer. A phenomenological research design with purposive sampling technique was used to recruit and collect data from 38 participants until saturation occurred. Face to face interviews were conducted using a developed semi-structured interview guide. The data collected was analyzed using content analysis after verbatim transcription was done. The study resulted in the identification of 2 main themes, and 10 subthemes. These themes focused on the multifaceted impact of cervical cancer on spousal caregivers' lives and the coping and support mechanisms utilized by spouses of cervical cancer patients. The findings indicated that men faced several challenging experiences as a result of their spouses' condition and revealed the strategies they employed to cope with the stress of caring for their wives. Almost every man adopted a strategy to cope with the condition of their wives. This study would assist other men to understand the psychological, social, emotional, and spiritual experiences the men went through to appreciate and adopt their coping strategies whenever they go through such challenges.

Attitude and preventive practices of pressure ulcers among orthopedic nurses in a tertiary hospital in Ghana.

BACKGROUND: Pressure ulcers (PUs), which affect millions of people worldwide, are among the five most prevalent hospitalized cases causing adverse impairment. Nevertheless, pressure ulcers are largely preventable, and their management depends on their severity. The authors, therefore, explored the attitude and preventive practices of pressure ulcers among orthopedic nurses in a tertiary hospital in Ghana. METHODS: An exploratory descriptive qualitative approach was employed for this study to help researchers explore the attitude and practices toward PU (Pressure Ulcer). Purposive sampling approach was employed, and data was analyzed using thematic content analysis. The sample size for this study was 30 which was obtained based on saturation. Participants were engaged in face-to-face interviews which were transcribed verbatim. FINDINGS: Two themes and eight subthemes were generated from the analysis of this study. The two themes were preventive practices and attitude towards PU. The study identified that there were no specific protocols illustrated on the wards for managing pressure ulcers. Nevertheless, the study participants were keen on preventing pressure ulcers and hence engaged in practices such as early patients' ambulation, early identification of PU signs, removing creases and crumps from patient beds, nutritional management for PU prevention, and dressing of PU wounds. CONCLUSION: Practices of pressure ulcer management were highly valued by the orthopedics nurses. Hence, the nurses recommended the need for accepted guidelines on pressure ulcer management to be illustrated in the various orthopedic wards in the country.

Clinical and laboratory profile and outcomes of hospitalized COVID-19 patients with type 2 diabetes mellitus in Ghana - A single-center study.

BACKGROUND: In sub-Saharan Africa and particularly in Ghana, there is scarcity of published literature specifically on the impact of DM on outcomes in COVID-19 patients. Based on the difference in genetic makeup and demographic patterns in Africans compared to the Western world and with the rising burden of DM and other non-communicable diseases in Ghana there is a need to define the impact DM has on persons with COVID-19. This would ensure adequate risk stratification and surveillance for such patients as well as appropriate scale up of therapeutic management if needed. AIMS: This single-center study describes the clinical and laboratory profile and outcomes of COVID-19 in-patients with type 2 diabetes mellitus (DM) in Ghana. MATERIALS AND METHODS: Retrospective analysis was undertaken of the medical records of adults with COVID-19 hospitalized at a facility in Ghana from March to October 2020. Clinical, laboratory and radiological data and outcomes were analysed. Comparisons between COVID-19 patients with DM and non-diabetics were done with an independent t-test or a Mann-Whitney test when normality was not attained. Odds ratios (95% CI) were calculated using univariate logistic regression. RESULTS: Out of 175 COVID-19 patients, 64 (36.6%) had DM. Overall mean age was 55.9 ± 18.3 years; DM patients were older compared to non-diabetics (61.1 ± 12.8 vs. 53.0 ± 20.2 years, p = .049). Compared to non-diabetics, diabetics were more likely to have higher blood glucose at presentation, have hypertension, be on angiotensin 2 receptor blockers [OR, 95% CI 3.3 (1.6-6.7)] and angiotensin converting enzyme inhibitors [OR, 95% CI 3.1 (1.3-7.4)]; and be HIV negative (p < .05). Although the values were normal, diabetics had a higher platelet count but decreased lymphocytes, aspartate transaminase and alkaline phosphatase compared to non-diabetics (p < .05). There was no difference in clinical symptoms, severity or mortality between the two groups. DISCUSSION: The clinical profile of patients studied are similar to prior studies. However the outcome of this study showed that DM was not associated with worse clinical severity and in-hospital mortality. This could have been due to majority of DM patients in this study having relatively good blood glucose control on admission. Secondly, DM alone may not be a risk factor for mortality. Rather its concurrent existence with multiple co-morbidities (especially cardiovascular co-morbidities which may predispose to pro-inflammatory and pro-thrombotic states) may be driving the rise in severity and mortality risks reported in other studies. Furthermore, this study was conducted among an African population and Africa has been shown to be generally less severely hit by the COVID-19 pandemic compared to other regions outside the continent. This has been postulated to be due, among other factors, to inherent protective mechanisms in Africans due to early and repeated exposure to parasitic and other organisms resulting in a robust innate immunity. CONCLUSIONS: This study suggested that DM was not associated with more severe clinical symptoms or worse outcomes among hospitalized COVID-19 patients. Despite this, it is important that DM patients adhere to their therapy, observe the COVID-19 containment protocols and are prioritized in the administration of the COVID-19 vaccines. STUDY HIGHLIGHTS: In this retrospective, single-centre study on the clinical and laboratory profile and outcome of hospitalized DM patients with COVID-19, patients with DM did not have a more severe clinical profile or worse outcomes. They were, however, significantly older, more likely to have higher admission blood glucose, have hypertension, be on angiotensin 2 receptor blockers and angiotensin converting enzyme inhibitors; and be HIV negative compared to the cohort without DM. DM patients should be a priority group for the COVID-19 vaccines.

