An Assessment of Female Prisoners' Perception of the Accessibility of Quality Healthcare: A Survey in the Kumasi Central Prisons, Ghana.

BACKGROUND: Accessibility of quality healthcare across the globe has generated a lot of attention among public health practitioners. AIM: This study explored the background characteristics of female prisoners and how it influences their assessment of the quality of accessible healthcare in the Kumasi Female Prison. SUBJECTS AND METHODS: This descriptive cross-sectional survey was conducted at the Female section of the Kumasi Central Prisons from June to December 2011. We used pretested questionnaires to obtain quantitative data from all 39 inmates of the female Prisons. An in-depth interview was used to obtain qualitative data from the prison healthcare giver. Data were analyzed with Epi Info Version 3.5.1, (Centers for Disease Control and Prevention), Excel, and Graph Pad Prism version 5.00 for Windows (Graph Pad software, San Diego California USA, www.graphpad.com). RESULTS: Using a 12-point scale inventory questionnaire, inmates with no formal education gave the highest mean health provision assessment score (6.0) whereas those with tertiary education gave the lowest (4.5). Females serving prison sentences gave the highest mean health assessment score whereas remand prisoners gave the lowest. Single females' mean health assessment score was 5.7 whereas that of married inmates was 4.9. Unemployed inmates scored 5.8, informal 5.4 while civil servants scored 5.0. CONCLUSION: Access to quality healthcare was poor and demographic characteristics, marital status, educational background, and occupation influenced inmates' perceptions of accessibility to quality healthcare. Inmates should be encouraged to be proactive in seeking healthcare irrespective of their background characteristics.

Assessment of annual whole-body occupational radiation exposure in medical practice in Ghana (2000-09).

Occupational exposure to radiation in medical practice in Ghana has been analysed for a 10-y period between 2000 and 2009. Monitored dose data in the medical institution in Ghana from the Radiation Protection Institute's database were extracted and analysed in terms of three categories: diagnostic radiology, radiotherapy and nuclear medicine. One hundred and eighty medical facilities were monitored for the 10-y period, out of which ~98% were diagnostic radiology facilities. Only one nuclear medicine and two radiotherapy facilities have been operational in the country since 2000. During the 10-y study period, monitored medical facilities increased by 18.8%, while the exposed workers decreased by 23.0%. Average exposed worker per entire medical institution for the 10-y study period was 4.3. Annual collective dose received by all the exposed workers reduced by a factor of 4 between 2000 and 2009. This is seen as reduction in annual collective doses in diagnostic radiology, radiotherapy and nuclear medicine facilities by ~76, ~72 and ~55%, respectively, for the 10-y period. Highest annual collective dose of 601.2 man mSv was recorded in 2002 and the least of 142.6 man mSv was recorded in 2009. Annual average values for dose per institution and dose per exposed worker decreased by 79 and 67.6%, respectively between 2000 and 2009. Average dose per exposed worker for the 10-y period was least in radiotherapy and highest in diagnostic radiology with values 0.14 and 1.05 mSv, respectively. Nuclear medicine however recorded average dose per worker of 0.72 mSv. Correspondingly, range of average effective doses within the diagnostic radiology, radiotherapy and nuclear medicine facilities were 0.328-2.614, 0.383-0.728 and 0.448-0.695 mSv, respectively. Throughout the study period, an average dose per medical institution of 3 mSv and an average dose per exposed worker of 0.69 mSv were realised. Exposed workers in diagnostic radiology primarily received most of the individual annual doses >1 mSv. The entire study period had 705 instances in which exposed workers received individual annual doses >1 mSv. On thermoluminescent dosemeter (TLD) return rates, facilities in Volta and Eastern Regions recorded highest return rates of 94.3% each. Ashanti Region recorded the least TLD return rate with 76.7%.

Assessment of annual whole-body occupational radiation exposure in education, research and industrial sectors in Ghana (2000-09).

Institutions in the education, research and industrial sectors in Ghana are quite few in comparison to the medical sector. Occupational exposure to radiation in the education, research and industrial sectors in Ghana have been analysed for a 10 y period between 2000 and 2009, by extracting dose data from the database of the Radiation Protection Institute, Ghana Atomic Energy Commission. Thirty-four institutions belonging to the three sectors were monitored out of which ∼65% were in the industrial sector. During the 10 y study period, monitored institutions ranged from 18 to 23 while the exposed workers ranged from 246 to 156 between 2000 and 2009. Annual collective doses received by all the exposed workers reduced by a factor of 2 between 2000 and 2009. This is seen as a reduction in annual collective doses in education/research and industrial sectors by ∼39 and ∼62%, respectively, for the 10 y period. Highest and least annual collective doses of 182.0 man mSv and 68.5 man mSv were all recorded in the industrial sector in 2000 and 2009, respectively. Annual average values for dose per institution and dose per exposed worker decreased by 49 and 42.9%, respectively, between 2000 and 2009. Average dose per exposed worker for the 10 y period was least in the industrial sector and highest in the education/research sector with values 0.6 and 3.7 mSv, respectively. The mean of the ratio of annual occupationally exposed worker (OEW) doses for the industrial sector to the annual OEW doses for the education/research sector was 0.67, a suggestion that radiation protection practices are better in the industrial sector than they are in the education/research sector. Range of institutional average effective doses within the education/research and industrial sectors were 0.059-6.029, and 0.110-2.945 mSv, respectively. An average dose per all three sectors of 11.87 mSv and an average dose per exposed worker of 1.12 mSv were realised for the entire study period. The entire study period had 187 instances in which exposed workers received individual annual doses >1 mSv, with exposed workers in the education/research sector primarily receiving most of this individual dose.

