20 year trends in renal disease mortality in Ghana: A review of autopsies.

AIM: Data on the changing levels in renal morbidity and mortality are scant globally. We sought to assess trends in renal disease mortality and attributable causes over a 20 year period in Ghana. METHODS: A retrospective analysis of 20 year autopsy records of the Pathology Departments of leading teaching hospitals in Ghana, (Korle-Bu Teaching Hospital (KBTH) in Accra and Komfo Anokye Teaching Hospital (KATH) in Kumasi) from January 1994 to December 2013. Data comprising autopsies from in-patients, community cases and coroners' cases were used. We defined primary cause of death as death directly due to renal disease and secondary cause of death as death in which renal disease was a comorbid or contributing factor. RESULTS: Over the period, there were a total of 94 309 deaths, of which 5608 were attributed to renal disease (5.9/100). Mortality rate remained fairly the same from 1994 to 2009 (5.0%), but doubled from 2010 to 2013 (10.8%). Similar trends were observed among males and females during the same period. However, males had slightly higher mortality rates (6.6%; 95% CI: 46.1%-6.8%) compared to females (5.6%; 95% CI: 5.4%-5.8%; P = 0.271). The major leading attributable causes of renal disease death include end stage renal disease 45.0% and acute pyelonephritis accounting for 20.9% of the cases. Hypertensive heart disease accounted for 30.0% of all secondary cause of death while congestive heart disease and septicaemia accounted for 13.0% and 12.0%, respectively. CONCLUSIONS: We observed marked increase in the renal disease mortality rate during the last few years predominantly driven by chronic and infectious related renal diseases as a main cause, and hypertensive heart disease and congestive heart failure as the main secondary causes. Measures geared towards prevention, treatment and managing such conditions may impact on the reduction of renal disease mortality rate among Ghanaian populations.

Chronic kidney disease burden among African migrants in three European countries and in urban and rural Ghana: the RODAM cross-sectional study.

Background: Chronic kidney disease (CKD) is a major burden among sub-Saharan African (SSA) populations. However, differences in CKD prevalence between rural and urban settings in Africa, and upon migration to Europe are unknown. We therefore assessed the differences in CKD prevalence among homogenous SSA population (Ghanaians) residing in rural and urban Ghana and in three European cities, and whether conventional risk factors of CKD explained the observed differences. Furthermore, we assessed whether the prevalence of CKD varied among individuals with hypertension and diabetes compared with individuals without these conditions. Methods: For this analysis, data from Research on Obesity & Diabetes among African Migrants (RODAM), a multi-centre cross-sectional study, were used. The study included a random sample of 5607 adult Ghanaians living in Europe (1465 Amsterdam, 577 Berlin, 1041 London) and Ghana (1445 urban and 1079 rural) aged 25-70 years. CKD status was defined according to severity of kidney disease using the combination of glomerular filtration rate (G1-G5) and albuminuria (A1-A3) levels as defined by the 2012 Kidney Disease: Improving Global Outcomes severity classification. Comparisons among sites were made using logistic regression analysis. Results: CKD prevalence was lower in Ghanaians living in Europe (10.1%) compared with their compatriots living in Ghana (13.3%) even after adjustment for age, sex and conventional risk factors of CKD [adjusted odds ratio (OR) = 0.70, 95% confidence interval (CI) 0.56-0.88, P = 0.002]. CKD prevalence was markedly lower among Ghanaian migrants with hypertension (adjusted OR = 0.54, 0.44-0.76, P = 0.001) and diabetes (adjusted OR = 0.37, 0.22-0.62, P = 0.001) compared with non-migrant Ghanaians with hypertension and diabetes. No significant differences in CKD prevalence was observed among non-migrant Ghanaians and migrant Ghanaians with no hypertension and diabetes. Among Ghanaian residents in Europe, the odds of CKD were lower in Amsterdam than in Berlin, while among Ghanaian residents in Ghana, the odds of CKD were lower in rural Ghana (adjusted OR = 0.68, 95% CI 0.53-0.88, P = 0.004) than in urban Ghana, but these difference were explained by conventional risk factors. Conclusion: Our study shows important differences in CKD prevalence among Ghanaians living in Europe compared with those living in Ghana, independent of conventional risk factors, with marked differences among those with hypertension and diabetes. Further research is needed to identify factors that might explain the observed difference across sites to implement interventions to reduce the high burden of CKD, especially in rural and urban Ghana.

