Risk factors and outcomes of delirium in hospitalized older Ghanaians.

OBJECTIVES: Delirium has been rarely studied in older West Africans. We sought to investigate its correlates and outcomes in hospitalized older Ghanaians. METHODS: This was a one-month prospective observational study. Delirium prevalence was assessed within 24 h of admission using the Confusion Assessment Method (CAM). Incident delirium was determined with repeat CAM assessments on post-admission days 4, 7, 14, 21 and 28, after censoring participants with prevalent delirium. Multivariate logistic regression analyses were used to explore risk factors. Estimates of adjusted hazard ratios for mortality were derived with the discrete time version of the Cox regression model for time invariant explanatory variables. RESULTS: Among 483 participants, 250 (51.8%, 95% CI: 47.3-56.3) had prevalent delirium while 10 of the remaining 233 (4.3%, 95% CI: 2.1-7.8) developed incident delirium. Being older than 80 years (adjusted odds ratio (OR) = 2.1, 95% CI: 1.2-3.6), having no formal education (OR = 2.2, 95% CI: 1.4-3.4), stroke (OR = 1.8, 95% CI: 1.1-3.0), infection (OR = 1.9, 95% CI: 1.2-3.0), and high Triage Early Warning Score (OR = 6.9, 95% CI: 2.5-19.0) predicted delirium. Delirium (adjusted hazard ratio (HR) = 1.8, 95% CI: 1.0-3.3) and high TEWS (HR = 4.6 (95% CI: 1.7-12.7) at baseline predicted mortality. These factors also predicted longer hospital stay. CONCLUSION: Over half of hospital-treated older Ghanaians in the present study had delirium on the first day of admission. The syndrome prolonged hospitalisation and increased mortality risk. Future studies in West Africa may investigate the epidemiology of delirium in primary care and community settings.

Course and characteristics of depression over a 12-month period among Ghanaians living with HIV: the EVERLAST study.

Individuals with HIV are predisposed to depression but there is limited data on its dynamics and correlates. We aimed to assess course and characteristics of depression among Ghanaian HIV patients over a 12-month period. We interrogated a longitudinal study dataset of patients at a tertiary hospital and assessed depression at month 0 and 12 using the Patient Health Questionnaire-9 (PHQ-9). Association between clinical, sociodemographic factors and changes in PHQ-9 scores were evaluated. Among 320 study participants, 171 (53.4%) and 55 (17.2%) had depression at month 0 and 12 respectively. Persistent depression was detected in 41 (24.0%) of the 171 patients with depression at month 0, whilst 135 (42.2%) of them never experienced depression. Patients' CD4 count was associated with depression at month 0 and 12 (p<0.05). Predictors of change in depression scores were urban dwelling [-1.98, 95%CI: -3.86 to -0.06, p=0.039], not knowing one's monthly income [2.10, 95%CI: 0.58 to 3.61, p=0.007], participant being single [-1.62 95%CI: -2.45 to -0.78, p<0.001] and being on antiretroviral therapy at recruitment [-1.5, 95%CI: -2.55 to -0.45, p<0.001]. There was a significant decrease in depression scores over a 12-month period and persistent depression is rife among this cohort of Ghanaians with HIV.

Contemporary prevalence and predictors of anxiety among patients living with HIV/AIDS in Ghana.

Objectives: To identify the prevalence and associated factors of anxiety in people living with HIV/AIDS in a tertiary centre in Ghana. Design: The study employed a cross-sectional design. Setting: The study was conducted in the outpatient HIV clinic of a tertiary hospital. Participants: Participants were adult PLWHA receiving OPD care, including those established on combined antiretroviral therapy (cART) and newer patients who were not on cART. Four hundred ninety-five participants aged ≥30 years were consecutively enrolled on the study. Interventions: Demographic and clinical data were collected using standard questionnaires and patient files. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression analysis was done to identify associated factors. Main outcome measure: Proportion of PLWHA who had HADS score of ≥8. Results: Overall prevalence of anxiety was 61.0% (95%CI: 56.6 - 65.3), with no significant difference between recently diagnosed (≤ 6 months, 64.3%) and those with established diagnoses (>6 months, 59.1%). Urban residence (aOR: 1.67, 95%CI: 1.12 - 2.51), alcohol use (aOR: 1.64, 95%CI: 1.13 - 2.38) and depression (aOR: 13.62, 95%CI: 7.91 - 23.45) were independently associated with anxiety. Conclusion: In this sample, 6 in 10 Ghanaian PLWHA had evidence of anxiety. Liaison with the national mental health service for more comprehensive and integrated care and further research into the mental health of PLWHA is recommended to reduce this high burden of anxiety. Funding: This study was funded by a grant from the National Institutes of Health Fogarty International Center (R21 TW010479).

Pharmacological management of seizures in patients with COVID-19: a systematic review.

