Unseen blindness, unheard deafness, and unrecorded death and disability: congenital rubella in Kumasi, Ghana.

OBJECTIVES: Although rubella serosusceptibility among women of reproductive age in West Africa ranges from 10% to 30%, congenital rubella syndrome has not been reported. In Ghana, rubella immunization and serologic testing are unavailable. Our objectives were to identify congenital rubella syndrome cases, ascertain rubella antibody seroprevalence during pregnancy, and recommend strategies for congenital rubella syndrome surveillance. METHODS: Congenital rubella syndrome cases were identified through prospective surveillance and retrospective surveys of hospital records. A rubella serosurvey of pregnant urban and rural women was performed. RESULTS: Eighteen infants born within a 5-month period met the congenital rubella syndrome case definitions, coinciding with a 9-fold increase in presentation of infantile congenital cataract. The congenital rubella syndrome rate for this otherwise unrecorded rubella epidemic was conservatively estimated to be 0.8 per 1000 live births. A postepidemic rubella immunity rate of 92.6% was documented among 405 pregnant women; susceptibility was significantly associated with younger age (P = .000) and ethnicity (northern tribes, P = .024). CONCLUSIONS: Congenital rubella syndrome occurs in Ghana but is not reported. Information about congenital rubella syndrome and rubella in sub-Saharan Africa is needed to evaluate inclusion of rubella vaccine in proposed measles control campaigns.

Innovative community-based postgraduate training for obstetrics and gynecology in west Africa.

OBJECTIVE: To describe a unique international effort to develop a training program in West Africa that would be of similar quality to any other in the world (but with sensitivity to cross-cultural needs) and would retain physicians in West Africa to improve women's health in that part of the world. METHODS: Step-by-step formulation of a program included initial trainee recruitment, the inclusion of foreign guest faculty, and the establishment of institutional libraries. This was followed by a phase of curriculum development, recruitment of West African faculty, and organization of an innovative, community-based fourth year. RESULTS: Between ten and 12 postgraduates will have completed the program by January 1996, and will be placed in Ghana. More than 60% of Ghanaian postgraduates have passed the relevant regional examinations, compared with less than 25% of candidates from other countries. Nine Ghanaian specialists have returned to Ghana to become faculty members in the program. Over 20 published peer-reviewed articles have resulted from this program since 1989. The number of residents being trained has increased from three to 28. Seven new residents joined the program in 1994. An early reduction in maternal mortality from 9.9 deaths per 1000 births in 1991 to 4.2 deaths per 1000 births in 1992 was noted when senior postgraduates took over labor and delivery at the teaching hospital in Accra, Ghana, where approximately 10,000 deliveries occur per year. CONCLUSION: Specialty training in obstetrics and gynecology that is specifically aimed at meeting the needs of West Africa has been initiated successfully. Long-range success will require support from regional governments and continued long-term commitments from the international community of obstetricians and gynecologists.

Oxygen free radicals and pelvic adhesion formation: I. Blocking oxygen free radical toxicity to prevent adhesion formation in an endometriosis model.

Intraperitoneal superoxide dismutase (SOD) and catalase were used to block the toxic effects of superoxide anion (O2) and hydrogen peroxide (H2O2), associated with the production of endometriosis and inflammation in a rabbit model. In a two-part animal study, the combined instillation of SOD and catalase significantly reduced the formation of intraperitoneal adhesions at endometriosis sites.

Menarcheal age in Ghanaian school girls.

In a cross-sectional retrospective study of 2087 Ghanaian school girls in various educational institutions in the Kumasi district, Ashanti region, Ghana, the mean menarcheal age was found to be 13.98 +/- 1.42 years. Differences in the menarcheal age of the girls was found to be significantly correlated to social class, parents ethnic origin, educational institution and home living area (P = 0.0001). The duration of the menarche and the interval between the menarche and the second period was found to be influenced by the age at menarche (P less than 0.01). Decline in menarcheal age in concurrence with world trends was observed. Further studies are necessary to identify the inherent and specific factors in the Ghanaian population which relate to and influence the age of menarche.