Ethnic Disparities in CKD in the Netherlands: The Healthy Life in an Urban Setting (HELIUS) Study.

BACKGROUND: Evidence suggesting important ethnic differences in chronic kidney disease (CKD) prevalence comes mainly from the United States, and data among various ethnic groups in Europe are lacking. We therefore assessed differences in CKD in 6 ethnic groups living in the Netherlands and explored to what extent the observed differences could be accounted for by differences in conventional cardiovascular risk factors (smoking, physical activity, obesity, hypertension, diabetes, and hypercholesterolemia). STUDY DESIGN: Cross-sectional analysis of baseline data from the Healthy Life in an Urban Setting (HELIUS) cohort study. SETTING & PARTICIPANTS: A random sample of 12,888 adults (2,129 Dutch, 2,273 South Asian Surinamese, 2,159 African Surinamese, 1,853 Ghanaians, 2,255 Turks, and 2,219 Moroccans) aged 18 to 70 years living in Amsterdam, the Netherlands. PREDICTORS: Ethnicity. OUTCOMES & MEASUREMENTS: CKD status was defined using the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) severity of CKD classification. CKD was defined as albumin-creatinine ratio ≥ 3mg/mmol (category ≥ A2) or glomerular filtration rate < 60mL/min/1.73m(2) (category ≥ G3). Comparisons among groups were made using prevalence ratios (PRs). RESULTS: The age-standardized prevalence of CKD was higher in all ethnic minority groups, ranging from 4.6% (95% CI, 3.8%-5.5%) in African Surinamese to 8.0% (95% CI, 6.7%-9.4%) in Turks, compared with 3.0% (95% CI, 2.3%-3.7%) in Dutch. Adjustment for conventional risk factors reduced the PR substantially, but ethnic differences remained for all ethnic minority groups except African Surinamese, with the PR ranging from 1.48 (95% CI, 1.12-1.97) in Ghanaians to 1.75 (95% CI, 1.33-2.30) in Turks compared with Dutch. Similar findings were found when CKD was stratified into a moderately increased and a combined high/very high risk group. Among the combined high/very high CKD risk group, conventional risk factors accounted for most of the ethnic differences in CKD except for South Asian Surinamese (PR, 2.60; 95% CI, 1.26-5.34) and Moroccans (PR, 2.33; 95% CI, 1.05-5.18). LIMITATIONS: Cross-sectional design. CONCLUSIONS: These findings suggest ethnic inequalities in CKD for most groups even after adjustment for conventional risk factors. These findings highlight the need for further research to identify other potential factors contributing to the ethnic inequalities in CKD.

Assessment of the level of agreement in the interpretation of plain radiographs of lumbar spondylosis among clinical physiotherapists in Ghana.

BACKGROUND: Objective physical assessment of patients with lumbar spondylosis involves plain film radiographs (PFR) viewing and interpretation by the radiologists. Physiotherapists also routinely assess PFR within the scope of their practice. However, studies appraising the level of agreement of physiotherapists' PFR interpretation with radiologists are not common in Ghana. METHOD: Forty-one (41) physiotherapists took part in the cross-sectional survey. An assessment guide was developed from findings of the interpretation of three PFR of patients with lumbar spondylosis by a radiologist. The three PFR were selected from a pool of different radiographs based on clarity, common visible pathological features, coverage body segments and short post production period. Physiotherapists were required to view the same PFR after which they were assessed with the assessment guide according to the number of features identified correctly or incorrectly. The score range on the assessment form was 0-24, interpreted as follow: 0-8 points (low), 9-16 points (moderate) and 17-24 points (high) levels of agreement. Data were analyzed using one sample t-test and fisher's exact test at α = 0.05. RESULTS: The mean score of interpretation for the physiotherapists was 12.7 ± 2.6 points compared to the radiologist's interpretation of 24 points (assessment guide). The physiotherapists' levels were found to be significantly associated with their academic qualification (p = 0.006) and sex (p = 0.001). However, their levels of agreement were not significantly associated with their age group (p = 0.098), work settings (p = 0.171), experience (p = 0.666), preferred PFR view (p = 0.088) and continuing education (p = 0.069). CONCLUSIONS: The physiotherapists' skills fall short of expectation for interpreting PFR of patients with lumbar spondylosis. The levels of agreement with radiologist's interpretation have no link with year of clinial practice, age, work settings and continuing education. Thus, routine PFR viewing techniques should be made a priority in physiotherapists' continuing professional education.

