Pharmacotherapy for Infertility in Ghana: A Prospective Study on Prescription Patterns and Treatment Outcomes among Women undergoing Fertility Treatment.

Background: Pharmacotherapy remains a first-line and major treatment option for couples struggling with infertility, especially in sub-Saharan Africa, where other expensive alternatives are rarely available. Despite the reliance on pharmacotherapy for treating infertility in the subregion, especially for those diagnosed with unexplained infertility, little is known about the actual influence of drug therapies on conception. Objectives: The study aimed to prospectively assess the prescription patterns and outcomes of pharmacotherapy for women undergoing fertility treatment in Ghana. Methods: This prospective cohort study involved 482 infertile women presenting for fertility treatment in 4 fertility clinics in the Cape Coast Metropolis of Ghana between March 2019 and February 2021. A simple random sampling technique was used to recruit subjects for the study. The women were followed up for 12 months to assess the outcome of drug therapy on conception. Data analysis was done using Stata version 14. Logistic regression was used to assess the association between trends with dichotomous outcomes. Results: The study identified that approximately 45.2% of the patients received monotherapy, whereas 24.1% received a combination of 2 drugs. Patients treated with a combination of 3 drugs were more likely to conceive (adjusted odds ratio = 4.10; 95% CI, 1.29-13.02; P = 0.02) than those without treatment. Conclusions: Patients treated with combination therapies had higher chances of conception than those without medications. However, a combination of nutritional and herbal therapies were associated with improved outcomes compared with conventional and nutritional supplements. The study's outcome could provide fertility specialists and stakeholders insight into choosing appropriate treatment options for prospective couples seeking fertility care. Consequently, fertility patients can access specific treatment options to meet their desired needs.

Effects of prenatal antibiotic treatment on early infant health: a retrospective study in a rural health facility in Ghana.

Background: Infant mortality remains a major developmental challenge in many low-income countries. Epidemiological evidence suggests that infant acquisition of maternal microbiome is essential for programming of immunity and metabolism. As such, irrational maternal antibiotic use may affect infant health. Objectives: The aim of the study was to determine the effects of prenatal antibiotic use on early postnatal life (90 days) in a low-income community in Ghana. Methodology: The study was a retrospective study of 412 mother-baby pair medical records in a low-income community in rural Ghana. Results: During the ninety-day period, the prevalence and relative risk of neonatal sepsis, respiratory disorders, and dermatitis were significantly higher in infants treated prenatally with antibiotics compared to untreated infants. Prenatal antibiotic treatment was not significantly associated with the risk of developing neonatal jaundice and conjunctivitis. However, prenatally antibiotic exposed infants were three times likely to visit the hospital for a non-scheduled/non-review treatment within the first 90 days compared to unexposed babies. Conclusions: Intrapartum antibiotic treatment is associated with poor early infant health. Rationalizing antibiotic use during pregnancy may contribute to reducing infant mortality.

Psychological distress of Ghanaian couples after unsuccessful treatment for infertility.

Objective: The main objective of the study was to assess psychological distress and to identify any gender specific differences in the psychological distress among infertile couples after one year of unsuccessful pharmacotherapy. Design: A descriptive cross-sectional study. Setting: The study was conducted in four fertility clinics in the Cape Coast Metropolis. Participants: One hundred and twenty respondents (71 women and 49 men) were recruited by simple random sampling. Statistical analysis: Statistical analysis was done using SPSS (v. 25). Psychological distress scores were presented as Mean±SD and were analysed using One-way ANOVA, followed by Bonferroni's post hoc test. Associations between exposures and outcomes were measured using relative risk. Outcome measure: The main outcome measure was the level of depression, anxiety, and stress among infertile couples after unsuccessful pharmacotherapy. Results: Anxiety was the predominant psychological distress experienced by respondents (60.8%), followed by depression (43.3%) and stress (37.5%). Generally, psychological distress scores increased with age among female respondents but decreased with age for male respondents. The duration of infertility only significantly affected anxiety (p=0.01) but not depression (p=0.51) and stress (p=0.06) levels. Approximately 31.7% of respondents reported experiencing extremely severe anxiety. Male respondents reported higher degree of depressive symptoms than females (46.9 vs. 40.8%). Conclusion: Unsuccessful pharmacotherapy of infertility is associated with varied degrees of psychological distress among Ghanaian infertile couples, which can be affected by age, duration of infertility and gender. Funding: None declared.

Antibiotic use during pregnancy: a retrospective study of prescription patterns and birth outcomes at an antenatal clinic in rural Ghana.

BACKGROUND: Babies are increasingly being exposed to antibiotics intrapartum in the bid to reduce neonatal and maternal deaths. Intrapartum antibiotic exposure, including even those considered safe in pregnancy, have been associated with childhood obesity and compromised immunity. Data on the extent of antibiotic use, safety and its impact on birth outcomes and neonatal health in Sub-Saharan Africa is very limited. This study sought to ascertain the extent of antibiotic use in pregnancy and its effects on birth outcomes in a rural hospital in Ghana. METHODS: The study was a retrospective randomized study of mothers who delivered babies in a rural hospital between 2011 and 2015 in Ghana. A total of 412 mother/baby records out of 2100 pre-selected met the inclusion criteria of the study. Indicators of neonatal health used were birthweight, Apgar score, incidence of birth defects. RESULTS: Sixty five percent of pregnant women were administered antibiotics at some stage during pregnancy. Beta Lactam antibiotics accounted for more than 67% of all antibiotics prescribed. There was a statistically significant association between antibiotic exposure and pregnancy factors such as stage of pregnancy, parity and mode of delivery but not with socio-economic status of the mother. Intrapartum antibiotic exposure did not significantly affect the birthweight, incidence of congenital birth defect and mean Apgar scores. After adjusting for method of delivery, however, perinatal antibiotic use (24 h to delivery) was associated with lower mean Apgar scores. Birth weight was affected significantly by maternal socio-economic factors such as age and marital status. CONCLUSION: Sixty five percent of women attending the antenatal clinic received antibiotics. Intrapartum antibiotics did not affect early markers of neonatal health such as birthweight, congenital birth defect and mean Apgar scores. However, antibiotic use less than 24 h to delivery was associated with a decrease in mean APGAR score.