PIP: In a cross-sectional retrospective study of 2087 Ghanian school girls in various educational institutions in the Kumasi district, Ashanti region, Ghana, the mean menarcheal age was 13.98 +- 1.42 S.D. years. The respondents ranged in age from 10-49 years. The mean age of the respondents was 19.18 years + or - 5.00 S.D. Differences in the menarcheal age were found to be correlated to social class, parents' ethnic origin, educational institution, and home living area. An analysis of variance was carried out with Chi-square analysis. The mean duration of the menstrual period was found to be 4.79 days with 64.42% having the normal duration of 3-5 days. The mean interval between menarche and the 2nd period was 65.05 days with 41.68% of the girls having had the normal interval of 26-30 days. The menarcheal age is compared to other Africans. Among Ghanians, the lowest mean age (13.00 years) by parents' ethnic group occurred among the Ga-Adangbes, Fantes, Akwakims, and Ewes. The difference in menarcheal age by parental ethnic group was statistically significant (P=0.0001). The 4 ethnic groups with the lowest menarcheal ages are southern Ghana ethnic groups. A statistically significant relation between menarcheal age and socioeconomic class is found (P=0.0001). The children of the most affluent social class have the lowest age (13.26) while those whose parents belong to social class 3 had a higher menarcheal age. The influence of social class is reflected in a statistically significant difference in the mean menarcheal age in different educational institutions. The home living area showed statistically significant influence in the variation in menarcheal age. Girls from urban areas had the lowest mean menarcheal age of 13.74 years. Girls from suburban and rural areas had mean ages of 14.47 and 14.75 respectively. The study showed a statistical decline in menarcheal age between 1946 and 1976-- a decline of 12.75 months (1.06 years).

The relation of the true conjugate to maternal height and obstetric performance in Ghanaians.

The true conjugate was determined intraoperatively with a caliper in 114 Ghanaian women and was correlated with their height, obstetric performance and fetal dimensions. Those patients undergoing cesarean section for cephalopelvic disproportion (Group Ia) were found to have a significantly shorter mean true conjugate (9.54 cm +/- 0.63 S.D.) and mean body height (152.68 cm +/- 5.46 S.D.) and a smaller true conjugate - fetal biparietal diameter difference (10.93 mm) than those who had no cephalopelvic disproportion (Group Ib) and whose mean measurements were 10.61 cm +/- 0.81 S.D., 157.20 cm +/- 5.69 S.D. and 21.50 mm, respectively (P = 0.0001). Recommendations for appropriate referral of rural clinic patients and for selection of patients for repeat cesarean sections are based on the above findings.

Maternal mortality in Ghana: is there a place for traditional birth attendants (TBAs) as reporters of maternal mortality-related data?

PIP: Analysis of hospital records from January 1983 to December 1985 at the Komfo Anokye Teaching Hospital in Kumasi, Ghana revealed a maternal mortality rate of 12.5/1000 births. During this period, 27,592 births and 342 maternal deaths occurred. The primary cause of death was hemorrhage(32.14%). Other leading causes of maternal deaths include hepatic failure (19.53%),postpartum hemorrhage (18.75%), eclampsia (11.01%), sepsis (10.71%), ruptured uterus (8.33%), and anemia (4.76%). Comparison of deaths with clinic attendants and non-clinic attendants revealed 43.68% more deaths with non-clinic attendants. 29.02% of the maternal deaths were among primipara and 31.09% among grandmultipara. Furthermore, 41.9% of the deaths were among women 24 years. A health profile of the Ashanti-Akim district indicated 14.8% of the population are females in the reproductive range; 47.1% live in areas having a population of 500; 55.1% reside within a 8 km radius of a health center; a 1:19,500 physician/population ratio; 45% greater home births in rural areas and 9% in urban areas; traditional birth attendants (TBAs) delivered 63% of all births. Adequate data gathering and maternal death registration are current problems. Through education, TBAs could collect available information on maternal mortality, make regular visits to the areas, and bring awareness to the population of the need for medical care. TBAs could provide a valuable contribution to the health care systems in improving maternal-child health and assist in reducing maternal mortality rates.^ieng

Systemic copper and sex steroids uptake by rat tissues.

Subcutaneous injection of copper sulphate into the rat produced a significant depression in the relative and absolute uptake of oestradiol by the uterus. With progesterone, an enhancement in the absolute count uptake in the uterus, muscle, liver and kidney occurred. The absolute uptake of oestradiol in muscle, liver and kidney were also enhanced.