Developing appropriate community-based postgraduate training in a developing country.

The School of Medical Sciences, KNUST, established in 1975, indicated its educational orientation to a community-based and community-oriented system using the problem-based learning approach. Falling victim to the phenomenon of brain-drain, the School developed a postgraduate medical curriculum which takes into account the needs and demands of national governments and communities for quality specialist care and equitable distribution of existing health facilities. There is an innovative community-based fourth year for obstetrics and gynaecology, ophthalmology, otorhinolaryngology, paediatrics, surgery and medicine. After attainment of the Part I Examination, residents are sent to Ulm, Maastricht, Britain and the United States for clinical attachments for a period of 3 to 6 months before returning to sit for their Final Part II for the Fellowship of the West African College of Surgeons or Physicians (FWACS, FWACP). By ensuring that the Final Examinations take place after the elective attachment, none of the new breed of specialists so far produced has been lost to the Western world. The strengths and weaknesses of the programme are discussed.

Pattern of connexin 26 (GJB2) mutations causing sensorineural hearing impairment in Ghana.

Mutations of the connexin 26 gene (GJB2) were studied in 365 apparently unrelated individuals with profound nonsyndromic, sensorineural hearing impairment from Ghana, West Africa. Among 121 mutated chromosomes found, 110 carried the previously described R143W mutation. A total of 6 novel mutations: L79P, V178A, R184Q, A197S, I203K, and L214P, were identified, whereby I203K was based on a dinucleotide exchange and R184Q appeared to be dominant. The GJB2 variants found in Ghana tend to comprise less nonsense and frameshift mutations and more mutations located in the C-terminal half of the molecule than the variants found in other parts of the world.

Assessment of cochlear damage after pneumococcal meningitis using otoacoustic emissions.

Three cases are reported of children in Ghana with pneumococcal meningitis and differing degrees of hearing loss. The children were examined up to 12 d after admission by means of otoacoustic emissions. The technique is objective, non-invasive, quick (< 5 min per ear) and suitable for use in paediatric wards.

The causes and prevalence of pre-school deafness in Ghana.

A study to determine the causes of deafness was done in Kumasi in central Ghana. A total of 128 deaf children aged between 1-5 years referred to the Ear, Nose and Throat clinic at the Komfo Anokye Teaching Hospital (KATH) were seen from January 1992 to June 1993. The procedure adopted included exploration and assessment of individual medical history, otoscopy, pre-audiometric and audiometric evaluation. It turns out that 66(51.5%) had congenital sensorineural hearing loss (CSHL), while the remaining 62(48.5%) had acquired sensorineural hearing loss (ASHL). Of the 66 congenital cases, 44 was due to unknown factors, while the rest were due to post-natal convulsion, measles, meningitis, mumps, fever and jaundice. Results of free-field tests were available in 116 children. Of these, 90 cases had a profound SHL while 38 had a severe-profound SHL. Again, of the 90 children with profound SHL, 56 was due to congenital factors, while the remaining 34 originated from acquired causes. Thus, the cases listed under CSHL showed a distinctly higher incidence of profound deafness. Primary prevention measures against diseases that cause deafness would be the most logical and practical way of helping to reduce the incidence of deafness in Ghana.

The incidence of Meniere's disease in Kumasi - Ghana

Fifty-nine (59) patients with Meniere's disease confirmed according to defined criteria were selected from the sample of one hundred and ninety-eight (198) consecutive patients with the referral diagnosis of Meniere's disease seen at the Komfo Anokye Teaching Hospital (KATH) in Kumasi between the period of January 1982 to January 1992. This represents an incidence of 0.32 per cent of the total of eighteen thousand two hundred (18;200) new clinic evaluations for all the ENT diseases during the ten year period under the review. Meniere's disease is surely not uncommon in our subregion; the high success rate encountered after conservative treatment in our study shows that it may have a better prognosis among negroes. Because the sensorineural hearing loss stabilizes in most cases after the first 2-3 attacks during the 3 months period in which treatment is received; subsequent investigations; especially if done by a new researcher; will not find the existence of the triad of symptoms necessary for the diagnosis of the disease. Only eleven (11) of our patients continued to have vertiginous attacks with a progressive sensorineural hearing loss and disturbing tinnitus. We could not find any statistical evidence for smoking and alcohol as possible aetiological factors. There was gender balance in the distribution of the disease

Two cases of otosclerosis in Kumasi, Ghana, case report.

The incidence of otosclerosis in relationship to race has been established in North America; however, there are no reliable data about its occurrence among negro Africans. Over a period of three years 650 consecutive cases of hearing loss excluding those with acute and chronic otitis media, Eustachian tube dysfunction, wax, foreign bodies, and traumatic perforations, were studied in Kumasi, Ghana. Only two cases of otosclerosis were detected. It is postulated that the rarity among people of the black race may be related to the flat occipital protuberance of the skull among African people.