Health-related quality of life among cervical cancer survivors at a tertiary hospital in Ghana.

INTRODUCTION: Cervical cancer is the second most common female cancer in Ghana. The disease and its treatment significantly affect survivors' health-related quality of life (HRQoL). We determined the overall quality of life (QoL) and identified its predictors among cervical cancer survivors after treatment. MATERIALS AND METHODS: A hospital-based cross-sectional analytical study was conducted on 153 disease-free cervical cancer survivors who completed curative treatment between January 2004 and December 2018 at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. We used the European Organization for Research and Treatment of Cancer core-30 item (EORTC QLQ-C30) and cervical cancer module (EORTC QLQ-CX24) to assess the survivors' overall QoL. QoL domain scores were dichotomised as affected or unaffected by disease and its treatment. Significant differences between the affected and unaffected groups within each QoL domain were determined using the student T-test. We used Kruskal-Wallis and Dunn's tests to examine the difference in QoL domains between treatment types, with significance based on Bonferroni corrections. Multivariable logistic regression was performed to identify predictors of overall QoL. A p-value of less than 0.05 was considered statistically significant. RESULTS: One hundred and fifty-three (153) women having a mean age of 58.3 (SD 11.4) years were studied. The overall QoL score was 79.6 (SD 16.0), and 74.5% of survivors reported good QoL score within the median follow up time of 41.8 months (interquartile range [IQR], 25.5-71.1 months) after cervical cancer diagnosis. Although the majority (66.0-84.3%) of the QoL functioning scale were unaffected, about a fifth (22.2%) to a third (34.5%) of the subjects had perceptual impairment in cognitive and role functioning. Financial difficulties, peripheral neuropathy and pain were most common symptoms reported as affected. A third of the survivors were worried that sex would be painful, and 36.6% indicated that their sexual activity as affected. The overall QoL scores for survivors who had surgery, chemoradiation and radiation-alone were 86.1 (SD 9.7), 76.9 (SD 17.7), and 80.7 (SD 14.7), respectively (p = 0.025). The predictors of survivor's overall QoL were loss of appetite [Adjusted Odd Ratio (AOR) = 9.34, 95% Confidence Interval (CI) = 2.13-35.8, p = 0.001], pain (AOR = 3.53, 95% CI = 1.25-9.31, p = 0.017) and body image (AOR = 5.89, 95% CI = 1.80-19.27, p = 0.003). CONCLUSION: About 75% of the survivors had a good overall quality of life. Primary surgical treatment affords the best prospects for quality of life with the least symptom complaints and financial burden. Loss of appetite, pain or diminution in body image perception predicted the overall quality of life of cervical cancer survivors after treatment.

Maternal and perinatal outcomes among women with hypertensive disorders in pregnancy in Kumasi, Ghana.

BACKGROUND: Data pertaining to maternal and perinatal outcomes associated with the complete spectrum of hypertensive disorders in pregnancy (HDPs) is sparse in low resource settings. This study aimed to determine adverse maternal and perinatal outcomes among women admitted with HDPs in a tertiary hospital in Ghana, and directly compare these outcomes among women with pre-eclampsia/eclampsia and those with chronic/gestational hypertension. METHODS: An analytical cross-sectional study was conducted among women who were admitted with HDPs to Komfo Anokye Teaching Hospital from July 1, 2014 to September 30, 2014. Data was collected on their socio-demographic and reproductive characteristics using a pretested structured questionnaire and review of their antenatal records. Crude and adjusted relative risks (RRs), with 95% confidence intervals (CIs), associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. P ≤0.05 was considered statistically significant. RESULTS: A total of 451 women with HDPs were studied: 5.3%, 32.4%, 48.8% and 13.5% had chronic hypertension, gestational hypertension, pre-eclampsia and eclampsia respectively. Over 80% were either referrals or "self-referred" from other facilities. Overall, 87% had adverse maternal or perinatal outcomes. Women with pre-eclampsia/eclampsia were at increased risks of caesarean section (adjusted RR, 1.37; 95% CI, 1.01-1.87), preterm delivery at <34 weeks' gestation (adjusted RR, 2.74; 95% CI, 1.40-5.36) and preterm delivery at <37 weeks' gestation (adjusted RR, 1.89; 95% CI, 1.25-2.85), compared to women with chronic/gestational hypertension. CONCLUSION: Women with pre-eclampsia/eclampsia were at higher risk of adverse pregnancy outcome compared to those with chronic/gestational hypertension. Strategies for prevention and management of pre-eclampsia/eclampsia to improve pregnancy outcomes are required in this major maternity care centre.