Prevalence of Hepatitis B Virus Infection among Inmates at the Monrovia Central Prison, Liberia.

Determination of hepatitis B virus (HBV) infections in key populations including prison inmates is crucial for formulating appropriate intervention approaches. However, in many low-income countries, such as Liberia, there is hardly any documentation on HBV prevalence among inmates. This study determined and evaluated the prevalence of HBV infections among incarcerated persons in the Monrovia Central Prison, Liberia. One hundred participants comprising 76 males and 24 females were studied. Participants' demographic and potential risk factors information were obtained using a semi-structured questionnaire, and blood samples were collected for the analysis. Plasma was tested for five HBV serological markers, namely, HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb. The seroreactivity of actively infected persons was confirmed by nucleic acid detection. Results of the serological assay showed that 34% of the participants had been exposed to the virus and 14% were actively infected. qPCR confirmed HBV DNA in seven actively infected samples. Statistical analysis indicated that a low level of education, a history of blood transfusion, and intravenous drug use, were significant predictors of active HBV infection and HBV exposure, respectively. These findings might make the testing and vaccination of convicts against HBV infection prior to their admission into prison facilities imperative.

Cross-sectional study of association between socioeconomic indicators and chronic kidney disease in rural-urban Ghana: the RODAM study.

OBJECTIVES: Studies from high-income countries suggest higher prevalence of chronic kidney disease (CKD) among individuals in low socioeconomic groups. However, some studies from low/middle-income countries show the reverse pattern among those in high socioeconomic groups. It is unknown which pattern applies to individuals living in rural and urban Ghana. We assessed the association between socioeconomic status (SES) indicators and CKD in rural and urban Ghana and to what extent the higher SES of people in urban areas of Ghana could account for differences in CKD between rural and urban populations. SETTING: The study was conducted in Ghana (Ashanti region). We used baseline data from a multicentre Research on Obesity and Diabetes among African Migrants (RODAM) study. PARTICIPANTS: The sample consisted of 2492 adults (Rural Ghana, 1043, Urban Ghana, 1449) aged 25-70 years living in Ghana. EXPOSURE: Educational level, occupational level and wealth index. OUTCOME: Three CKD outcomes were considered using the 2012 Kidney Disease: Improving Global Outcomes severity of CKD classification: albuminuria, reduced glomerular filtration rate and high to very high CKD risk based on the combination of these two. RESULTS: All three SES indicators were not associated with CKD in both rural and urban Ghana after age and sex adjustment except for rural Ghana where high wealth index was significantly associated with higher odds of reduced estimated glomerular filtration rate (eGFR) (adjusted OR, 2.38; 95% CI 1.03 to 5.47). The higher rate of CKD observed in urban Ghana was not explained by the higher SES of that population. CONCLUSION: SES indicators were not associated with prevalence of CKD except for wealth index and reduced eGFR in rural Ghana. Consequently, the higher SES of urban Ghana did not account for the increased rate of CKD among urban dwellers suggesting the need to identify other factors that may be driving this.

Depression and quality of life in patients on long term hemodialysis at a nationalhospital in Ghana: a cross-sectional study.

