Psychiatry as a specialization: influential factors and gender differences among medical students in a low- to middle-income country.

OBJECTIVES: To assess the perception of Ghanaian medical students about factors influencing their career interest in psychiatry and to explore gender differences in these perceptions. METHODS: This is a cross-sectional quantitative survey of 5th and 6th year medical students in four public medical schools in Ghana. Data were analyzed with descriptive and inferential statistics using SPSS version 20. RESULTS: Responses were obtained from 545 medical students (response rate of 52%). Significantly, more male medical students expressed that stigma is an important consideration for them to choose or not to choose a career in psychiatry compared to their female counterparts (42.7% v. 29.7%, respectively). Over two-thirds of the medical students perceived that psychiatrists were at risk of being attacked by their patients, with just a little over a third expressing that risk was an important consideration for them to choose a career in psychiatry. There were no gender differences regarding perceptions about risk. Around 3 to 4 out of 10 medical students will consider careers in psychiatry if offered various incentives with no gender differences in responses provided. CONCLUSION: Our study presents important and novel findings in the Ghanaian context, which can assist health policy planners and medical training institutions in Ghana to formulate policies and programs that will increase the number of psychiatry residents and thereby increase the psychiatrist-to-patient ratio in Ghana.

Low level of transmitted HIV Drug resistance at two HIV care centres in Ghana: a threshold survey.

BACKGROUND: As access to antiretroviral therapy (ART) increases, the emergence and transmission of HIV drug resistant strains becomes a major problem. The World Health Organization (WHO) therefore recommends an initial minimum-resource method to signal when transmitted HIV drug resistance (HIVDR) requires action. OBJECTIVE: This survey sought to generate information on the presence of HIV drug-resistant strains in the locality where Ghana's ART for HIV was first introduced. METHODS: The Ghana HIVDR threshold survey (TS) was conducted and analyzed according to WHO strategy for surveillance of HIVDR in the Eastern Region of Ghana. Sixty (60) plasma specimens were collected from 2007 to 2009 by an unlinked anonymous method from HIV seropositive pregnant women, aged between 15 to24 years, who were with their first pregnancy and ART naive. Genotyping was done as follows; Ribonucleic acid (RNA) was extracted from the samples and the protease (PR) and reverse transcriptase (RT) genes amplified and sequenced. The sequences were then analyzed for HIV drug resistance mutations using Stanford University HIV Drug Resistance Database. RESULTS: Only two individuals were found with major HIVDR mutations: one each in the PR and RT genes. Thus the level of HIVDR in the study population in 2009 was classified as low (< 5%). CONCLUSION: As at February 2009, transmitted drug resistance was not a serious problem in the Eastern Region of Ghana. However, it is important to continue monitoring tHIVDR in order to understand the dynamics of the evolution of HIV drug resistance in the country.

The relationship between antenatal provider type and maternal care in rural Ghana: a cross-sectional study.

OBJECTIVES: To investigate the influence of antenatal provider type on maternity care in rural Ghana. METHODS: An analysis of maternal care by antenatal provider type using the 2008 Ghana Demographic and Health Survey. Study population included rural Ghanaian women aged 15-49 years with report of a live birth between 2003 and 2008. Bivariate chi-square analysis was performed to examine differences in maternal report of WHO Maternal Health Interventions. Multivariate linear and logistic regression were performed to assess differences in antenatal care (ANC) scales and maternal care packages. RESULTS: Thousand and three hundred and sixty-seven rural women reported a live birth. Provider distribution was: doctor, 15.6%; midwife, 70%; community health officer (CHO), 9.1%; no provider, 5.3%. Women from lower socio-demographic categories were more likely to report midwife or CHO. Report of CHO vs. no provider was positively associated with maternal services (P < 0.01). Report of doctor or midwife vs. CHO was significantly associated with maternal services (P < 0.01). CONCLUSION: There is a positive association between antenatal provider length of training and maternal specialization and report of maternal services. Community-based providers are associated with markedly increased report of maternal services compared with no provider. Structural factors appear to underlie some differences in service provision.

The first cases of Lassa fever in Ghana.

Lassa fever is a zoonotic disease endemic in West Africa but with no previous case reported in Ghana. We describe the first two laboratory confirmed cases of Lassa fever from the Ashanti Region of Ghana detected in October and December, 2011.

Acceptability of routine offer of HIV Testing (opt-out approach) among pregnant women in the Wa municipality.