A cardiovascular polypill for secondary stroke prevention in a tertiary centre in Ghana (SMAART): a phase 2 randomised clinical trial.

BACKGROUND: A cardiovascular polypill containing generic drugs might facilitate sustained implementation of and adherence to evidence-based treatments, especially in resource-limited settings. However, the impact of a cardiovascular polypill in mitigating atherosclerotic risk among stroke survivors has not been assessed. We aimed to compare a polypill regimen with usual care on carotid intima-media thickness (CIMT) regression after ischaemic stroke. METHODS: In SMAART, a phase 2 parallel, open-label, assessor-masked, randomised clinical trial, we randomly allocated individuals (aged ≥18 years) who had an ischaemic stroke within the previous 2 months, using a computer-generated randomisation sequence (1:1), to either a polypill or usual care group at a tertiary centre in Ghana. The polypill regimen was a fixed-dose pill containing 5 mg ramipril, 50 mg atenolol, 12·5 mg hydrochlorothiazide, 20 mg simvastatin, and 100 mg aspirin administered as two capsules once per day for 12 months. Usual care was tailored guideline-recommended secondary prevention medications. The primary outcome was the change in CIMT over 12 months with adjustment for baseline values, compared using ANCOVA in all participants with complete data at month 12. Safety was analysed in all randomly assigned participants. This trial is registered at ClinicalTrials.gov, NCT03329599, and is completed. FINDINGS: Between Feb 12, 2019, and Dec 4, 2020, we randomly assigned 148 participants (74 to the usual care group and 74 to the polypill group), 74 (50%) of whom were male and 74 (50%) female. CIMT was assessed in 62 (84%) of 74 participants in the usual care group and 59 (80%) of 74 participants in the polypill group; the main reason for loss to follow-up was participants not completing the study. The mean CIMT change at month 12 was -0·092 mm (95% CI -0·130 to -0·051) in the usual care group versus -0·017 mm (-0·067 to 0·034) in the polypill group, with an adjusted mean difference of 0·049 (-0·008 to 0·109; p=0·11). Serious adverse events occurred among two (3%) participants in the usual care group, and eight (11%) participants in the polypill group (p=0·049). INTERPRETATION: The polypill regimen resulted in similar regression in subclinical atherosclerosis and many secondary and tertiary outcome measures as the tailored drug regimen, but with more serious adverse events. Larger, longer-term, event-based studies, including patients with stroke in primary care settings, are warranted. FUNDING: US National Institutes of Health. TRANSLATION: For the Akan (Twi) translation of the abstract see Supplementary Materials section.

Pediatric nurse-patient communication practices at Pentecost Hospital, Madina: A qualitative study.

Purpose: Delivering quality health care requires effective communication between health care providers and their patients. Nurse-patient effective communication remains a challenge in Ghana, despite criticism and concern expressed by the public. The study, therefore, aims to assess the effective nurse caregivers' communication practices among pediatric nurses at Pentecost Hospital, Madina. Methods: A qualitative exploratory and purposive sampling technique were used. Participants were engaged in Focus group discussions or face-to-face interviews. In all, 4 focus group discussions were conducted with 7 participants in each group and 15 face-face in-depth interviews, with a total sample size of 43. The data was content analyzed. Interviews were taped recorded and transcribed verbatim. Results: The data analysis yielded 3 themes and 11 subthemes. The main themes were: effective communication practices, factors influencing effective communication, and attitudes towards effective communication. The study revealed how the participants communicated with patients who are deaf-mute, anxious, and those who refused treatment. In addition, participants reported how they used techniques such as silence, listening, and leading cues in communicating with patients and their relatives. Conclusion: Effective communication between pediatric nurses, patients, and their parents is ascertained to be a key tool in the delivery of quality health care. However, several factors are found to hinder this therapeutic communication. Hence, further studies are needed to improve effective communication skills among pediatric nurses and their patients to enhance health care for children.

Clinical presentations and outcomes of COVID-19 infection in sickle cell disease patients: Case series from Komfo Anokye teaching hospital, Ghana.

Patients with sickle cell disease and COVID-19 may not have a more dire outcome than the general population. Nevertheless, they may present with acute chest syndrome and other sickle cell crises which should be aggressively managed.