Background: Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to exhibit neurological symptoms such as seizures and impaired consciousness. Our study reviews reported cases to assess the pharmacological approach to managing seizures in SARS-CoV-2 patients and associated outcomes. Methods: A systematic review of case reports on the incidence of seizures following coronavirus disease 2019 (COVID-19) among patients that reported use of antiepileptic drugs (AEDs) in management was performed by using the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines. Databases used included EMBASE, PubMed, SCOPUS, and Google Scholar. Data was presented as qualitative and descriptive data. Results: In total, 67 articles were selected for full-text assessment, of which 19 were included in the final review. Patients had a median age of 54 years, most of whom were male. Remdisivir, dexamethasone, Laminavir, hydroxychloroquine, azithromycin, and Lopinavir-ritonavir were common agents used in the management of COVID-19. Most patients presented with either generalized tonic-clonic seizures or status epilepticus. Most patients received levetiracetam as drug choice or as part of their regimen. Other AEDs commonly prescribed included midazolam and sodium valproate. Some patients received no antiepileptic drug therapy. Most of the patients who died had more than one comorbidity. Also, most of the patients who died received COVID-19 treatment drugs. None of the patients who received midazolam as drug choice or as part of their regimen developed recurrent seizures in contrast to patients who received levetiracetam and sodium valproate as drug choice or as part of their regimen. Interestingly, none of the patients who received no AEDs suffered recurrent seizures or died. Conclusions: Standard guidelines for managing seizures in COVID-19 patients may be required. A limitation of this review is that it involved the use of case reports with no controls and a small number of patients.

Caregiver burden in Buruli ulcer disease: Evidence from Ghana.

BACKGROUND: Buruli ulcer disease (BUD) results in disabilities and deformities in the absence of early medical intervention. The extensive role of caregiving in BUD is widely acknowledged, however, associated caregiver burden is poorly understood. In this paper we assessed the burden which caregivers experience when supporting patients with BUD in Ghana. METHOD/ PRINCIPAL FINDINGS: This qualitative study was conducted in 3 districts in Ghana between August and October 2019. 13 semi-structured interviews were conducted on caregivers of BUD patients in the local language of Twi. Data was translated into English, coded into broad themes, and direct content analysis approach was used to analyse results. The results show the caregivers face financial, psychological and health issues as a consequence of their caregiving role. CONCLUSION/ SIGNIFICANCE: This study found significant caregiver burden on family members. It also highlighted the psychological burden caregivers experience and the limited knowledge of the disease within endemic communities. Further research is needed to quantify the caregiver burden of BUD at different economic levels in order to better understand the impact of possible caregiver interventions on patient outcomes.

Mental health and quality of life burden in Buruli ulcer disease patients in Ghana.

BACKGROUND: Buruli ulcer disease (BUD) is a necrotic skin neglected tropical disease (NTD) that has both a mental and physical health impact on affected individuals. Although there is increasing evidence suggesting a strong association between neglected tropical diseases (NTDs) and mental illness, there is a relative lack of information on BUD's impact on the mental health and quality of life (QoL) of affected individuals in Ghana. This study is to assess the impact of BUD on mental health and quality of life of patients with active and past BUD infection, and their caregivers. METHODS: We conducted a case control study in 3 BUD endemic districts in Ghana between August and November 2019. Face-to-face structured questionnaire-based interviews were conducted on BUD patients with active and past infection, as well as caregivers of BUD patients using WHO Quality of Life scale, WHO Disability Assessment Schedule, Self-Reporting Questionnaire, Buruli Ulcer Functional Limitation Score and Hospital Anxiety and Depression Scale data tools. Descriptive statistics were used to summarize the characteristics of the study participants. Participant groups were compared using student t test and chi-square (χ2) or Fisher's exact tests. Mean quality of life scores are reported with their respective 95% confidence intervals. Data was analysed using STATA statistical software. RESULTS: Our results show that BUD patients with active and past infection, along with their caregivers, face significant levels of distress and mental health sequelae compared to controls. Depression (P = 0.003) was more common in participants with active (27%) and past BU infection (17%), compared to controls (0%). Anxiety was found in 42% (11/26) and 20% (6/29) of participants with active and past BUD infection compared to 14% (5/36) of controls. Quality of life was also significantly diminished in active BUD infection, compared to controls. In the physical health domain, mean QoL scores were 54 ± 11.1 and 56 ± 11.0 (95% CI: 49.5‒58.5 and 52.2‒59.7) respectively for participants with active infection and controls. Similarly in the psychological domain, scores were lower for active infection than controls [57.1 ± 15.2 (95% CI: 50.9‒63.2) vs 64.7 ± 11.6 (95% CI: 60.8‒68.6)]. Participants with past infection had high QoL scores in both physical [61.3 ± 13.5 (95% CI: 56.1‒66.5)] and psychological health domains [68.4 ± 14.6 (95% CI: 62.7‒74.0)]. CONCLUSIONS: BUD is associated with significant mental health distress and reduced quality of life in affected persons and their caregivers in Ghana. There is a need for integration of psychosocial interventions in the management of the disease.