BACKGROUND: With the introduction of the opt out HIV testing policy in Ghana, the HIV test is offered routinely to all pregnant women unless they decline testing. OBJECTIVE: To assess acceptability of the routine offer of HIV testing antenatal clinic (ANC) clients in the Wa municipality, Ghana. DESIGN: Cross-sectional study of 270 randomly selected ANC attendees. RESULTS: More than 90% of respondents were in favour of the opt-out policy. The most commonly cited reasons were that it would help pregnant women know their status and facilitate prevention of mother to child transmission of HIV (PMTCT). About 60% of respondents had tested for HIV in the current pregnancy with more than 90% reporting that the test was offered them in a manner in which they could have refused the test. HIV testing in the current pregnancy was associated with having heard of the opt-out policy (p <0.001) and awareness that the test was offered at the facility (p < 0.001), but there was no relationship with educational level. Out of the 112 clients who had not had HIV test in the current pregnancy, 61.8% claimed the test had not been offered to them while 82.4% expressed willingness to have the test done if offered. CONCLUSION: The opt-out HIV testing policy is acceptable to the pregnant women surveyed in the Wa municipality. A well laid out process to ensure that all pregnant women are routinely offered HIV testing at the ANC may help minimize missed opportunities for utilizing PMTCT services.

Care of patients on anti-retroviral therapy in kumasi metropolis.

OBJECTIVE: To assess the characteristics of a cross-section of HIV infected persons receiving treatment from the Antiretroviral Therapy (ART) clinic in Komfo Anokye Teaching Hospital (KATH), Kumasi and highlight perspectives related to taking their treatment. DESIGN: Using a structured questionnaire, sociodemographic characteristics and information related to taking ART were elicited from a random sample of 227 persons living with HIV (PLHIV) accessing ART in Kumasi in 2007. Health workers at the ART clinic were also given self-administered questionnaires to obtain their perspectives on the clinic. RESULTS: Of those sampled, the majority (79.7%) were women and a third (34.8%) were unemployed. More than 95% of the study participants were on the recommended three drug antiretroviral therapy and most of the study participants, (80.6%) said they had never missed a dose of their drugs since starting treatment. About half of the respondents (51%) said the cost of the treatment was not affordable. Seven out of ten (73.6%) waited 3 hours at the clinic before being attended to. On an average clinic day, the number of patients the health workers attended to ranged from 30 to 100. CONCLUSION: PLHIV accessing ART in Komfo Anokye Teaching Hospital were found to be managed as per national HIV treatment guidelines. Inability to afford the cost of treatment and service providers being overwhelmed by the large number of patients patronizing the clinic may have implications for patients taking ART as prescribed and the quality of care.

Factors associated with sexually transmitted infections among young ghanaian women.

OBJECTIVE: To identify factors associated with a history of sexually transmitted infections in Ghanaian women 15 - 24 years. DESIGN: The study was a cross-sectional data analysis of 1280 sexually experienced females from the 2003 Ghana Demographic Health Survey. Using chi square and t-test, those with a history or symptoms of STI were compared with those denying such a history on demographic, individual and partner level variables. Significant variables were entered into logistic regression to identify variables associated with STI. RESULTS: The STI group comprised 12% of the study population. Compared to those denying a history of STI, the STI group was less likely to know where to get condoms (37% vs 23%, p=.001) but more likely to use a condom at their last sexual encounter (27% vs 17%, p=.003). Women in the STI group were significantly less likely to discuss family planning with their partners but more likely to have 2 or more partners in the preceding 12 months. Logistic regression showed that factors associated with STI among sexually active Ghanaian female youth included not knowing where to get condoms and not discussing family planning with partner. CONCLUSION: Majority of sexually experienced Ghanaian female youth do not know where to get condoms. Lack of knowledge of source of condoms was identified as a risk factor for STI for these women.

Complement binding to erythrocytes is associated with macrophage activation and reduced haemoglobin in Plasmodium falciparum malaria.

We have examined IgG and complement factor C3d deposition on erythrocytes by means of the direct Coombs' test (DAT) and looked for an association with the anaemia seen in falciparum malaria in children living in an area of hyperendemic malaria transmission (in Ghana). In one study (in 1997), 53 out of 199 patients had a positive DAT. Of these, 45 samples reacted with anti-C3d antibodies, 2 with anti-IgG and 6 with both reagents. There were significantly lower haemoglobin (Hb)-levels and higher prevalence of spleen enlargement in DAT-positive than in DAT-negative patients. Hb-levels were independently associated with DAT and age. This initial study was designed to investigate the role of intravascular haemolysis (IVH), but we found no association between IVH and either DAT result or anaemia. Because of the risk of selection bias we repeated the study using consecutive enrollment of malaria patients and were able to confirm the results in a total of 49 DAT-positive and 183 DAT-negative patients. This second study (in 1998) was designed to look at the importance of erythrophagocytosis through measurement of plasma neopterin levels and total nitrite and nitrate as markers of NO-release. Both parameters were significantly higher in DAT-positive than in DAT-negative patients (P < 0.001), indicating that complement binding to erythrocytes was associated with macrophage activation. Plasma levels of haptoglobin, interleukin-10 and tumour necrosis factor-alpha did not vary between the groups. The studies support the role of complement activation and erythrophagocytosis in the pathogenesis of anaemia in falciparum malaria in African children.