The study examined quality of life and prevalence of depressive symptoms in patients on long term hemodialysis. Further, it explored the impact of socio-demographic characteristics on depression and quality of life. DESIGN: Study design was cross-sectional. SETTING: Study was conducted in the two renal dialysis units of the Korle-Bu Teaching hospital in Accra, Ghana. PARTICIPANTS AND STUDY TOOLS: One hundred and six participants on haemodialysis were recruited for the study. The Patient Health Questionnaire and the World Health Organization Quality of Life instrument were used to assess depression and quality of life. RESULTS: Forty five percent of participants screened positive for symptoms of depression. Approximately 19% obtained low scores on overall quality of life. There were significant negative correlations between the following: Depression and overall QoL, Depression and duration of dialysis treatment and Depression and income level. There was positive correlation between overall QoL and duration of dialysis, treatment and income. CONCLUSION: Depressive symptoms were common amongst patients on long term hemodialysis. Haemodialysis patients who obtained low scores on quality of life measures were more likely to screen positive for depressive symptoms. Screening for depressive symptoms among these patients is critical as early treatment may improve their general wellbeing. FUNDING: Not indicayed.

Helicobacter pylori cagA and vacA genes in dyspeptic Ghanaian patients.

BACKGROUND: Helicobacter pylori infection is prevalent in Ghana. The development of gastro-duodenal disease is dependent on virulence of the infecting strain, host susceptibility and environmental factors. Helicobacter pylori cagA and vacA strains induce more inflammation, ulceration and oncogenesis. Here, for the first time we present data on H. pylori cagA and vacA genes and their association with gastro-duodenal disease in Ghana. A total of 159 patients with dyspepsia at Korle-Bu Teaching Hospital, Accra, were investigated for H. pylori with urease-CLO, of which 113 (71.1%) were positive. Genomic DNA was extracted from antral biopsies using QIAGEN DNeasy kit. Detection of H. pylori vacA and cagA genes were determined by PCR as previously described. RESULTS: In total, 110 (69.2%) vacAs1, 71 (44.7%) vacAm1, 35 (22.0%) vacAm2, 77 (48.4%) cagA-(hydrophilic region) and 109 (68.6%) cagA-(internal duplication region) were detected. In multivariate analysis, duodenal ulcer was more likely than other diagnoses to have detectable cagA-(hydrophilic region) (OR 3.1 CI 1.2-7.9) or vacAs1m1 (OR 6.5 CI 1.2-34.0). CONCLUSIONS: Majority of biopsies were colonized with H. pylori harboring both cagA and vacA. H. pylori cagA-(internal duplication region) was more prevalent than cagA-(hydrophilic region). Duodenal ulcer was more likely than other diagnoses to have detectable cagA-(hydrophilic region) or vacAs1m1.

Relationship between educational and occupational levels, and Chronic Kidney Disease in a multi-ethnic sample- The HELIUS study.

BACKGROUND: Ethnic minority groups in high-income countries are disproportionately affected by Chronic Kidney Disease (CKD) for reasons that are unclear. We assessed the association of educational and occupational levels with CKD in a multi-ethnic population. Furthermore, we assessed to what extent ethnic inequalities in the prevalence of CKD were accounted for by educational and occupational levels. METHODS: Cross-sectional analysis of baseline data from the Healthy Life in an Urban Setting (HELIUS) study of 21,433 adults (4,525 Dutch, 3,027 South-Asian Surinamese, 4,105 African Surinamese, 2,314 Ghanaians, 3,579 Turks, and 3,883 Moroccans) aged 18 to 70 years living in Amsterdam, the Netherlands. Three CKD outcomes were considered using the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) severity of CKD classification. Comparisons between educational and occupational levels were made using logistic regression analyses. RESULTS: After adjustment for sex and age, low-level and middle-level education were significantly associated with higher odds of high to very high-risk of CKD in Dutch (Odds Ratio (OR) 2.10, 95% C.I., 1.37-2.95; OR 1.55, 95% C.I., 1.03-2.34). Among ethnic minority groups, low-level education was significantly associated with higher odds of high to very-high-risk CKD but only in South-Asian Surinamese (OR 1.58, 95% C.I., 1.06-2.34). Similar results were found for the occupational level in relation to CKD risk. CONCLUSION: The lower educational and occupational levels of ethnic minority groups partly accounted for the observed ethnic inequalities in CKD. Reducing CKD risk in ethnic minority populations with low educational and occupational levels may help to reduce ethnic inequalities in CKD and its related complications.

