A qualitative enquiry into the challenging roles of caregivers caring for children with Autism Spectrum Disorders in Ghana

BACKGROUND

Autism Spectrum Disorder (ASD) is a condition commonly characterized by challenges with social interaction, repetitive atypical behaviour, and restricted interest. It is estimated that about 1 in 160 children has ASD. Caring for children with ASD is challenging for many parents or caregivers.

OBJECTIVES

The study aims at exploring the challenges experienced by caregivers of children with ASD.

METHODS

A qualitative phenomenological study was employed using an exploratory descriptive research design. A total of 10 participants were recruited in this study using a purposive sampling technique. Data were analysed using content analysis procedures.

RESULT

Caregivers of children with ASD face social, financial, and emotional challenges, challenges in accessing health care, education and training of their children in mainstream school settings.

CONCLUSION

The numerous challenges have implications for the quality of life of the caregivers and their children. The financial challenges and inaccessibility of specialist health services have serious implications for the continuous medical care and monitoring of children with ASD. The challenges in education and training of children with ASD has negative consequences for enrolment and retention of children with ASD in mainstream school settings.

Hepatitis B infection prevention: Audit of selected healthcare facilities in the Greater Accra Region, Ghana

Introduction

The risk of occupational exposure to Hepatitis B Virus (HBV) is high among healthcare workers (HCWs), especially in developing countries like Ghana where the prevalence of HBV is high. Unfortunately, in such regions, HCW protection does not appear to be a priority, and healthcare facilities (HFs) have been reported to have unsatisfactory levels of implementing preventive strategies to protect HCWs from blood-borne infections including HBV.

Methods

A cross-sectional and Q audit was performed involving 255 HFs selected by proportional allocation and systematic random sampling. Data was collected using a structured pretested questionnaire with HF managers being the respondents. Data were analysed using IBM ® SPSS® (Statistical Package for the Social Sciences, version 21.0) where univariate, bivariate, and multivariate analysis was done with the level of significance set at <0.05.

Results

Overall adherence to recommended strategies, structures, and programs for HBV prevention among the HFs was generally low, with a mean score of 37.02 (95% CI = 33.98-40.05). There was a statistically significant difference in the level of adherence between the HF categories (F = 9.698; P = <0.001). Being a hospital (OR = 3.9: CI = 1.68-9.29), possessing infection, prevention and control (IPC) guidelines (OR = 6.69: CI = 3.29-13.63) as well as having functional IPC committees in place (OR = 7.9: CI = 3.59-17.34) were associated with good adherence to HF-level HBV preventive strategies.

Conclusion

Overall adherence to HF-level prevention of HBV is sub-optimal. Higher-level facilities were better resourced with HBV vaccine and Hepatitis B immunoglobulin (HBIG). Adherence to HBV prevention strategies depends on the type of HF and the availability of IPC committees and their respective IPC coordinators.

Hepatitis B Virus vaccination post serological testing and antibody levels of vaccinated health care workers in Accra, Ghana

Introduction

Hepatitis B Virus (HBV) infection is an important occupational hazard to Health Care Workers (HCWs) all over the world. International health organizations have strongly recommended the use of the HBV vaccine, especially among individuals at risk of HBV infection. A laboratory test aimed at measuring Anti-HBs concentration (titer) 1-2 months following a 3-dose vaccination schedule is the most reliable approach for diagnosing seroprotection against HBV. This study sought to assess post-vaccination serological testing, seroprotection against HBV, and associated factors among vaccinated HCWs in Ghana.

Methods

A hospital-based analytical cross-sectional study involving 207 HCWs. Pretested questionnaires were used to collect data. 5mls of venous blood were collected from consenting HCWs under strict aseptic conditions and quantitatively analyzed for Anti-HBs using ELISA procedures. SPSS Version 23 was used to analyze data with the level of significance set at 0.05.

Results

Median age; 33, IQR of 29-39. The post-vaccination serological testing rate was 21.3 %. HCWs with high-risk perception and working at the regional hospital had lower odds of adherence to post-vaccination serological testing (aOR = 0.2; 95 % CI = 0.1-0.7) and (aOR = 0.1; 95 % CI = 0.1-0.6) p < 0.05. The seroprotection rate was 91.3 % (95 % CI = 87 %-95 %). Minority, 18 (8.7 %) of the 207 vaccinated HCWs had antibody titers below 10mIU/mL and were not seroprotected against HBV. Geometric Mean Titers (GMTs) were higher in those who received three doses, took a booster, and were less than 25 kg/m².

Conclusion

The post-vaccination serological testing practice was sub-optimal. The seroprotection rate was higher with higher GMTs in those who adhered to the 3-dose vaccination regimen, took a booster dose, and had BMI < 25 kg/m². It may be inferred that those with Anti-HBs below 10 IU/ml had their antibodies diminishing or waning off with time or they are true vaccine non-responders. This observation calls for strict adherence to post-vaccination serological testing, especially for HCWs who are at high risk of percutaneous and mucocutaneous exposures that could result in HBV infection.