Sonographic parameters for diagnosing fetal head engagement during labour.

The purpose of this study was to investigate the diagnostic performance of the head-perineum distance, angle of progression, and the head-symphysis distance as intrapartum ultrasound parameters in the determination of an engaged fetal head. Two hundred and one women in labour underwent both ultrasound and digital vaginal examination in the estimation of fetal head station. The transperineal ultrasound measured head-perineum distance, angle of progression, and head-symphysis distance for values correlating with digital vaginal examination head station. Using station 0 as the minimum level of head engagement, correlating cut-off values for head-perineum distance, angle of progression, and head-symphysis distance were obtained. Receiver operating characteristics were used in determining the diagnostic performance of these cut-off values for the detection of fetal head engagement. With head-perineum distance of 3.6 cm the sensitivity and specificity of sonographic determination of engaged fetal head were 78.7 and 72.3%, respectively. A head-symphysis distance of 2.8 cm also had sensitivity and specificity of 74.5 and 70.8%, respectively, in determining engagement, whilst an angle of progression of 101° was consistent with engagement by digital vaginal examination with 68.1% sensitivity and 68.2% specificity. Ultrasound shows high diagnostic performance in determining engaged fetal head at a head-perineum distance of ≤3.6 cm, head-symphysis distance of ≤2.8 cm, and angle of progression of ≥ 101°.

Prevalence and factors predictive of long-acting reversible contraceptive use in a tertiary hospital in urban Ghana.

OBJECTIVE: To determine the prevalence, socio-demographic and reproductive factors associated with long-acting reversible contraceptive (LARC) use among clients resorting to reversible birth control methods in a tertiary hospital in Ghana. METHODS: Retrospective review of records of clients who opted for reversible family planning (FP) methods at Komfo Anokye Teaching Hospital, Kumasi, Ghana, from 1 July 2003 to 30 June 2008. We recorded data on their contraceptive history, and socio-demographic- and reproductive characteristics. Categorical variables were compared using the χ(2) test and factors associated with LARC uptake examined by binomial regression with a log-link function to estimate relative risks (RRs) and 95% confidence intervals (CIs). RESULTS: Of 5946 clients who opted for reversible contraception, 71% chose LARCs, and the remaining 29% chose shorter-acting contraceptives. LARCs were employed mainly by women with more living children (p trend < 0.001) who had previously used LARCs (adjusted RR: 1.49; 95% CI: 1.39-1.60). Over half of non-contraceptive users started with LARCs while 27% of women switched from shorter-acting contraceptives to LARCs. CONCLUSION: The prevalence of LARC uptake was much higher than the national average. Significant factors associated with current LARC use were the number of surviving children and previous LARC use.

Trend, client profile and surgical features of vasectomy in Ghana.

OBJECTIVE: To examine the socio-demographic and reproductive characteristics of vasectomy acceptors and surgical features of vasectomy in Ghana. METHODS: Retrospective review of 271 vasectomies performed between 1 January 2000 and 31 December 2009 in three healthcare facilities. RESULTS: Less than 0.5% of family planning clients opt for vasectomy in Ghana; acceptors are both professional and semi-skilled workers. The mean age of vasectomy acceptors was 40.7 years, and their mean number of children four. All clients had two children or more; there was a trend towards a greater number of children with increasing age (p trend <0.001) or a lower educational level of the clients (p trend =0.01). Most clients obtained their information on vasectomy through the media and healthcare workers. Nearly all vasectomies were performed under local anaesthesia using the no-scalpel technique. The operating time of gynaecologists was significantly shorter than that of urologists (median operating time 10 minutes vs. 25 minutes; p <0.001). The reported vasectomy failure rate was about 1%. CONCLUSIONS: The prevalence of vasectomy is low in Ghana. The factors influencing utilisation of male sterilisation services must be identified in order to improve uptake of this method of contraception in the country.