Effects of aerobic exercise on selected physiological parameters and quality of life in patients with type 2 diabetes mellitus.

BACKGROUND: The aim of this study was to evaluate the effects of an 8-week aerobic exercise program on physiological parameters and quality of life in patients with type 2 diabetes mellitus. METHODS: Patients attending a diabetes clinic participated in this randomized control trial. They were randomly assigned to an intervention or control group by ballot. The intervention group, in addition to regular conventional treatment, received individually prescribed aerobic exercise for 30 minutes, at 50%-75% of maximum heart rate three times weekly. Main outcome measures included fasting blood sugar, glycosylated hemoglobin (HbA(1c)), high-density lipoprotein, low-density lipoprotein, and a World Health Organization quality of life questionnaire (WHOQoL-BREF). Data analysis involved paired and unpaired t-tests and mixed-design two-way analysis of variance. RESULTS: Eighteen patients with type 2 diabetes and of mean age 46.22 ± 9.79 years participated in the study. Mean duration since onset of diabetes in the intervention and control groups was 4.44 ± 3.33 years and 3.92 ± 2.66 years, respectively. Both groups were similar for duration since onset, baseline physiological parameters, and quality of life. Within-group comparison did not show any significant differences (P > 0.05) for HbA(1c), fasting blood sugar, low-density lipoprotein, or high-density lipoprotein. The intervention group improved significantly (P < 0.05) in their postexercise quality of life compared with baseline. Between-group comparison did not show any significant differences in physiological parameters or quality of life. CONCLUSION: Patients with type 2 diabetes improved in fasting blood sugar, low-density lipoprotein, high-density lipoprotein, and quality of life following 8 weeks of aerobic exercise training. These perceived improvements were not reflected by statistically significant differences in between-group comparison for any parameters.

Cryptosporidial Diarrhoea in Children at a Paediatric Hospital in Accra, Ghana.

Background: Diarrhoeal diseases are common among children in developing countries, and are caused by several aetiological agents including Cryptosporidium sp. Several species of this parasite exist which may belong to either anthroponotic or zoonotic forms. With recent application of molecular tools, species involved in human transmission in any locality and sources of infection can now be determined. Aim: We screened children with acute diarrhoea at a paediatric hospital in Accra, Ghana for enteric parasites to determine frequency of cryptosporidial diarrhoea. Cryptosporidium isolates were then characterized by molecular methods to determine the genetic species in transmission. Methodology: A total of 365 diarrhoeic children of age ≤ 5 years were used in this cross-sectional study. Stool samples were collected and tested for enteric parasites by microscopy and ELISA. Cryptosporidium isolates were subsequently genotyped by PCR-RFLP and confirmed by sequencing of the 18S rRNA gene. Demographic and clinical data were obtained by a structured questionnaire and data analysed for possible association with cryptosporidial diarrhoea. Results: Enteric parasites detected were Cryptosporidium sp. (22.2%), G. lamblia (5.8%) and E. histolytica (0.8%). Neither gender nor breastfeeding habits, presence of domestic animals, source of children’s food, seasons (dry or rainy) appeared to be associated with infection of Cryptosporidium sp. However, age of children, source of drinking water, and education level of mother seems to have association with infection of the parasite. Genotyping results show that C. parvum is the only species involved in transmission. Conclusion: Cryptosporidium parvum is the commonest enteric parasite causing diarrhoea among children with acute diarrhoea. Children ≤ 3 years and those who drank sachet water were most affected. A carefully planned health education among illiterate mothers and improved sanitary conditions could reduce rate of infections. Further sub-genotyping of C. parvum is needed to determine whether source of infection is zoonotic or anthroponotic.