Seroprevalence of Hepatitis B virus infection and associated factors among health care workers in Southern Ghana

Introduction

The World Health Organization estimates that 37% of Hepatitis B Virus (HBV) infections among Health Care Workers (HCWs) are due to percutaneous occupational exposure to blood and body fluids. In Ghana, occupational exposures are rising; however, the burden of HBV infection in HCWs remains unknown. Our study estimated the prevalence of HBV surface antigens and associated factors among HCWs.

Methods

We conducted a cross-sectional survey of 340 HCWs using a structured pretested questionnaire and screening for HBV surface antigens. Data were analyzed using SPSS version 20.0 with a level of significance set at <0.05.

Results

The overall crude prevalence of current HBV infection was 5.9 % (95% CI, 3.0-8.0). Adjusted prevalence by test performance was 5.8%. Prevalence was highest among males 10.2% (95% CI, 4.8-18.5), HCWs other than nurses and doctors 9.2% (95% CI, 4.5-16.2), and those working at lower-level facilities 9.7% (95% CI, 4.8-17.1). Training in the prevention of blood-borne infections was significantly associated with HBV infection (adjusted odds ratio 3.2; 95% CI, 1.1-9.1).

Conclusions

HBV infection is high in this population. In addition to lifesaving interventions such as vaccination and the use of immunoglobulin, training in blood-borne infections could prevent new HBV infections among Ghanaian HCWs.

Development of Holistic Health Care Interventions for Women With Infertility: A Nominal Group Technique

Infertility care is often directed by a biomedical approach rather than a holistic approach, especially in African countries. This article explores the opinions of health care providers regarding holistic health care interventions in managing women with infertility in Ghana. Data were retrieved using a qualitative design and nominal group technique with a purposive sample of 12 health care providers in Ghana. Data were analyzed through thematic analysis. Health care providers explored various psychological, educational, spiritual, social, and medical interventions to ensure women diagnosed with infertility receive holistic treatment and attain optimal health.

Holistic management of female infertility: A systematic review

Although issues pertaining to infertility affect both males and females, women often become victims of stigmatization and rejection, making them susceptible to emotional pain and suffering. Due to these psychosocial problems, they require not only biomedical treatment, but also psychological, social, and spiritual support. Unfortunately, many women with infertility are not treated holistically. The aim of this review was to retrieve existing evidence of holistic healthcare interventions for women with infertility. Global databases were searched for articles published anywhere in the world between 2010 to 2018 that explored holistic healthcare interventions for women diagnosed with infertility. A total of 18 articles meeting the inclusion criteria were assessed, and data extraction was performed. Findings revealed that interventions adopted in managing infertile women alongside the bio-medical management included: counseling; cognitive behavioral therapy; acceptance and commitment therapy; educational interventions; spiritual interventions; emotionally focused therapy/intervention and integrative body-mind-spirit interventions. The results of this review have implications for healthcare professionals to ensure holistic care of women diagnosed with infertility in Ghana and Africa at large.

Conditional expression of glycosylphosphatidylinositol phospholipase C in Trypanosoma brucei

Trypanosoma brucei glycosylphosphatidylinositol phospholipase C (GPIPLC) is expressed in the bloodstream stage of the life cycle, but not in the procyclic form. It is capable of hydrolyzing GPI-anchored proteins and phosphatidylinositol (PI) in vitro. Several roles have been proposed for GPIPLC in vivo, in the release of variant surface glycoprotein during differentiation or in the regulation of GPI and PI levels, but none has been substantiated. To explore GPIPLC function in vivo, tetracycline-inducible GPIPLC gene (GPIPLC) conditional knock-out bloodstream form and tetracycline-inducible GPIPLC-expressing procyclic cell lines were constructed. We were unable to generate GPIPLC null mutants. Cleavage of GPI-anchored proteins was abolished in extracts from uninduced conditional knock-outs and was restored upon induction. Despite the barely detectable level of GPIPLC activity in uninduced conditional knock-out bloodstream forms, their growth was not affected. GPI-protein cleavage activity could be induced in procyclic cell extracts, up to wild-type bloodstream levels. Myo-[3H]inositol incorporation into [3H]inositol monophosphate was about 14-fold lower in GPIPLC conditional knock-out bloodstream forms than in the wild type. Procyclic cells expressing GPIPLC showed a 28-fold increase in myo-[3H]inositol incorporation into [3H]inositol monophosphate and a 1.5-fold increase in [3H]inositol trisphosphate levels, suggesting that GPIPLC may regulate levels of inositol phosphates, by cleavage of PI and phosphatidylinositol 4,5-bisphosphate.