Endothelial dysfunction is associated with left ventricular mass (assessed using MRI) in an adult population (MESA).

Brachial flow-mediated dilation (FMD) is a measure of endothelial nitric oxide bioavailability. Endothelial nitric oxide controls vascular tone and is likely to modify the ventricular muscle coupling mechanism. The association between left ventricular mass and FMD is not well understood. We assessed the association between left ventricular mass index (LVMI) and FMD in participants of the Multi-Ethnic Study of Atherosclerosis (MESA). MESA is a population-based study of 6814 adults free of clinical cardiovascular disease at baseline who were recruited from six US clinics. LVMI (left ventricular mass per body surface area) and FMD were measured in 2447 subjects. Linear regression analysis was used to evaluate the association. The subjects had a mean age of 61.2±9.9 years, 51.2% females with 34.3% Caucasians, 21.6% Chinese, 19.4% African Americans and 24.7% Hispanics. The mean body mass index (BMI) was 27.4±4.8 kg m⁻², 9.4% had diabetes, 11% were current smokers and 38% hypertensives. The mean±s.d. LVMI was 78.1±15.9 g m⁻² and mean±s.d. FMD was 4.4%±2.8%. In univariate analysis, LVMI was inversely correlated with FMD (r= -0.20, P<0.0001). In the multivariable analysis, LVMI was associated with FMD (ß coefficient (se) = -0.50 (0.11), P<0.001 (0.5 g m⁻² reduction in LVMI per 1% increase in FMD)) after adjusting for age, gender, race/ethnicity, systolic blood pressure, diabetes mellitus, smoking, weight, statin use, antihypertensive medication use, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol. The association between brachial flow mediated dilation and LVMI maybe independent of traditional CV risk factors in population based adults.

Optimization of radiation protection for the control of occupational exposure in Ghana.

Investigation of the optimization of protection of occupational exposed workers (OEWs) in Ghana had been carried out on the three practices in the country, namely medical applications, industrial radioisotope applications and research and education from 2002 to 2007. Mean annual effective dose and collective effective dose were estimated from dosimetry records from the Radiation Protection Institute of those occupationally exposed from 2002 to 2007. The mean annual effective dose estimated for about 650 OEWs per year ranged from 0.42 to 0.68 mSv compared with a global value of 0.5 mSv estimated by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR 2008 Report). This implies that efforts should still be made to institute as low as reasonably achievable culture in most practices in Ghana even though trend of doses incurred was low. The collective effective dose for this same period estimated ranged from 0.26 to 0.47 man Sv. A reference monetary value of the man sievert was estimated using the human capital approach for each year from 2002 to 2009; it ranged from 172 to 22 US $ per man Sv, which provided a basis for estimating the cost of averting a unit collective effective dose of 1 man Sv. This value could not be used for quantitative optimization since the range of mean annual effective dose estimated was below 1 mSv.

Radiation exposure control from the application of nuclear gauges in the mining industry in Ghana.

The use of nuclear gauges for process control and elemental analysis in the mining industry in Ghana, West Africa, is wide spread and on the increase in recent times. The Ghana Radiation Protection Board regulates nuclear gauges through a system of notification and authorization by registration or licensing, inspection, and enforcement. Safety assessments for authorization and enforcement have been established to ensure the safety and security of radiation sources as well as protection of workers and the general public. Appropriate training of mine staff is part of the efforts to develop the necessary awareness about the safety and security of radiation sources. The knowledge and skills acquired will ensure the required protection and safety at the workplaces. Doses received by workers monitored over a period between 1998 and 2007 are well below the annual dose limit of 20 mSv recommended by the International Commission on Radiological Protection.

Public exposure to hazards associated with natural radioactivity in open-pit mining in Ghana.

The results of studies carried out on public exposure contribution from naturally occurring radioactive materials (NORMS) in two open-pit mines in the Western and Ashanti regions of Ghana are reported. The studies were carried out under International Atomic Energy Agency-supported Technical Co-operation Project GHA/9/005. Measurements were made on samples of water, soil, ore, mine tailings and air using gamma spectrometry. Solid-state nuclear track detectors were used for radon concentration measurements. Survey was also carried out to determine the ambient gamma dose rate in the vicinity of the mines and surrounding areas. The effective doses due to external gamma irradiation, ingestion of water and inhalation of radon and ore dusts were calculated for the two mines. The average annual effective dose was found to be 0.30 +/- 0.06 mSv. The result was found to be within the levels published by other countries. The study provides a useful information and data for establishing a comprehensive framework to investigate other mines and develop guidelines for monitoring and control of NORMS in the mining industry and the environment as a whole in Ghana.

Patient dose assessment due to fluoroscopic exposure for some selected fluoroscopic procedures in Ghana.

Organ and effective doses to 90 patients undergoing some selected fluoroscopic examinations at the Korle-Bu Teaching Hospital were estimated using the Monte Carlo-based program (PCXMC version 1.5). Radiation dose was estimated from free-in-air measurements. The mean effective doses were found to be 0.29 +/- 0.07, 0.84 +/- 0.13, 3.15 +/- 0.44, 6.24 +/- 0.70 and 0.38 +/- 0.05 mSv for urethrogram, barium swallow, barium meal, barium enema and myelogram examinations, respectively. The dose area product was estimated to be 3.55 +/- 0.95, 16.44 +/- 2.60, 50.81 +/- 7.04, 99.69 +/- 10.85 and 9.32 +/- 0.99 Gy cm(2) for urethrogram, barium swallow, barium meal, barium enema and myelogram examinations, respectively. Optimisation of procedures is required for barium enema and barium meal examinations.