Maternal mortality in Ghana: a hospital-based review.

OBJECTIVE: This study examines the leading causes of maternal mortality in Ghana, classifies the main causes of maternal deaths and suggests how maternal care can be improved. DESIGN: Retrospective review. SETTING: Komfo Anokye Teaching Hospital, Ghana. SAMPLE: Three hundred and twenty-two maternal deaths with 30 269 live births in the period 1 January 2008 to 30 June 2010. METHODS: Data on maternal mortality and morbidity were retrieved from the Biostatistics Unit of the hospital. MAIN OUTCOME MEASURES: Maternal mortality ratio (MMR), case fatality rate, leading causes of maternal deaths, duration of admission and staff/patient ratio. RESULTS: The MMR was calculated to be 1 004 per 100 000 live births (95% confidence interval 895.0-1113.2). Of these, 71.1% were direct deaths, 22.4% were indirect deaths and 6.5% were unclassified. Hypertensive states of pregnancy were the leading cause of mortality (26.4%) and, together with hemorrhage, genital tract sepsis and early pregnancy deaths, accounted for 62.2% of all-cause maternal deaths and 87.3% of direct deaths. Infection and sickle cell disease accounted for 13.7% of all-cause maternal deaths and 61.1% of indirect deaths. CONCLUSIONS: Hypertensive states of pregnancy were the current leading cause of maternal mortality. Adopting a multi-pronged approach through reducing delays in access to emergency obstetric care, promoting contraceptive use, encouraging early, regular antenatal attendance and shared antenatal care with the medical team is essential to tackle the situation.

Sonohysterography: time to step up its use in gynaecologic imaging in West Africa.

Sonohysterography is a simple, safe and convenient technique that is easily and rapidly performed in the ultrasound room; yet the technique seems to be underutilized in West Africa. We present two cases that were successfully carried out in our centre followed by detailed description, uses and challenges of the technique, with the hope of encouraging clinicians and sonographers in the sub-region to step up its use. Two women were referred for evaluation of their endometrial cavities on account of increasingly heavy menstrual bleeding. Sonohysterography revealed intracavity uterine masses with hyper-echoic focal thickening highly suggestive of endometrial polyps; histology confirmed the diagnosis of endometrial polyps. Sonohysterography is an affordable and feasible diagnostic modality for evaluating the endometrial cavity. Where equipment and skill permit, the technique should be used more often in the West African sub-region. Sonohysterography, Tansvaginal sonography, Gnaecologic imaging, West Africa.

Attitude of women with abortion-related complications toward provision of safe abortion services in Ghana.

OBJECTIVES: To determine the attitude and perception of women with abortion-related complications toward the provision of safe abortion services, their sociodemographic characteristics, and their awareness of the law permitting abortion under certain circumstances in Ghana. METHODS: A cross-sectional study using a standardized questionnaire was conducted over a 2-month period among patients admitted with abortion-related complications at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. RESULTS: Abortion-related complications accounted for 42.7% of admissions to the gynecological ward. The median age of the women was 26 years. Of the 296 patients interviewed, 28% reported induced abortion in the index pregnancy, 29% were not married, 30% had no formal education, and 92% were not aware of the current legal status of abortion in Ghana. They thought there was the need to provide safe abortion services in the country, and almost all of them were willing to patronize such services. CONCLUSIONS: Awareness of the current legal status of abortion was lacking among women with abortion-related complications attending a tertiary center in Kumasi. However, the provision of safe abortion services was much needed in this population.